Thorpewood Medical Group Also known as Woodside 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. We assessed a total of 6 quality statements from this key question. At our last inspection we rated this key question as Good. At this assessment, the rating is Requires Improvement.

The provider did not always check that people’s assessments were up to date. They also lacked an effective system to identify people with previously undiagnosed conditions. We did not see evidence that the provider routinely monitored people’s care and treatment to continuously improve it.
 

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people using the service was very positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. However, the provider did not always check that people’s assessments were up-to-date and the provider also lacked an effective system to identify people with previously undiagnosed conditions. We were not assured that systems for assessing and reviewing people’s care and treatment were always effective.

Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for an interpreter 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. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

We saw instances where care was not provided in line with current guidance. For example, our clinical searches highlighted 42 patients with a potential missed diagnosis of Chronic Kidney Disease (CKD) (stage 3, 4 or 5). However 3 of the 5 patient records we reviewed did not evidence further investigation or diagnosis of CKD This was not in accordance with current guidance and highlighted a lack of adequate systems in place to undertake effective monitoring and take appropriate action.

We also undertook a further remote clinical records search which identified that 72 patients with Asthma had had 2 or more courses of rescue steroids in the last 12 months. Rescue steroids are medications taken by mouth to reduce inflammation in the airways and relieve asthma symptoms. NICE Asthma guidance recommends a follow up consultation within 48 hours for patients with a suspected acute exacerbation of asthma. However, 4 out of the 5 patient records we reviewed highlighted the absence of a follow up consultation within the recommended timescale.

We undertook a remote clinical records search which identified 27 patients with hypothyroidism who had potentially not had thyroid function test monitoring for 18 months. NICE recommends consideration should be given to annual thyroid stimulating hormone (TSH) monitoring.

We also undertook a remote clinical records search to assess whether diabetes care was evidence-based and in line with good practice standards. Our clinical records search identified 144 patients with diabetes with a latest HbA1c (average blood sugar level) of more than 75mmol/l and who therefore required enhanced diabetes monitoring such as annual medications reviews. However, 2 out of 5 patient records reviewed were either missing a medications review or were overdue a medications review.

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.

Local care home staff spoke positively about how information was shared to ensure continuity of care. They gave an example of where access to information had enabled a respite care assessment to quickly take place.

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. People spoke positively about how they were supported to live healthier lives.

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. The nurse manager told us that staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Specifically, the clinical notes we reviewed highlighted instances where the provider’s approaches to monitoring care, treatment and outcomes were not always effective.

Information we reviewed prior to our assessment indicated the provider had not met the national target for cervical screening uptake or for Pneumococcal infection booster immunisation. During our assessment we were shown unverified provider data which indicated that the cervical screening uptake national target had been met. Administrative and nursing staff told us how they had sought to improve cervical screening uptake. This included phone calls, text messages, home visits for housebound patients and opportunistic screening (approaching the patient when they attended the practice for another reason).
 

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Local care home staff spoke positively about how end of life care was well-managed. People spoke positively about how views and wishes were taken into account when care was planned.

We looked at 3 patient records to ensure that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in consultation with the patient or, where appropriate, their family/carers. However, 1 of the 3 records did not include a documented rationale for the DNACPR decision or evidence of discussion with the patient or their representative.