Horndean 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 Good.

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 made sure people’s care and treatment was effective by 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. 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 service had effective systems to identify people with previously undiagnosed conditions, for example people who had potentially a misdiagnosis of diabetes had all been reviewed. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

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. Clinical records we saw demonstrated care was provided in line with current guidance. For example, all people who had been prescribed Hydrochlorothiazide had been advised of side effects and no outstanding issues noted. National NHS data indicated the service met childhood immunisation uptake targets, with 98% of children aged 2 receiving the measles, mumps, and rubella vaccine, surpassing the 95% benchmark.

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. A weekly team meeting was held by the lead GP to discuss people who may be nearing the end of their life. The service used ‘GP2GP’, a digital system provided by NHS England, which enabled the secure and efficient transfer of electronic records when a person moved between GP practices. This helped the GP have timely access to accurate and up-to-date clinical information, reducing the risk of delays in care.

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. The service had access to a social prescriber to signpost people. For example, to connect people to non-medical community activities such as Dementia support.

Everyone registered with the service who had a learning disability or autism had received their annual health review

During our onsite visit, we observed in the reception area, the service showed several short videos via television screens, including how to check your mouth for signs of mouth cancer, a message from a PPG member, and a personal story from someone who had an abnormal cervical screening test, encouraging others to attend their screening.

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

Pathology results were reviewed and actioned in a timely manner and people were supported to understand and manage their individual needs.

Whilst the service met the national target for childhood immunisation uptake, data from the UK Health Security Agency showed the service did not meet some national targets for screening programmes. For example, cervical screening rates for eligible people aged 25-49 years were 75%, which was below the national target of 80%. The service was aware of this and had taken action to increase the uptake.

From the clinical notes we reviewed, we noted people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance. For example, people received educational information and monitoring for long term health conditions such as diabetes.

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. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. DNACPR decisions were reviewed annually, and people were offered the chance to discuss and ask any questions with their GP. The service had a current DNACPR policy and this was reviewed annually. Nurses who provided women's health services, including the fitting of contraceptive coils described the consent process, which included a discussion with people prior to the procedure and the provision of written information alongside a consent form. While people were encouraged to sign the form, verbal consent was accepted and documented before the procedure commenced.