Gladstone House Surgery

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• 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 67 (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 mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The National GP Survey results found 96% of people who responded to the survey were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was comparable with the national average of 91%.

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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

However, our remote clinical searches identified 18 people with a potentially missed diagnosis of diabetes. We looked at 5 records and found repeat blood tests were not always completed within the required timescales to confirm diagnosis, and annual reviews were not always completed for those people in the pre-diabetic range. The records we looked at for people with diabetes whose blood glucose levels were high demonstrated the service had made reasonable attempts to ensure the appropriate checks and reviews had been completed.

The service 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 and current 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, although the provider needed to ensure people with asthma, who had been prescribed 2 or more doses of rescue steroids in a 12-month period, were issued with a steroid card where appropriate.

The service worked well across teams and services to support people. 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.

There was evidence of working with the wider health care teams through community delivery multidisciplinary team meetings. People had access to services provided by the Primary Care Network (PCN), including first contact physiotherapists, mental health workers and social prescribers. The practice also worked closely with the frailty team, which supported people living in care homes. The service was part of a local GP federation which provided the ‘on day’ service, seeing people on behalf of GP practices during normal hours, as well as the ‘enhanced access’ service for evening and weekend appointments.

Feedback from staff was positive about how teams and different staff groups worked together to provide care and treatment. They reported that staff were supportive of all colleagues within the service.

The service supported people to manage their health and wellbeing to 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 people’s health, including those in the last 12 months of their lives, people 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. People could be referred to Live Life Better Derbyshire for a range of support and guidance.

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. There were systems in place to ensure that people with long-term conditions were reviewed regularly.

The service met the national target for immunisations, with 4 of the 5 indicators achieving 100%. Uptake of cervical screening at 79% in both age group indicators, which was compatible with the national target of 80%. Systems were in place to follow up people who did not attend screening appointments.

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.

A do not attempt cardiopulmonary resuscitation (DNACPR) / ReSPECT policy was available for staff to refer to. We looked at the records for 4 people with decisions in place, and only 2 completed forms were available in the electronic records. We saw in the other 2 records, only half of the form had been scanned in the electronic record for one person, and although the Derbyshire Healthcare Plan was on record for the other person, the ReSPECT form was not.

Representatives from the care homes where the provider provided care and treatment told us that DNACPR decisions were well managed by either the GPs from the service or the frailty team. They told us the GPs also engaged families or those people important to the person in any decisions.