Thorpe-le-Soken 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. 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 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.

Feedback from people using the service was positive. People told us they felt involved in the assessment of their needs and were confident that staff understood their individual and cultural needs. Reception staff used digital flags within the patient 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 and medicine reviews. Clinical staff used templates when treating and monitoring people’s health and wellbeing. The practice had processes that identified people with previously undiagnosed conditions during routine monitoring. Staff could refer people with social needs, such as those experiencing social isolation, benefit support, or housing advice, to a social prescriber.

The practice planned and delivered people’s care and treatment with them, this included what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. The systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we reviewed demonstrated that care and treatment was provided in line with current guidance. The staff and leaders shared with us links used within their clinical records system provided the current guidance needed to provide assurance they worked in line with evidence based good practice and standards.

The service worked well across teams and partner services to support people. They supported people by sharing the assessment of their care and treatment when they moved between different health care services.

Staff told us they had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other health services to ensure continuity of care, including where clinical tasks were delegated to other services.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. People told us they were supported to live healthier lives and where possible, reduced their future need for care and support.

Staff focussed on identifying risks to peoples’ 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. We found appropriate patient information regarding screening and health advice clearly displayed in the waiting room areas at both practice sites.

The practice staff routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and met both the clinical expectations and the expectations of people themselves. From the clinical notes we reviewed, we found that people experienced positive outcomes as set out in legislation, clinical standards, and evidence-based clinical guidance. The remote searches we carried out prior to the practice visit showed effective routine monitoring for people with long-term conditions and their regular medicine reviews. For example, all the high-risk medication reviews we randomly reviewed had the risks mitigated by peoples upcoming appointments already requested. The practice shared the action plans to mitigate any risk for those records we had not randomly selected and checked however identified as needing monitoring in the searches. The work identified had been allocated to staff members and added to the regular review work in the future.

The practice met national targets for screening and immunisations as seen on the practice system at the site visit. The management team told us this was achieved by running regular reports to ensure people received recalls for appropriate screening and immunisations.

The service told people about their rights around consent and respected there rights when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent was clearly recorded on peoples records. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions and recommended summary plans for emergency care and treatment and (ReSPECT) forms were regularly reviewed, appropriate and in line with relevant legislation. Staff showed us where this information was documented in peoples’ computer records. When we spoke with the staff and managers at the local care home’s they confirmed the practice reviewed these forms regularly.