The Summerhill 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.

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.

We found that staff involved people in decisions about their care and treatment and provided them advice and support. Staff worked together and collaboratively with other services to make sure people could access other services easily.

Patients received care and treatment that supported them to live healthier lives including being supported to undertake national screening programmes and vaccinations. Patients who required monitoring underwent regular checks on their health.

Our review of the clinical patient record system for the sample of patients whose records we looked at showed that care and treatment had been delivered in line with evidence-based guidance.

Multi-disciplinary meetings were held where the needs of patients with complex conditions or those approaching the end of life could be discussed, reviewed and planned for. The supporting documents and alerts where people had undergone an assessment for ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) were available on the patient record system.

This service scored 75 (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.

All requests for appointments were triaged by a paramedic and reception staff who were trained in care navigation, so that patients were prioritised who reported symptoms that could be considered a clinical emergency. Patients were told when they needed to seek further help and what to do if their condition deteriorated. 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 and the provider 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. We found the provider held registers which were reviewed to prioritise care for their most clinically vulnerable patients. For example, we reviewed a sample of patients with a DNACPR record to consider whether the DNACPR had been prepared and found this had been reviewed and agreed appropriately.

Systems were in place to identify individuals with caring responsibilities, who were offered an annual review. All patients with a severe mental illness or a learning disability were invited to attend an annual health assessment.

Care home staff reported that the system of regular calls and visits to assess and review residents was effective. New care home residents were able to register with the practice promptly. Each care home had an allocated GP, and most had a named clinician who visited regularly. Care homes staff had access to a dedicated phone line to facilitate timely assessments and address prescription related queries.Requests for visits or updates on patient wellbeing were triaged by Advanced Nurse Practitioners. Clinical emergencies or deteriorating patients were identified and prioritised, with appropriate action immediately taken. For example, home visits were undertaken by clinicians or intervention from appropriate Community Services such as Ambulance services.

Staff shared relevant information with other professionals when planning care and treatment. Patients’ treatment records and prescriptions were updated to reflect any changes needed. People living with a long-term condition and those with a learning disability were invited for regular review of their health, care and treatment and staff used templates for this to ensure the reviews were appropriately detailed. The provider had effective systems to identify people with previously undiagnosed conditions.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based guidance and standards.

Clinical records we saw demonstrated care was provided in line with current guidance. Systems were in place to ensure staff were up to date with national guidance, evidence-based practice and required standards. Staff attended regular meetings, training, educational sessions and underwent regular appraisal.

The experience of people who used the service as indicated in the National GP Patient survey showed that 98% of respondents (compared to 92% nationally) stated that during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to.

We looked at the workflow for managing clinical correspondence and tasks and found these were up to date. Our review of the clinical record system for the sample of people whose care and treatment we looked at, indicated that people received care, treatment and support that was evidence-based and in line with good practice standards. The results of the clinical searches for the management of patients living with long term conditions were good and did not identify any significant gaps in the monitoring of patients. Our assessment indicated that the provider achieved the highest performance in hypertension management across the Dudley locality.

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 provider worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. The provider worked with other services to ensure continuity of care and shared records and information where relevant.

Leaders and staff worked collaboratively with colleagues in the local Primary Care Network (PCN) to address the needs of the patient population. The provider contributed to shared learning by delivering an information session focused on improving outcomes through cancer audits, supporting the dissemination of best practice across the network.

The practice provided care for a significant number of local care homes, with named GPs and clinical staff assigned to meet residents’ needs. Regular multidisciplinary meetings were held to ensure effective coordination when individuals received care from multiple teams or services. Clinically vulnerable patients were prioritised, and the provider worked collaboratively with other professionals to deliver integrated care packages.

Feedback from care home representatives was largely positive, with most describing a good to very good working relationship with Summerhill Surgery. Several homes expressed specific appreciation for individual staff members. The provider was generally viewed as responsive and supportive, although a minority of care homes indicated a desire for more frequent visits.

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 tackling obesity. For example, the provider was aware their breast screening uptake had declined during the pandemic and hosted an information session to patients to educate and increase uptake. As a result, there uptake increased from 68% to 75% at May 2025.

Staff signposted patients to local support services offering information, education, advice, and tailored support based on individual needs. This included referrals for diabetes education and dietary guidance. Patients were actively encouraged to participate in national health initiatives, such as cancer screening programmes and childhood immunisations. The provider had met and, in some areas, exceeded World Health Organisation targets. Follow-up contact was made with patients who did not attend, to promote uptake and engagement with these services.

Results from the National Patient Survey results demonstrated that 68% of people had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses which was above the local average of 64% and in line with the national average.

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.

The provider was performing below the national average for cervical screening targets. However, established systems and processes were in place to recall patients and implement flagging procedures aimed at promoting opportunistic uptake. Both clinical and non-clinical audits were conducted to support ongoing efforts to enhance patient outcomes.

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 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.

People who used the service felt they could make an informed decision about their care and treatment because they had been provided with the information, they needed to support them to do so. The National GP patient survey results showed that 96% of respondents (compared to 91% nationally) stated that during their last appointment they were involved as much as they wanted to be in decisions about their care and treatment.

Staff understood the importance of ensuring that people knew what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Staff had undergone training in the Mental Capacity Act (MCA) and understood the requirements of legislation and guidance when considering consent and decision making.