Parson Drove 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

This means we looked for evidence people had the best possible outcomes because their needs were assessed and care and treatment was provided in line with up-to-date best practice.

At our last inspection we rated this key question Inadequate. At this inspection, the rating has changed to Requires Improvement. This is because the service did not always have fully established processes in place.

We assessed a total of 6 quality statements from this key question. Some people told us that they did not feel that staff always involved people in decisions about their care and treatment and provided them with advice and support. The provider had started to implement some systems and processes to keep clinicians up to date with current evidence-based practice, however this required further embedding.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

80% of respondents to the National GP Patient Survey for the practice stated that during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment, this is below the expected national average of 74%. The PPG was involved in assisting the practice to understand and assess people's needs.

Staff told us they would use a series of alerts on the patient record to highlight people’s communication needs and any impairments. We did not observe any specific examples of reasonable adjustments being implemented.

Access for patients had been identified by the provider as an area in need of improvement. The practice had made positive improvements relating to appointment availability. There were protected appointments available on the day for vulnerable patients. However, planning for future clinical and non-clinical staff absences were not always considered which could result in significant gaps throughout the service.

A new Appointment policy and Home Visit policy had been created and implemented since our previous inspection. However, the practice needed to continue to strengthen the improvements they had made surrounding assessing peoples’ needs. There was an Access Control policy in place, but this was not specific to the practice.

The practice held regular clinical governance meetings to assess patients’ needs. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. There were 317 carers on the practice register however, during interviews with staff and leaders they did not share with us examples of how they supported carers.Following the inspection leaders told us that carers are offered flexible appointment times and referrals can be made to local support groups. We found that this was not always clearly communicated to patients.

51% of respondents to the National GP patient survey responded positively to their overall experience of Parson Drove Surgery. This was below the local and national average of 74%. However, 91% of respondents to the GP patient survey stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to. We received mixed feedback through our give feedback on care link.

Clinical records we saw through our searches showed practice staff provided care that was in line with current guidance. Staff described systems and processes in place to recall and review people with long-term conditions according to their requirements. We saw that patients with poor mental health were referred to appropriate services.

Since the last inspection, staff told us that they were working more closely with professionals in the Primary Care Network. Staff told us that they hoped that this would lead to improvements care and treatment. Leaders acknowledged this was not fully embedded yet and further audit would be required.

The provider had started to implement systems and processes to keep clinicians up to date with current evidence-based practice. Our previous inspection found that GPs did not always follow up with service users who had received treatment in hospital or out of hours services for an acute exacerbation of asthma. The provider had updated and amended their policy to reflect this advice. During our clinical searches we found that of the 5 clinical records we reviewed no patient had received this follow up. Further work was required to embed the changes made.

Since our last inspection, the practice had made improvements in diagnosing and monitoring patients with Chronic Kidney Disease (CKD). As part of this assessment, we saw that a standard operating protocol for finding and follow up of new chronic renal disease had been implemented.

Our clinical searches did not identify any concerns about how the practice diagnosed and managed patients with CKD or diabetes.

The practice had also made significant improvements in opioid prescribing. The provider was working with services to gain specialist advice regarding safely reducing the amount of opioid prescribing in order to keep people safe.

The practice had made improvements in how they carried out medicine reviews and other required patient reviews. At this assessment, we saw the practice now completed reviews to a standard that was in line with national expectations.

The practice needed to make sure they sustained these improvements to ensure patient safety.

We received feedback from some members of the public who said they had to chase referrals and had experienced delays in care and treatment as a result.

Staff described some systems in place to work with other organisations, for example vulnerable patients were followed up if they failed to attend appointments. Leaders told us that staff's learning needs were identified through annual appraisals, team feedback, and clinical audits. We did not see any evidence during our review of staff files that all staff had received a documented appraisal.

Staff told us they felt able to raise concerns if required.

The provider had been working closely with the Primary Care Network to reduce waiting times for patients and provide local community support.

The practice had also been working closely with the PPG. We saw evidence that a representative from the local hospital had provided updates and useful information to the provider during a meeting with the PPG.

We were told by the ICB that they had seen some improvements in the way that the provider worked. There were other areas that were still to be fully addressed, and the sustainability of these improvements had not yet been demonstrated.

The provider had created a system to improve the oversight of referrals, however it lacked detail about working with the specialties. Leaders had identified this as an area that required improvement and started to put some systems in place to allow staff to submit referrals in a timely manner. Although there had been an improvement the provider did not have robust processes in place to cover key personnel and therefore sustain these systems during a period of staff absence.

We did not receive feedback from patients about how the provider specifically supported them to live healthier lives. Therefore, we did not receive enough evidence from patients to score this evidence category.

Leaders shared examples of occasions that staff have supported people to live healthier lives. Some staff told us about examples when they have supported people struggling with their mental health.

Staff and leaders told us they promoted and encouraged patients living healthier lives. There were documents available for staff containing guidance on how to make referrals to external services relating to health promotion. During staff interviews and our onsite visit some of the staff we spoke to were not aware of these and were unable to provide examples of how they supported patients to lead healthier lives.

We were told by leaders that out of 2127 people eligible for an NHS health check only 229 people had been offered a review. A total of 104 people had received a completed NHS health check in the last 12 months. Leaders told us that this could be inaccurate due to codes not being added appropriately to clinical records.Following the inspection leaders told us that they had updated these codes.

Practice leaders told us 21 of the 22 people registered with the practice who had a learning disability had been offered an annual review. However, leaders explained reviews had been completed for only 12 of these patients. We did not see any evidence that these patients who had not attended a learning disability review had been or would be followed up.

We were told that leaders had undertaken an audit to review the practice prevalence and Quality and Outcomes Framework plan for 2024/2025. As a result, they planned to implement targeted initiatives for example an enhanced patient recall system, better disease monitoring, and increased clinician training. Leaders told us that they intend to request further support from commissioners to assist with a formal roll out.

We received mixed feedback from patients. Some people told us that they found it difficult to access recommended monitoring such a blood tests. They were concerned that conditions would worsen or go untreated.

During our site visit patients we spoke to said that appointment availability for monitoring had improved recently.

At the last inspection staff told us that there was no recall system in place, at this inspection we saw a new process had been implemented. Staff provided positive feedback regarding this new recall system.

The practice recognised that the data indicated that they were performing lower than the national targets for cervical screening. They discussed plans to improve cervical screening uptake in younger women. This had not yet taken place.

The provider used the information collected for the Quality and Outcomes Framework and performance against national screening programmes to monitor outcomes for patients. Leaders told us that Quality and Outcomes Framework results for 2024/2025 showed 28% increase from the previous year.

Leaders had created an action plan to address the areas where they were below expected levels. However, our clinical searches showed that there were patients who were not receiving the required monitoring, so the action plan had not yet been effective.

A sample of the records of patients with long-term health conditions were checked to ensure the required monitoring was taking place. We found that the practice was regularly running the searches. The provider had implemented this since our previous inspection.

Our previous inspection found that GPs did not always follow up with service users who had received treatment in the hospital or out of hours services for an acute exacerbation of asthma. During this assessment we found that there were improvements still required in this area. The total number of patients on the practices Asthma register is 933 out of this 48 people had been prescribed 2 or more courses of rescue steroids in the last 12 months. We found that not all of these patients had received a follow up within 1 week of steroids. This meant that there was a risk of these patients deteriorating due to their asthma and not being seen on time. We noted that the Asthma policy had been changed and updated since the previous inspection.

Through our clinical searches, we identified 44 patients had been recorded on the clinical records system as having a diagnosis of advanced CKD (stages 4 or 5). We looked at the records for a sample of these patients and found 1 patient's record had not been updated to reflect their current level of kidney disease.

In our previous inspection we identified there were service users living with hypothyroidism (low thyroid levels) who may not had received the appropriate blood monitoring. During this assessment we found that improvements had been made in this area and no concerns were identified through our clinical searches.

Since our previous inspection we found there had been significant improvement in the management and diagnosis of diabetes. No issues were identified in our clinical searches for this assessment.

Our clinical searches did not find any issues with monitoring patients on DMARD (Disease-modifying antirheumatic drugs) medication specifically methotrexate in the last 6 months.

Our clinical searches of the practice's system found that 2 patients out of 36 were identified as awaiting monitoring for the anticoagulant medicine they were prescribed. Leaders were already aware of this and had taken action to monitor these patients and encourage them to have a medicine review. 1 patient had received monitoring from the hospital.

We found that 2 patients out of 6 on citalopram or escitalopram had not had their medicine dose reduced in line with a current drug safety MHRA alert. Leaders had undertaken increased monitoring of these patients and were able to provide a rationale for the clinical requirement to not alter these patients' medicines.

We did not receive any feedback from patients specifically about consent to care and treatment. Therefore, we did not receive enough evidence from patients to score this evidence category.

Staff told us they always obtained consent from patients or if appropriate their guardian and offered a chaperone where appropriate. However, some staff told us this was not always recorded on the clinical system.

The practice had a Chaperone policy in place and patients were offered a chaperone when conducting examinations. Staff who performed chaperone duties were trained for the role. Staff had also completed mandatory training in Consent, Mental Capacity, and Deprivation of Liberty Safeguards (DoLS).

The practice told us DNACPR records were reviewed during a monthly multi-disciplinary meeting. During the assessment, we conducted a review of 10 medical records for patients with a coded Do not attempt cardiopulmonary resuscitation (DNACPR) decision. We found that not all the records showed that there had been any discussions regarding mental capacity and/or consent. This meant that there was a risk that decisions could be made without fully informed consent.