The Brimington 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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing needs with them.

There was a system in place to recall people with long-term conditions in their birth month for a review of their condition. However, this was not always effective. For example, asthma reviews had not always been completed when required. We carried out our subsequent on-site visit and found that the provider had taken appropriate action to address this in full.

People were assessed and treated appropriately when presenting with an exacerbation of asthma. However, they had not been followed up within 48 hours when prescribed steroids, in line with national guidance. During our subsequent on-site visit we found the provider had embedded protocols and flow charts into the practice’s IT system to ensure this would be done going forward.

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.

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. Data from the National GP Survey showed that 95% of respondents stated that during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment. This was comparable with the national average of 91%.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They mostly 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 mostly provided in line with current guidance.

However, Medicines and Healthcare products Regulatory Agency (MHRA) guidance was not always followed. For example, a particular class of medicine used in the treatment of diabetes.

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.

Staff engagement and sharing of information was enabled through regular cross sector meetings and leaders’ meetings.

The practice had worked with the Patient Participation Group to establish a walking group to improve people’s physical activity and to reduce social isolation.

Representatives from 3 of the care homes where the practice delivered care and treatment were positive, or very positive, about the service provided to people living in the home and told us that the service was responsive to their requests.

Feedback from staff was very 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.

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. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

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 practice mostly met national targets for screening and immunisations. Four of the 5 childhood immunisation targets meet the 90% minimum target. However, the percentage of children aged 5 who had received immunisation for measles, mumps and rubella (MMR) was 87% which was below the national target of 90%. The provider told us that several parents had refused to have the joint MMR vaccine and preferred to have the immunisations separately. There was a proactive recall system in place. Representatives from the 3 care homes we spoke with told us that people living in the homes had all received their flu and Covid vaccinations for this year.

Uptake of cervical screening was 81% for women aged 50 to 64 years and above the national target of 80%. However, for women aged 25 to 49 years it was below the national target at 75%. More recent, unverified data, provided by the service showed that this had increased to 85%. The provider told us to address the needs of working aged people, Saturday clinics had been established for people to receive cervical screening, and the uptake had been excellent. There was also a recall system in place to follow up people who failed to attend. There were systems in place to ensure that people that had transitioned and still had a cervix were offered cervical screening. Staff had access to easy read material for people with a learning disability to help them to understand how the screening was carried out.

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.