Porters Avenue Doctors Surgery

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 75 (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 maintained up-to-date patient assessments and ensured staff understood individuals’ current health and care needs. Vulnerable patients were prioritised, with annual health checks offered to those with learning disabilities and reasonable adjustments were made to support attendance. Carers were recognised and maintained on carers register. They received additional support, such as yearly flexible appointment times and reviewing carers needs periodically. There were 494 carers on their carers register, which represented over 2% of their practice population.

Care and treatment were regularly reviewed, with attention being placed to wellbeing and communication preferences. Feedback regarding the care received from healthcare professionals was positive, with patients feeling involved and understood. For example, 81% of patients from the National GP Patient Survey felt their needs were met during their last appointment. Eighty-four percent of respondents stating the healthcare professional they saw had all the information they needed about them during their general practice appointment.

Reception staff used digital flags to highlight specific needs, such as interpreter support or extended appointments. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had systems to identify previously undiagnosed conditions, and staff referred individuals with social challenges, such as isolation or housing issues, to a social prescriber employed by the Primary Care Network.

The service 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, for example, through monthly educational meetings, paid courses and study leave and access to local guidelines through the services’ intranet. The service held regular clinical, staff and quality and governance meetings to discuss evidence-based care. Clinical records we saw demonstrated care was provided in line with current guidance.

The service worked well across teams and services to support people and shared patients’ assessment of needs when moving 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. Leaders and staff worked closely with colleagues within their local Primary Care Network (PCN). Multi-disciplinary meetings were held on a regular basis, both in-house and with other services. Referrals to specialist services were well documented, included all required details, and were actively monitored to avoid delays.

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 provided preventive lifestyle advice to 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 service carried out a ‘Healthy Living Years Project’ where they looked at risk factors and key risk groups that were leading to reduced healthy life expectancy and carried out targeted intervention in these groups.

The service 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 service performed two-cycle clinical and non-clinical audits to find ways they can improve the quality of patient care. For example, the practice performed an audit into the prescribing of amoxicillin.

Between 1 April 2023 and 31 March 2024, the service did not achieve the World Health Organisation national target of 95% for all five key childhood immunisation indicators. The national targets of 80% for cervical screening uptake for the eligible population aged 25- to 49-year-olds was not met, with 69% uptake achieved, and a 74% uptake achieved for the eligible population of patients aged 50 to 64.

The service acknowledged the low uptake in some of the areas and implemented an action plan to increase uptake. This involved following up with patients who missed appointments and contacting those with vaccine hesitancy to address their concerns. Additionally, administrative staff sent text messages containing information and a self-booking link to encourage participation.

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 service informed people of their rights regarding consent and ensured these rights were respected in the delivery of person-centred care and treatment. Staff understood and applied legislation relating to consent.