Nunwell Surgery

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. 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 practice made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. There were systems and processes in place to identify patient’s needs and preferences. Reception staff were aware of the needs of the local community as patients were coded to highlight any specific needs such as requirement for a longer appointment or the need for a translator. A hearing loop was present, interpretation services were available, and the practice adhered to patients’ communication preferences. Therefore, the practice met the accessible information standard. Staff could refer patients with social needs, such as those experiencing social isolation or housing difficulties to a social prescriber within the primary care network. The practice launched a new website to improve the key functions of the website that highlighted appointment booking, medication requests and provided health information. The website also demonstrated a dedicated patient participation group (PPG) page to encourage staff to leave feedback to ensure the practice addressed individual needs. People felt involved in assessments of their needs and felt confident that staff understood their individual and cultural needs. Staff checked people’s health, care, and wellbeing needs during health reviews. 92% of patients that completed the National GP Patient Survey data agreed that they felt their needs were met during their last GP appointment and 92%felt the healthcare professional they saw had all the information they needed about them during their last GP appointment. Both scores were higher than the national average.

The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. Meetings were held to ensure staff were updated with the latest information, guidance and changes within the practice.

The remote clinical searches we undertook of the practice’s clinical records system showed the monitoring of people with long-term conditions was not always followed in line with National Institute for Health and Care Excellence (NICE) recommendations. For example, one of our clinical record searches reviewed the number of patients with asthma who had been prescribed two or more courses of rescue steroids in the last 12 months. We identified a total of 50 patients and reviewed a random sample of 5 patient records. We found that not all patients had been reviewed in a timely manner after an exacerbation to check their response to the treatment. Following this feedback, leaders assured us the identified patients have a review appointment booked and their processes will be adapted to follow clinical guidelines.

We reviewed monitoring of people with hypothyroidism (when the thyroid gland does not produce enough thyroid hormone that can lead to tiredness and weight gain) and found that there was not a clear escalation process to follow if the patient did not respond to the recall review messages sent by the practice. This was raised with the provider so they could take appropriate action.

We also reviewed the monitoring of diabetes care and found that the care was in line with legislation and current evidence-based good practice. The practice shared evidence of clinical audits to improve patient care. We discussed our findings with the practice, and they took immediate action to address the gaps identified.

The practice worked well across teams and services to support patients. Information was shared between teams and services to enable continuity of care and ensure patients only had to tell their story once when moving between different services. The practice regularly held multidisciplinary team meetings. Staff were supportive of each other to ensure they had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. To ensure staff were able to work together effectively, the practice adopted an open-door policy to encourage staff to speak up so that any queries were resolved to reflect a positive working environment. Multidisciplinary meetings were held on a regular basis to ensure all teams were up to date with relevant information.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. They supported patients to live healthier lives and where possible reduce their future needs for care and support by sharing advice and guidance. Patients were encouraged to take an active role in reviewing their health and were given support to recognise changes in their own health and wellbeing. Staff members were able to advise and signpost patients to the social prescriber, nurses or health care assistant to improve or maintain their care. Health promotion material was observed in the practice and further information could be found on their website that supported national priorities and initiatives to improve population health by supporting people.

Findings from the clinical search records indicated that the practice routinely monitored people’s care and treatment to improve and ensure that both clinical and patient expectations were met. At the time of our assessment, the latest published information from the UK Health Security Agency (UKHSA) showed that the practice did not meet the World Health Organisation target of95% as the observed percentage was 88% for the number of children immunised against various infectious childhood diseases. The latest published information from NHS Digital showed the practice’s uptake for cervical cancer screening for women aged 25 to 49 years old was below the 80% national target and was observed at 69.5%. The practice’s uptake for cervical cancer screening for women aged 50 to 64 years old was also below the 80% national target and was observed as 75.3%.Staff were aware of these findings and told us they were engaging with patients to try and increase the uptake. For example, multiple invitations that included the importance of these appointments were sent to patients and if patients continued not to attend, staff would call them directly to highlight the importance.

The practice told patients about their rights around consent and respected these when delivering care and treatment. Staff understood the importance of consent and respected the importance of obtaining consent before care or treatment was delivered. Considerations regarding consent were also given when providing care to children and young people, and the need to assess the mental capacity of patients to give consent. Patients received information about care and treatment in a way they could understand. Patient’s capacity and ability to consent was considered and clearly recorded. Chaperones were available upon request.