Fell Cottage 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 71 (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 was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The practice had systems in place to invite patients for required monitoring. During these reviews, staff assessed patients’ health, care, and wellbeing needs, with clinical staff using structured templates to support a comprehensive review of wider health and wellbeing. However, we found that when patients did not respond to repeated review invitations, no further actions were routinely taken to encourage attendance.

Following our assessment, the practice confirmed that outstanding patients had been proactively contacted to complete the required checks. The practice was also in the process of introducing a new standard operating procedure to support staff in encouraging and supporting patients to attend reviews and monitoring in a timely manner.

However, 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.

Reception staff were aware of the needs of the local community. They 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 could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. Social prescribing is a key component of Universal Personalised Care. It is an approach that connects people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing.

The practice generally delivered care and treatment in line with legislation and evidence-based guidance, however some areas required improvement. For example, our clinical searches identified that some patients were overdue for reviews. While these patients had been contacted, no additional measures had been implemented to promote attendance.

However, the service planned and delivered people’s care and treatment with them, including what was important and mattered to them.

The majority of feedback from people using the service was very positive, including the National GP Patient Survey where results were consistently above the national average. Feedback from NHS Friends and Family Test patients showed patients felt involved in the assessment of their needs and staff understood their individual and cultural needs.

The practice provided evidence of a range of audits they had undertaken to enhance care. These included annual cyclical audits, which help staff to review and improve the management of specific treatments and health checks, as well as ongoing audits focused on the safe monitoring of higher‑risk medicines. For example, audits were completed for patients with Chronic Obstructive Pulmonary Disease (COPD) to ensure they were appropriately monitored and managed. In addition, audits of 6 to8 week mother and baby checks were undertaken to confirm that ICON guidance had been provided. ICON is a programme designed to support parents in understanding and coping with infant crying.

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.

We spoke with leaders at the 2 care homes aligned to the practice. They reported consistently high levels of support from practice staff for their patients, and families and the staff team. The GP was accompanied by the community nurse practitioner on a weekly basis and a pharmacist on a monthly basis ensuring a coordinated and integrated approach to patient care.

We saw examples of recent multi-disciplinary team meetings (MDT) where for example, safeguarding and palliative care were discussed.

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 patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. Locally, the primary smoking cessation service was delivered through community pharmacy provision.

Staff were able to refer people with social needs, such as those experiencing social isolation or housing difficulties, to a team of social prescribers based at a nearby practice. The social prescribers were employed by the primary care network.

The practice was proud to be an Armed Forces accredited practice, to support serving and veteran patients in the area.

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.

Child immunisations were 100% for children aged 1 year, 98.6% for children aged 2 years and 95.3% for children aged 5 years old. These were all above the 95% expected vaccination rate for good practice as recommended by the World Health Organisation.

The practice uptake for cervical screening was slightly below national targets. For patients 24-49 years old screening was at 77.1%, just below the 80% target. The practice was also slightly below the 80% target for women aged 50–64 years, with uptake at 75.1%. Childhood immunisation rates were consistently strong, exceeding the World Health Organisation’s recommended minimum vaccination rate of 90%.

There were 40 patients aged 14 years and above with a learning disability registered at the practice. Staff had completed 31 annual learning disability reviews, representing 78% of eligible patients. Of the 9 patients who had not attended an annual learning disability review, 4 were also registered with paediatric mental health services and had declined a practice review. The remaining 5 patients either declined their annual review appointment or did not attend despite several invitations.

The practice had a dedicated administrator responsible for coordinating learning disability review appointments with patients and their carers to support and improve uptake. Staff told us this approach has led to improved relationships and developed an understanding of individual needs and the necessary adjustments to encourage attendance.

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.

The practice had a chaperone policy in place and patients were offered a chaperone during examinations. Staff who carried out chaperone duties were trained for the role and had received a Disclosure and Barring Service (DBS) check.