Eldene Surgery Also known as Dr Philip Gnana Asirvatham Bauliah

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.

This is the first inspection for this service since its registration with CQC. This key question has been rated as Good.

This service scored 83 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident staff understood their individual and cultural needs. The percentage of respondents to the nation GP Patient Survey (2025) who stated that ‘during their last GP appointment the healthcare professional they saw or spoke to was good at listening to them’ was 94%, which was significantly above the local and national average.

The service had access to translation services to support those who required them. Staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for a translator to be present. The service also had pop-ups appear when staff accessed records to indicate when people needed longer appointments, including people whose first language was not English, and people who had a learning disability.

People with a learning disability were clearly identified on the clinical system. They were proactively invited to attend annual health checks to help monitor their wellbeing and support early identification of health needs. These reviews were supported by structured templates to ensure care was comprehensive and consistent.

Staff checked people’s health, care, and wellbeing needs during health reviews. A high percentage, 95%, of people said their needs were met during their last appointment, which was higher than local and national averages. This was also reflected in feedback sent to the CQC. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The provider had effective systems in place to identify patients who may have undiagnosed conditions, such as diabetes or cancer. Clinically vulnerable individuals were prioritised for review, through their risk-stratified recall process, and the service worked collaboratively with other healthcare professionals to ensure coordinated and proactive care.

The service demonstrated a strong commitment to quality assurance and learning from audits. Health reviews were completed by appropriately trained clinicians, such as asthma-trained nurses for people with asthma. Following a recent retirement at the service, leaders promptly recruited a replacement member of nursing staff and undertook an audit which identified areas where reviews could be improved. The service responded effectively by arranging targeted training and deploying a respiratory nurse from the PCN to support delivery in the interim. Leaders acknowledged this resulted in some delays and conducted a further audit to ensure no harm had occurred. The audit confirmed that all relevant individuals had been appropriately reviewed following exacerbations, with no evidence of harm, out-of-hours visits, or hospital admissions.

As a result of the learning, the service implemented a new clinical protocol to alert the respiratory team to any recorded exacerbations and improved the accuracy of coding. A further safeguard was introduced to notify the GP or respiratory team whenever an oral steroid was prescribed, ensuring timely follow-up and continuity of care. Further evidence supplied by the service demonstrated that since the implementation of the protocol, there had been 5 documented asthma exacerbations. All cases had their notes reviewed by a respiratory nurse within 1 week, and 80% of people have attended a follow-up appointment, with the remaining 20% being scheduled. This was an improvement compared to the previous rate, where only 60% of individuals had a follow-up appointment within 2 months following an asthma exacerbation.

The service planned and delivered people’s care and treatment with them, including what was important to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Information on best practice was cascaded to staff at clinical meetings and via newsletters and emails. The service had also implemented lunch-and-learn sessions to promote sharing of learning and best practice.

Specific meetings had been set up to discuss the care and treatment of people with long-term conditions and information shared included latest clinical guidance. For example, there were regular meetings held with specialists, consultants and members of the service’s clinical team to discuss treatment plans for people with uncontrolled diabetes.

Our remote review of clinical records confirmed care was provided in accordance with current guidance. Staff used evidence-based tools to manage long-term conditions effectively. People with long-term conditions were appropriately monitored, and reviews were structured and comprehensive, reflecting their needs and best interests, including those with a learning disability.Multidisciplinary team (MDT) reviews were held regularly to ensure care plans remained up to date and in line with current clinical guidelines. These reviews supported staff to respond promptly to changing needs. For example, a person with multiple diagnoses was discussed in a clinical meeting to coordinate care, agree the best approach for working with the individual and their family, and reduce unnecessary appointments.

The service used an NHS-approved system to find and support people who may be at greater risk, helping to make sure they got the right care when they needed it and that staff time was used efficiently. This system supported a consistent and evidence-based approach to monitoring people who used the service, in line with national best practice guidance.

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 in partnership with external stakeholder services, such as the community mental health team, to develop and implement treatment plans that promoted safe and effective support for vulnerable individuals. The service held regular Gold Standard Framework (GSF) meetings, involving external stakeholders such as the local hospice, to review people on the GSF register and ensure well-coordinated end-of-life care (GSF is an evidence-based programme to support services improve planning and delivery of end-of-life care). This included everyone receiving palliative or end-of-life care, and any necessary actions were identified and taken to support their care.

Home-visiting services were offered to people unable to attend the service’s premises, with staff working closely with community teams such as the district nursing team and the local hospice. Clinical and integrated care records were used to share information, ensuring continuity and coordination of care.

Our remote review of the service’s clinical records showed effective processes to ensure safe and coordinated transitions of care between services. Referrals and discharge summaries were handled appropriately and reflected people’s individual needs and ongoing care requirements. Shared care records were in place when needed and enhanced access services were able to access people’s care plans and medical records, including any do not attempt cardiopulmonary resuscitation (DNACPR) forms.

The service worked with other providers to ensure continuity of care, including when clinical tasks were shared or delegated. The service worked with the local GP federation and ‘Livi’, an NHS-approved online platform for video consultations, to offer appointments beyond normal hours. Both the enhanced access clinics and the ‘Livi’ service mirrored existing care pathways and were fully integrated within the service’s clinical system. This ensured that, with appropriate consent, information and medical records were shared across services to support continuity of care.

The service used the ‘Cinapsis’ system, which enabled clinicians to quickly seek specialist advice or interim guidance before referring people to secondary care. By securely uploading images or case notes for review, clinicians received timely expert recommendations, reducing unnecessary referrals and streamlining care. For example, clinicians used the system to share images of a suspicious mole with a dermatology expert. After reviewing the person’s medical history, the specialist decided that a referral was unnecessary and suggested monitoring the condition along with providing safety netting advice. The consultant's recommendations were recorded in the clinical notes and relayed to the individual as part of an action plan. This system improved communication and facilitated prompt decision-making, as shown by positive NHS Friends and Family Test results. Specialists also advised on routine and urgent referrals, ensuring appropriate practices and lowering the likelihood of referral rejections.

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 peoples’ 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. The service offered NHS health checks and new patient checks to promote healthy living. The service had information boards with posters and leaflets tailored to the needs of the people who used the service. Staff changed these boards regularly to promote relevant national campaigns, for example, encouraging uptake of cervical screening during cervical screening awareness week. Information was also available on the service’s website.

Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. People were also encouraged and supported to make healthier lifestyle choices to promote their wellbeing and prevent deterioration through the involvement of an in-house health and wellbeing coach.

The service identified people who may need extra support and directed them to relevant services.The service was able to refer people with social needs, such as social isolation or lack of support, to a social prescriber. This included individuals who frequently called emergency services. The social prescriber provided ongoing support, connecting people with community-based, non-medical resources, which improved their health outcomes and helped them resume normal activities.

People were asked whether they were, or have a, carer, and this information was flagged in their clinical records. People coded as carers were then invited to events, such as coffee support mornings, and offered health checks and flu vaccinations. The service’s website provided further information and guidance to connect carers with relevant support. An upcoming roadshow event was being organised by the service to support the local carers’ community, with talks from charities and specialists to provide information, guidance, and support.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and met both clinical expectations and the expectations of people themselves.

From the clinical notes we reviewed, people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. Clinicians performed minor surgical procedures, including skin lesion removals, with appropriate training and ongoing updates. Their practice was audited for outcomes, such as post-operative infection rates, and findings were shared with the team to improve treatment quality. The latest audit reviewed 12 cases, and none of them resulted in post-operative infections.

Data reviewed prior to the inspection showed uptake of cervical screening for eligible women had not met the national target. For example, 72.9% for those eligible aged 25-49 years and 74% for those eligible aged 50-64 years, against the national target of 80%. However, unverified data provided by the service as part of this inspection, demonstrated the target had since been met. People were offered opportunistic cervical screening when possible and could access this service outside of core hours, to improve uptake. The provider recently held a cancer roadshow event, in collaboration with the primary care network (PCN), which comprises all the services operated by the provider. The event promoted the importance of cancer screening, with a particular focus on cervical screening. Staff were able to book eligible people into cervical screening appointments during the event, helping to improve uptake and support early detection of cancer. The service also recognised some people were housebound and unable to attend the service. To address this, nurses carried out cervical screening in people’s homes, with appropriate safeguards in place, further increasing uptake and improving care and treatment outcomes.

The service monitored people with long-term conditions and recalled them by their birthday month for review. Each person had a personalised care plan and was supported to discuss their care and treatment at their annual review. The service had effective systems to ensure invites for immunisations, screenings and reviews were sent appropriately and in a timely manner. They also had arrangements to follow up on missed appointments for health checks and immunisations. Staff opportunistically offered immunisations, or other outstanding tests, to people to help improve care outcomes.

Data reviewed prior to the inspection showed the service met national targets for all childhood immunisations except one indicator. However, unverified data provided by the service, demonstrated this target had since been achieved. The service continued to promote immunisation uptake by offering flexible appointment times outside of dedicated clinics, including through enhanced access sessions. Targeted communication was also used to highlight the importance of immunisations; for example, the provider implemented a programme to engage directly with families to encourage uptake.

The service recognised some of the people it served were short-term residents and worked proactively with these groups to promote immunisation uptake. Information was available in multiple languages, and a representative from the patient participation group, who worked closely with local ethnic minority communities, helped to promote the importance of childhood immunisations, and subsequently improved uptake.

Leaders were aware of the wider challenges faced by primary care services and took action to address them. For example, they identified concerns around opioid prescribing and undertook an audit and review of all people prescribed these medicines. This included consultations with individuals to discuss their treatment and agree on appropriate plans. The initial audit identified around 690 people prescribed an opioid, some of whom had been taking them long term. After the review, leaders and clinicians evaluated each prescription to determine its necessity and worked with people to develop strategies to safely decrease usage when suitable, such as helping individuals lower their dosages or discontinue use altogether. A follow-up audit identified there were only 290 people still prescribed opioids, all of whom had received a full medication review. These individuals continued to require opioid medication for ongoing clinical reasons; however, the service was actively working with them to safely reduce their usage and dosages where appropriate, ensuring no unnecessary prescriptions remained.

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

Staff understood and applied legislation relating to consent. Consent for care and treatment was obtained from people who used the service, either verbally or in writing, and recorded clearly in their clinical records. Staff showed good understanding of consent procedures, ensuring people were fully informed before receiving care or treatment. Mental Capacity Act training had been completed by all relevant staff, and clinical staff understood how to apply the legislation and associated guidance when making decisions about consent.

Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. Records we reviewed demonstrated that DNACPR forms were appropriately completed and reviewed, shared with relevant services, and alerts were added to the person’s record. Relevant documentation was also present in the care records those who lacked the capacity to make decisions.