The Caxton 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 inspection, we rated this key question as Requires Improvement. At this assessment, the rating has changed to Good. The provider had made improvements in the following areas: There was now a formal system for monitoring the non-medical prescribers and clinicians now worked more in line with best practice guidance in relation to asthma and diabetes.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice 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 mainly positive. People felt involved in the assessment of their needs and felt confident that staff understood their individual and cultural needs. This was reflected in the most recent National GP Patient survey where 90% of respondents said theywere involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. In addition, 89% of respondents commented that they felt their needs were met during their last GP appointment.

Reception staff were aware of the needs of the local community. Digital flags were used within patient records for identifying any support needs, including identifying any vulnerable patients. Patients identified as vulnerable had a nominated GP for continuity and meetings were held to discuss their needs. Longer appointments were offered to patients where needed. Additional support, including allowing patients to use a room and computer at the practice for any specialist remote appointments was available upon request.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions.

At our last inspection, we found that clinicians were not always working in line with best practice guidance in relation to asthma and diabetes. At this assessment, we found that this had improved. The practice planned and delivered people’s care and treatment with them, including what was important and mattered to them. On the whole, they did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to encourage staff to keep up to date with evidence-based guidance and legislation. There was a strong culture of training and development within the practice and clinical supervision was offered. Several meetings were held to support the sharing of information which included learning sessions from external speakers from Child and Adolescent Mental Health Services (CAMHS) on others to provide updates on subjects such as diabetes and psychiatry. Staff had access to guidance and medical journals. External meetings and training events were also held to share best practice within the local Primary Care Network (PCN).

The practice 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.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. They also supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff told us that the practice had resumed undertaking the NHS health checks and were involved in an upcoming Primary Care Network (PCN) project in the early detecting of Atrial Fibrillation.

Patients had access to a dietician via the PCN who offered support to people with diabetes as well as medically complex patients requiring support with weight loss. Staff supported national priorities and initiatives to improve population health and were able to refer or support patients to self-refer to a smoking cessation service run by the local authority.

Patients had access to a social prescriber service as well as a community care co-ordinator, which offered support with bereavement, exercise, weight, lifestyle, housing, employment, carers support and loneliness and signposted patents to other agencies and local support groups as appropriate. Patients also had access to a cancer care co-ordinator via the PCN who offered support and signposting.

A review of the most recently published data for cervical cancer screening showed the practice had achieved an uptake of 62.1% within the last 3.5 years for their eligible population aged 25 to 49 years old and 69.5% uptake within the last 5.5 years for their eligible population aged 50 to 64 years old. These were below the national target of 80%. The practice had met the minimum based target of 90% and were just short of the recommended 95% uptake in 4 of the 5 childhood immunisation indicators. The practice achieved 88.1% uptake for the percentage of children aged 5 who had received immunisation for measles, mumps and rubella (two doses of MMR). The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. Those practices achieving this level are considered as performing for this indicator and are an example of good practice.

The practice had attempted to improve on the cervical screening uptake through a variety of ways. Recent audits undertaken identified that the uptake of cervical screening was not so good among the Bulgarian Community. This led the practice to undertake outreach work with the Bulgarian community to better understand their culture and to introduce targeted displays in the waiting room, which included contact details of who to contact for screening.

The practice had introduced extra clinics to offer flexibility for working age staff to attend their appointment. There was also a designated staff member responsible for calling patients to remind patients of the benefits of screening and provided opportunities to discuss any anxieties. Staff reported that they felt attendance was improving on last year.

Clinical staff spoken with demonstrated an understanding of consent and had access to a policy to support them. Written consent forms were used for minor surgery.

We sampled 5 patient records with a do not attempt cardiopulmonary resuscitation (DNACPR) decision in place. Two of the 5 patients were considered not to have capacity however no record of a completed mental capacity assessment was available on their file specific to this decision. On the whole, DNACPR decisions and preferences had been recorded. We could see from the records that 1 DNACPR form was under review with the person concerned. Other forms were dated as completed in 2020 and 2022 and had not been reviewed since implementation. No review dates had been set. We asked about the practice policy regarding the frequency of the reviews. We were told that the policy did not stipulate review dates due and decisions would be reviewed on a case- by- case basis as the decision could change within days, weeks or months.