Bridge Road Medical Centre

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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

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 assessed all quality statement from this key question. At our last assessment, we rated this key question as good. The rating remains good following this assessment.

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.

Patient experience of the service as indicated in the National GP Patient Survey showed that 97% of respondents had confidence in the healthcare professionals treating them (national average 93%) and 95% felt that their needs were met at their last appointment (national average 90%). In addition, 91% felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment.

Support was available for people with additional needs or communication needs. For example, people who required the services of an interpreter or patients who had a learning disability.

Staff told us they received training and knew how to prioritise patients who reported symptoms that could be considered a clinical emergency. Staff told patients when they needed to seek further help and what to do if their condition deteriorated. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

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 so as to ensure the reviews were appropriately detailed. The provider had effective systems to identify people with potentially undiagnosed conditions, for example chronic kidney disease.

People who were the most clinically vulnerable were prioritised and the practice worked with other healthcare professionals to deliver coordinated packages of care.

Systems were in place to ensure staff were up to date with national guidance, evidence-based good practice and required standards. Staff attended regular meetings, training, and educational sessions.

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 our 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. We noted that patients with asthma were not always followed up following an exacerbation of their condition where steroid treatment had been required and consultations for prescribing these were not always documented. The provider had a procedure in place for follow up of these patients, but this had not been implemented effectively. A new detailed protocol was devised in response to our findings.

We looked at the workflow for managing clinical correspondence and tasks and found these were up to date.

Staff worked together and collaboratively with other services to make sure people could access other services easily. Leaders and staff worked closely with colleagues in the local primary care network (PCN) to meet the needs of the patient population.

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.

Multi-disciplinary meetings were held on a regular basis where the needs of patients with complex needs or those approaching the end of life could be discussed, reviewed and planned for.

Systems were in place to ensure referrals to other services were made effectively and timely and patients referred under the two-week wait rule for suspected cancer were followed up to ensure they had attended their appointment.

Our review of the clinical record system indicated that patients received care and treatment that supported them to live healthier lives. Members of the clinical team provided patients with information and support to manage their own health, care and wellbeing where possible. People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing and prevent deterioration.

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 smoking cessation and weight management.

A system was in place to ensure that people living with long term health conditions underwent regular monitoring. They were referred or signposted to local support services for information, education, advice and support linked to their needs. This included referral for diabetes education, dietary advice and smoking cessation.

Patients were encouraged to attend cancer screening and to take up vaccinations offered as part of national programmes. Uptake for childhood vaccinations and cancer screening were overall lower than target, but the provider was aware of this and worked to increase this through contacting people who did not attend to encourage uptake of these services.

The service routinely monitored people’s care and treatment to continuously improve it. People who required monitoring underwent regular checks on their health.

From the clinical records we reviewed, we found that people who used the service experienced positive outcomes in line with best practice guidance. Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used information and data to drive improvement.

Clinical and non-clinical audits were carried out as a means to improve outcomes for patients. The provider could consider a planned programme of two cycle clinical audits.

Systems were in place to improve where the service was performing lower than other services within the locality and nationally for data linked to outcomes for patients.

Staff involved people in decisions about their care and treatment and provided them advice and support.

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 results of the national GP patient survey showed that 92% of respondentswere involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment.

Staff understood the importance of ensuring that people understood 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. Leaders and staff understood the requirements of legislation and guidance when considering consent and decision making.

We looked at a sample of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in patient records. The full records were available on the patient record system, alerts were in place to ensure staff were aware of this and the decision had been shared with other relevant services as appropriate.