Spring Gardens Group Medical Practice

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 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 meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident staff understood their individual and cultural needs. The National GP Patient Survey found 90% of patients surveyed felt their needs were met during their last general practice appointment which was in line with the national average.

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.

The practice had effective systems in place to identify people with previously undiagnosed conditions. Clinical searches identified 182 patients with a potentially missed diagnosis of diabetes. We looked in detail at 5 patient’s records and found all 5 patients had received the required reviews and had been coded on the clinical system appropriately. Leaders confirmed the remaining patients would be checked as soon as possible. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service planned and delivered people’s care and treatment in partnership with them, taking account of what was important and mattered to them. Care was provided in line with relevant legislation and current evidence-based practice and standards.

Systems were in place to ensure staff remained up to date with evidence-based guidance and legislative requirements. Clinical records we reviewed showed care delivery aligned with current guidance. A GP specialist advisor completed remote clinical searches of the practice’s records on behalf of CQC, which demonstrated monitoring in most areas was consistently good. For example, there were 84 patients with stage 4 or 5 chronic kidney disease who required regular blood tests to monitor kidney function. We reviewed a random sample of 5 of these patients and found all had received the appropriate tests.

However, one area showed inconsistent results. This related to patients with asthma who had been prescribed 2 or more courses of rescue steroids for acute flareups. These patients should receive follow up from the practice within 1 week of each course. While follow up had occurred in some cases, this had not happened consistently for the 5 patients we examined in detail. The following day, leaders provided evidence which showed all patients had since been followed up and a reminder had been issued to all clinicians to ensure this process was completed reliably in the future.

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. They worked closely with other practices within the primary care network with practice staff taking on key roles so they could be fully involved in developing areas which would benefit their patients.

Staff engaged in regular meetings about safeguarding, frailty and palliative care where they discussed patients with other agencies such as community nurses, health visitors and staff from the local hospice for adults. The practice provided 24-hour medical cover for the local children’s hospice.

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.

The service monitored all people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they fully met both clinical expectations and the expectations of people themselves. The practice worked towards meeting national targets for screening and immunisations. From the clinical notes we reviewed, we found people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

Published national data showed the practice was slightly below the World Health Organisation 90% minimum targets for 4 out of 5 childhood immunisations. The percentage of children aged 5 who had received immunisation for measles, mumps and rubella (two doses of MMR) was 85%. The practice had a process in place for following up children who missed vaccinations and exploring why this was the case.

Published national data for the uptake of cervical screening was below the national average however, the practice had taken steps to improve these results. This included participating in regular Saturday morning screening clinics with the primary care network (PCN) and contacting people who did not respond to reminders. This had shown an increase in the uptake of cervical screening.

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.