Mayfield Medical Centre

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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 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 the service was managed by a different provider and when we inspected the service, we rated this key question as good. This was the first assessment of the service under the new provider and the rating of this key question has remained 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.

Staff were aware of the needs of people, including the cultural needs of the local community. Digital flags within people’s records were used to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. We heard examples from staff we spoke with about adjustments made to meet people’s individual needs. These included supporting an autistic person by providing a separate, quieter room to wait for their appointment and utilising the different languages spoken by staff in the service to support people’s immediate needs rather than waiting for interpretation services.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them and did not always follow current evidence-based good practice and standards.

Our remote clinical searches reviewed the care for people with long-term conditions. We reviewed the care for people with hypothyroidism which identified 4 people with the condition. We reviewed these records and identified 3 had not had a medication review in the last 12 months. In mitigation, all 3 had been identified by the service prior to the assessment and had been reminded to book reviews. The remaining person had received appropriate care. There were no concerns with the reviews of people with diabetes and chronic kidney disease.

Our review of people with asthma found 1 person had been prescribed steroids without an adequate review or assessment of their condition. The service was aware of this and had recalled the person for review prior to our assessment.

Our remote clinical searches identified that safety alerts were not consistently actioned, meaning evidence-based care and treatment were not always assured.

We received feedback from people using the service that their experience of requesting support for mental health had not always been positive. However, our remote clinical searches reviewed a sample of 5 mental health care plans and we noted all 5 care plans were in line with expected standards and all had been shared other organisations appropriately to ensure continuity of care.

Staff we spoke with confirmed they referred to guidance when delivering care and treatment.

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 service worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services. For example, we were told the nursing team had good relationships with community services and would contact the service after referring, to alert them and give any additional information. We also heard how the service valued the local hospice and felt the working relationship benefitted people by ensuring they received timely care where concerns existed and continuity through effective information sharing.

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 people’s health, including those in the last 12 months of their lives, people 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.

Staff explained that when people registered, they received a complete review of their health to ensure that any missing vaccinations, screening and health checks were completed to support them with their health.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The service shared examples of clinical audits which had been carried out. These did not always clearly show care and treatment met clinical expectations or followed evidence-based guidance. For example, we reviewed an audit of the service’s compliance when making urgent referrals for suspected colorectal cancer. The audit found no referrals had been fully compliant. The key findings were identified along with the changes necessary to improve compliance. A further audit was planned to see whether the changes had improved compliance.

Although we found clinical audit did not always improve the quality of care, we also reviewed an audit of the prescribing for a medicine used to support patients to lose weight. This was to establish compliance against evidence-based guidance and to support clinical decision-making about whether to continue therapy. Overall the audit found recording had not followed guidance because no outcomes had been recorded at the 6 month interval, but baseline information had been recorded and 38% of people had outcomes reviewed at the 3 month interval. Changes to improve the quality of care had been identified and a reaudit was planned 6 months after these were made.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood legislation relating to consent, including the Mental Capacity Act. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

Staff we spoke with provided examples about how they would ensure people had the capacity to consent to treatment. We heard how staff would ensure time was available to explain procedures, address any concerns and provide people with information they needed to make informed decisions about treatment they were consenting to.

Staff explained guidance they would use, known as the Fraser guidelines, to establish whether a person under the age of 16 could consent to contraceptive treatment or sexual health advice and treatment without parental knowledge or permission.