Front Street Surgery Also known as Drs Orr, Green, Pal & Nellist

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Good. At this assessment, the rating remains the same.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber, via the primary care network. Strong relationships with the local GP federation supported people to access the care and treatment they needed.

The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.
Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance. The management of people with long term conditions such as hypothyroidism, asthma, chronic kidney disease, and diabetes was effective and timely, and people were regularly recalled for reviews of their conditions. There were effective arrangements for interpretation and translation services through a digital application that the provider had subscribed to. Information from the local integrated care board showed that despite the practice having one of the highest multimorbidity scores (where people have more than one complex health condition and require regular monitoring), they ranked highly in the delivery of GP appointments, per patient, in the area. Clinical staff we spoke to could easily access evidence-based guidelines and information they needed to treat people safely.
Clinical searches that we ran as part of our assessment yielded positive results. For example, of the patients with chronic kidney disease (stages 4 or 5) that we sampled, we saw that all of them had received appropriate monitoring in the last 9 months. All patients with hypothyroidism that we sampled had received appropriate thyroid function test monitoring for 18 months, and safe (short term) prescribing of their medicines when they had failed to attend a review. Similarly, searches of patients’ records showed that high-risk medicines were well managed by the practice team, and there were no issues of concern regarding any of the medicines we looked at.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, complex cases were discussed at meetings involving GPs, practice nurses, mental health services, social care, physiotherapy, occupational therapy, social prescriber, Local Area Coordinator, and third sector staff. The practice had an effective relationship with the secondary care diabetes specialist team and had regularly invited other teams into the practice to support the training needs of staff. Where there were less strong relationships with other teams, the practice had reflected on how they could strive to strengthen them.

The service always supported people to manage their health and wellbeing to fully maximise their independence, choice, and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. Where there were gaps in services, the practice ensured that patients received the treatment they needed, regardless of remuneration. For example, they visited a housebound patient to deliver a vaccination that the practice received no payment for, because other community services were unable to deliver this. Friends and Family data captured that some patients, where needed, had been given a tailored and individualised exercise plan to help manage their condition.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The practice was above national targets for childhood immunisations. Cervical screening data was slightly below the national average; however, the practice had implemented some initiatives to improve the data. As a result of understanding its population, the practice introduced walk-in cervical screening clinics and offered early morning and late afternoon appointments to increase uptake. They brought a social prescriber on board to form therapeutic relationships with people who were anxious about being screened. From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.