Hartshill Medical 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

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 assessment, we rated this key question as good. At this assessment, the rating remains the same.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

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 a translator 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. The provider 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. Test results were sent to the clinician who requested them. If the clinician was not available, the results went to the clinician deputising to action, to ensure timely care and treatment. The provider told us they run searches on their system on a monthly basis for people that may have additional needs, for example people with a learning disability or people with caring responsibilities.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Systems were in place to act upon Medicines and Healthcare products Regulatory Agency (MHRA) alerts and other safety alerts. However, the practice was not always actioning alerts that flagged up on people’s records when prescribing medication. For example, when issuing steroid cards. We sampled 4 of the 10 patient records who had a potential missed diagnosis of diabetes and found the practice were not consistently following repeat blood test time frames. Leaders, in discussion, agreed the need for the application of a consistent approach.

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. There was a duty doctor who provided clinical oversight daily for triage. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. A policy was in place for referrals which included urgent referrals and referrals to other practices within the primary care network. The staff we spoke with told us how this policy worked in practice with urgent referrals and their roles and responsibilities around this.

There was a range of policies in place to support staff when making care and treatment decisions.

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.

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 stopping smoking and tackling obesity. The practice had also introduced their own reviews, for example lifestyle reviews.

The service did not always routinely monitor people’s care and treatment to in a timely way. Some clinical expectations had not been met. The practice had completed audits to improve outcomes for people.

The practice had not achieved the recommended minimum 95% uptake for all childhood immunisations. The practice were aware they had not met all the targets for these immunisations and stated they discussed this in practice meetings and contacted the guardians of these children with relevant information to help them decide. If the child’s guardian declined, the practice told us they did document this.

The practice had not met the national target for cervical screening. There was a protocol in place which detailed steps to take if people did not respond to their invite for a screening.

There was a recall system in place to manage long term conditions and whilst our clinical searches found that generally long-term conditions were managed well, the systems in place were not always working effectively. For example, the total number of people with asthma who have been prescribed 2 or more courses of rescue steroids was 43 out of a total number on asthma register of 673. We sampled 5 people and found that although safety netting advice was given, not all patients were followed up following an exacerbation in their condition, as recommended by National Institute for Health and Care Excellence (NICE) guidance. We also found asthma reviews were not always done at the recommended intervals.

The practice had completed a range of audits for quality improvement and evaluated the impact of any improvements made.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider would listen to their concerns. Staff felt there was an open culture, and that managing patient safety was a primary concern. We saw the leaders’ investigated incidents and these were documented. The ones we reviewed showed a lack of a detailed route cause analysis and risk mitigation; however, staff told us these were discussed in meetings. There was a system to record and investigate complaints. We saw complaints were responded to and when things went wrong, staff apologised. However, when we reviewed their complaints responses we saw the service not always document the next steps, and responses were not always timely. The leadership team in response to our feedback updated the complaints leaflet whilst on site to include timelines for acknowledgement and responses. Staff told us learning from incidents and complaints resulted in changes that improved care for others.