Saltley Centre for Health Care

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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 assessed a total of 6 quality statements from this key question. We found evidence to demonstrate the action taken to address the issues identified at the last inspection. We found at this assessment that there were areas for further improvement, our discussion with practice staff assured us that they were aware of these and had already taken action to improve. People were involved in assessments of their needs. Care was based on latest evidence and good practice. Staff reviewed assessments taking account of people’s personal and health needs. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people such as their named carer and took decisions in people’s best interests where they did not have capacity to make decisions.

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.

People were involved in assessments of their needs. Feedback from people who used the practice was on the whole positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The practice made sure people’s care and treatment was effective by assessing and reviewing their health, wellbeing, care and treatment needs with them. Digital alert flags within the patients care records system highlighted any specific individual needs, such as the requirement for longer appointments or blood tests.

Patients told us that they were encouraged to be involved in their care and treatment plans. Patients said staff made sure they understood their care and treatment and were asked for their consent to some treatments when needed.

We discussed our findings following the review of patient clinical records with the GPs and leadership team. The GP Partners told us that they were aware of some of the concerns we raised and as part of their improvement plans ongoing reviews were in place to address them. This was evidenced by completed clinical and non-clinical audits and supervision of consultations undertaken by clinical staff.

The practice planned and delivered people’s care and treatment 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. This included guidance from NICE (The National Institute for Health and Care Excellence) and MHRA (The Medicines and Healthcare products Regulatory Agency).

Our review of a sample of patient clinical records found appropriate monitoring was in place for most patients with long term conditions. Our clinical searches demonstrated that health reviews had been carried out, we noted however there were omissions which meant not all reviews had been fully completed. For example, patients diagnosed with asthma who were prescribed oral steroid treatment (given to reduce symptoms where asthma is hard to control) were not all issued with steroid cards where appropriate and in line with national guidance.

The clinical records for women of childbearing age who were prescribed medicines with a known or potential teratogenic effect (could cause harm to an unborn child) did not all show that pregnancy had been excluded before they started taking the medicine. Comprehensive details of the discussion particularly around contraception, sexual activity and the risk of pregnancy were not documented in line with guidance. There was also a gap in the length of time one of the patients was prescribed the medicine and when they were advised of the risks.

We found that there were occasions when it would have been best practice for patients to have had face to face consultations. For example, patients diagnosed with diabetes who were poorly controlled to ensure close monitoring and prevention of potential complications.

Staff told us they worked well across teams and services to support patients. They made sure assessments of patients individual needs was shared and accessed in a timely manner 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. Our remote access of the practice patient information system found patient test results had been filed and actioned in a timely manner. Systems were in place for all test results to be reviewed and filed on the day they were received. All unfiled results seen were dated 15 October 2024, the date of our remote access and were allocated to be filed that day. This showed practice staff were following procedures to maintain good practice.

The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, out of hours (OOH) services were able to upload patients’ information in the form of secure special notes.
 

The practice was not meeting the national targets for screening and immunisations. Data showed that the practice uptake for the cervical screening programme was 48.5% which although higher than the local average of 45.6% was significantly lower than the 70% expected uptake. The practice was aware of the uptakes rates and following a review had made adjustments to allow for better access. There was a policy to offer reminders for patients who did not attend for their cervical screening test. Patient information was available in multiple languages. Face to face discussions and a robust recall system was put in place.

Childhood immunisation rates for vaccinations given were comparable to the local uptake. Childhood immunisation rates showed that the uptake rates for children under 2 years old was 83.3% this was above the expected uptake rate of 80% and for children aged 5 years the uptake rate was 78.1% which was below the uptake rate. The practice regularly monitored childhood immunisation uptake. Initiatives included education for parents' to increase their understanding of the need for children to be vaccinated and the risks of children not being vaccinated.

The practice was supported by local ICB and council initiatives to actively to raise awareness in the community about the importance of vaccination and screening programmes.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. Patients had access to appropriate health assessments and checks including NHS checks for patients aged 40 to 74. The practice supported people to live healthier lives. Health checks, including frailty assessments, were offered to patients over 75 years of age. Flu, shingles and pneumonia vaccinations were offered to relevant patients. All patients with a learning disability were offered an annual health check at a location of their choosing.

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 conditions and those with caring responsibilities. The practice had access to a social prescriber to support patients in addressing social and practical needs that may impact their health, such as loneliness, isolation, or mental health challenges. On inspection we found patients and visitors to the practice had access to information in the form of notice boards and leaflets in the reception area.

Practice staff shared with us a programme of clinical, medicines, non-clinical audits and quality improvement initiatives they planned to carry out.

One of the clinical audits, undertaken in August 2024, looked at the practice’s use of oral steroids in the management of childhood asthma to assess compliance with national guidelines. The audit looked at patients aged 0-16 years who had two or more courses of oral Prednisolone in the last 12 months, 3 patients were identified for the audit. The findings showed that all 3 patients had attended regularly for their reviews. The audit also identified areas of non-compliance such as patients not regularly taking the prescribed medicine to manage their condition. None of the children were followed up within 3 days of their asthma worsening and rescue packs were issued on repeat without a thorough face to face examination. An action plan was developed and implemented to address the findings. The practice planned to repeat the audit in 6 months.

The practice told people about their rights around consent and respected these when delivering person-centred care and treatment. The practice obtained consent to care and treatment in line with legislation and guidance.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. At the onsite visit we reviewed Do not attempt cardiopulmonary resuscitation (DNACPR) decisions which were appropriate and were made in line with relevant legislation.