Roundwood 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

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same. This meant people’s outcomes were good, and people’s feedback confirmed this. People were involved in decisions about their care and treatment.

This service scored 79 (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 healthcare, wellbeing, and communication needs with them. Feedback from people using the service was mostly positive. People felt listened to. Reception staff were aware of the needs of the local community. Digital flags within the care records system were used 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, housing difficulties, and homelessness to a social prescriber and/or Severe Multiple Disadvantage (SMD) care coordinator.

All staff had completed learning disability and autism training, and people with complex health needs were given longer appointments with both a nurse and doctor to review their complex needs. The practice offered a quiet place for people to sit whilst waiting for their appointments who may be anxious to wait in a busy and noisy room.

People’s care and treatment was planned and delivered, and people were involved in decisions about their care, including what was important and mattered to them, for example, end of life care. This was done 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.

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. Staff feedback was positive about how they worked together within the service. For example, there was a team who worked across different staff groups to address issues such as follow up of people who failed to attend important appointments. The service worked with external services to ensure continuity of care, including where clinical tasks were delegated to other services. People had access to services provided by the primary care network (PCN), including physiotherapy, social prescribers, and extended access appointments. Mutual support and learning were shared across the PCN. For example, the practice engaged with a dietitian employed through their PCN who delivered a two-hour face to face nutrition training session at care homes within the local area. The PCN and dietitian identified that 35% of care home residents were malnourished upon admission, which increased the risk of falls, infections, hospital admissions and increased GP visits. The aims of the training sessions were to support and empower care home staff to identify and treat malnutrition early, using a food-based approach and promote good hydration in line with the Enhanced Health in Care Homes framework. Over 60 care home staff had received the training. One care home reported that they noted residents had stable weights or had increased weight gains as a result of this joint working.

The service completed weekly ward rounds providing medical care to registered people residing in local care homes. Feedback from one care home was positive about the input from Roundwood Surgery, stating the service actively worked to ensure that people were treated with dignity and respect and investigations and examinations were carried out in the best interest of the person. The care home also reported that ward rounds were carried out in such a way that there was an educational component for those care home staff present.

Referrals to other services were audited to ensure that appointments were created for people in a timely manner, for example, when people were referred for suspected cancers. We were assured the practice were engaging with people and encouraging them to attend cancer screening appointments. The practice regularly held multidisciplinary meetings with community nurses, palliative care nurses and specialist nurses, to review vulnerable people’s holistic care and treatment.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment to continuously improve it. The service did not meet national targets for screening cervical cytology which was below the national target of 80%. The practice achieved 79.9% for cervical cytology. Leaders expressed ongoing challenges to achieve higher uptake rates. To mitigate these challenges robust systems were implemented to invite eligible women, in their preferred method of contact and language, utilising interpreters where required and offered flexible appointments for ladies. The service had systems in place to monitor attendance and follow up non-attenders. The service engaged in audits and quality improvement. For example, an audit was conducted of over 80-year-old people who were recorded as had a cerebrovascular event (stroke) or transient ischemic attack (mini stroke) and whose blood pressure was in range; the audit found that 91% of people’s blood pressure was in range. The audit followed the National Institute for Health and Care Excellence guidance (NICE).

In addition, an audit of people who were prescribed lithium (to mainly treat bipolar disorder), was carried out and improvements were made in people’s compliance to regular monitoring of their lithium levels, by a simple change made by the service, to issue people with a lithium monitoring book which detailed the date of their next review and their lithium level at each review

The practice had effective processes for recording consent within the medical record and guidance was accessible on the practice’s website. The staff had good knowledge of gaining and assessing consent options, allowing the delivery of person-centred care and treatment which was in the person’s best interest. The service told people about their rights around consent and respected these when delivering person-centred care and treatment. The practice kept records of lasting power of attorney and consent to treatment forms were in place where people had mental capacity. We reviewed three records which showed Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.