Testvale Surgery Also known as Dr Entwisle and Partners

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 75 (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 overall positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. The service had access to translation services to support those who required them. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Digital flags and pop‑ups within the service’s clinical system were used to alert staff to any reasonable adjustments or specific individual needs. For example, people with a learning disability had a flag on their record, with an additional pop‑up outlining required adjustments such as longer appointments.

Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used standardised templates when conducting care reviews to support the review of people’s wider health and wellbeing. People with a learning disability were clearly identified on the clinical system. They were proactively invited to attend annual health checks to help monitor their wellbeing and support early identification of health needs.

The provider had effective systems to identify people with previously undiagnosed conditions. For example, we reviewed people who may have a potential missed diagnosis of diabetes. Of those, 13 records were identified, and we reviewed 5 of these in more detail. There were 2 people who had recently received a diabetes diagnosis with appropriate coding and monitoring process, while the remaining 3 did not indicate any issue with misdiagnosis.

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. For example, information on best practice was shared with staff at clinical meetings and through emails. Clinical records we saw demonstrated care was provided in line with current guidance. With recent changes to the routine childhood immunisation schedule, the service ensured staff had access to the relevant UK Health Security Agency (UKHSA) webinars, publications and training in order to safely implement these changes.

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, such as after people were discharged from hospital.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The service worked with other services to maintain continuity of care. Staff held monthly multidisciplinary meetings, and care plans were regularly reviewed and updated. Clinical tasks were sometimes delegated, and staff promptly shared relevant information with these services, such as when people were being referred.

Home-visiting services were offered to people unable to attend the service’s premises, with staff working closely with community teams such as the district nursing team and the local hospice. The nursing team reported positive working relationships with the tissue viability nurses, who have visited regularly to support care and treatment.

The service worked closely with the community mental health team (CMHT) to support people facing mental health challenges. The CMHT reported communication was effective and the service was responsive, with the service’s mental health GP lead noted as an accessible advocate for mental health. CMHT reported referrals for people with severe mental health concerns were handled efficiently and they praised the service for its person‑centred, recovery‑focused approach.

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. The service offered NHS health checks and new patient checks to promote healthy living. A health monitor machine was available in the waiting room to facilitate self-screening for people when they attended the service.

There were information boards with posters and leaflets tailored to the needs of the people who used the service. Information was also available on the service’s website. Staff supported national priorities and initiatives to improve population health, including signposting to stopping smoking services though ‘Smokefree Hampshire’ and making referrals to a diabetes prevention programme.

The service was able to refer people with social needs, such as social isolation or lack of support, to social prescribers available through the primary care network (PCN). The social prescribers provided ongoing support, connecting people with community-based, non-medical resources, which helped them resume normal activities, such as returning to work. The PCN also employed a dedicated young person social prescriber to provide tailored support for children and adolescents.

People were asked whether they were, or had, a carer, and this information was flagged in their clinical records. People coded as carers were offered health checks and flu vaccinations. People with dementia, along with their families and carers, were signposted to the local ‘Dementia Care Hub’ for emotional support, social groups, well-being activities, carer programs, and advice on long-term care planning. Additional information and guidance were available on the service’s website to help carers access relevant support.

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

Diary entries were used as an alert system within the service’s clinical system to identify when people were next due for a long‑term condition review. Administrative actions were then completed prior to this, including sending a letter and making a telephone call to book the appointment.

From the clinical notes we reviewed, people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. The service met national childhood immunisation targets but fell short of the 80% national target for cervical screening. For example, uptake for those eligible aged 25-49 years was 72.3% and those eligible aged 50-64 years was 75.5%. However, to address this, the service considered local demographics and offered education, as well as evening and Saturday appointments to encourage uptake. Leaders also reviewed the cervical screening recall system weekly and changed processes so reminders to book appointments were sent by text instead of letters. Nurses phoned those who did not attend appointments to rebook and took opportunist approaches for those who were overdue their cervical screening.

An audit carried out by a member of the nursing team assessed whether extending initial wound‑care appointments from 10 to 20 minutes would improve safety and experience of those who used the service. The findings showed that longer appointments allowed for more holistic assessments. As a result, the service increased initial wound‑care appointments to 20 minutes and then standardised all wound‑care appointments to this length.

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. Consent for care and treatment was obtained either verbally or in writing and recorded clearly in their clinical records. Staff showed good understanding of consent procedures, ensuring people were fully informed before receiving care or treatment. Mental Capacity Act training had been completed by all relevant staff, and clinical staff understood how to apply the legislation and associated guidance when making decisions about consent.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Records we reviewed demonstrated DNACPR forms were appropriately completed and reviewed. Relevant documentation was also present in the care records for those who lacked the capacity to make decisions. For people who lacked capacity, the necessary documentation relating to both the capacity assessment and the decision-making process was present in their care records.