Brook Health Centre

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

This is the first assessment for this service since its registration with CQC. We assessed all the quality statements from this key question. We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. This key question has been rated as good. We found staff involved people in decisions about their care and treatment and provided them with advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This service scored 71 (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 practice was positive. People felt involved in the assessment of their healthcare needs and felt confident that staff also understood their individual and cultural needs. Leaders and staff told us the practice used codes and alerts on the patient’s record to highlight special needs and requirements. 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. The practice had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The practice 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 good practice and standards. Systems were in place to ensure staff were up to date with evidence-based guidance and legislation.

Clinical records we saw demonstrated care was provided in line with current guidance. Our clinical record searches found majority of the patients were receiving safe management and monitoring for medicines within the advised time frame. For instance, all monitoring of people with Asthma, Diabetes, Chronic Kidney Disease and Hypothyroidism was carried out in-line with current guidance. The leaders informed us they put in place protocols and system processes to effectively manage this. We reviewed records of patients prescribed a specific blood thinning medicine and found 8 out of 36 patients who did not appear to have received their monitoring within the required period. For these patients their bloods were being checked at a local anticoagulation clinic which did not automatically share results with the practice. We discussed this with clinical leaders who advised the system was reliant on patients sharing their results with the practice and this did not appear to be happening regularly every 3 months as required. During our assessment the clinical leadership team agreed to review and improve this protocol. Action was taken immediately following our assessment to review the 8 patient records identified by our clinical searches. Evidence of actions taken and an updated standard operating procedure were shared with us.

The practice held registers for patients and provided annual health checks for those with learning disabilities, carers, people with severe mental health conditions and palliative patients.

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 processes in place enabled staff to liaise regularly with community teams such as community nurses, health visitors, and palliative care nurses. Staff told us regular multi-disciplinary team meetings were held with external agencies where vulnerable people were discussed and actions recorded. The practice regularly discussed patients receiving end-of-life care. Although, community nurses did not regularly attend meetings for palliative care, they were based in the same premises as the practice and staff were readily able to liaise with them. Leaders advised they were continuing with efforts to encourage the community team to attend formal palliative care meetings. Following our assessment, the practice confirmed community health staff had agreed to attend formal palliative care meetings from 10 October.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. The practice supported people to live healthier lives and where possible, reduce their future needs for care. Staff focused on identifying risks to people’s health, including those who are (or might be) vulnerable such as 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.

The practice 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 practice met national targets for screening and immunisations. For 4 out of 5 childhood immunisations the practice exceeded the World Health Organisation (WHO) standard of 95% achievement. 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 practice told people about their rights around consent and respected these when delivering person-centred care and treatment. People we spoke with and the evidence we reviewed did not raise any concerns around consent. People understood their rights about consent to the care and treatment they were offered. Clinicians understood the requirements of legislation and guidance when considering consent. Clinicians supported people to make decisions ensuring their views and wishes were considered during care planning. Assessments of mental capacity were carried out when needed and were decision-specific. Staff told us they were able to adapt or translate information about care and treatment so that people could understand, to support them making informed decisions. All staff we spoke with had completed relevant training and were able to discuss how to gain informed consent for treatment. We reviewed a random sample of staff training records which showed staff had up-to-date training on informed consent, the 2005 Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw that consent was documented and processes were in place for chaperones to be present if requested.

We reviewed a random sample of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found information on DNACPRs were not always readily available. We discussed this with the leadership team who advised this had been identified as an area of improvement prior to our assessment. Immediately following our assessment, the practice submitted an action plan of steps they had already taken and planned to take in the near future to ensure consistency in record keeping for these patients which included a full review of records for all patients affected.