Willow Wood Surgery

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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

Feedback from people who used the service indicted that they felt they received effective care and treatment, they felt listened to, involved in decisions about their care and treatment, and treated with care and concern. People were referred to other services promptly for tests and investigations and had been given good explanations as to their condition and treatment options. Staff worked together and collaboratively with other services to make sure patients could access other services easily. Our review of the clinical patient record system for the sample of patients whose records we looked at showed that care and treatment had been delivered in line with evidence based guidance overall. We noted some good examples of detailed consultation records.

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 experience of people who used the service as indicated in the National GP Patient Survey showed that patients felt involved in decisions about their care and treatment and they had confidence in the healthcare professionals treating them. Feedback from people who used the service that was shared with us was very positive overall and patients' comments did not include any concerns relating to the assessment of their needs. There had been no particular themes of complaints linked to the assessment of people’s needs made to the provider. Systems to support people with their communication needs were in place. For example, people who required the services of an interpreter or people who have a learning disability. People’s individual communication needs were identified and recorded in the patient record system so staff could provide additional support during any contacts or consultations.

Feedback from all staff and leaders indicated that they worked to provide a high quality of care to meet the immediate and ongoing assessed needs of people who used the service. Reception staff told us the GPs were responsible for prioritising patients who reported symptoms which could be classed as a clinical/medical emergency. We saw examples in the patient record system where people had been informed as to when they needed to seek further help and what to do if their condition deteriorated. Staff shared relevant information with other professionals when deciding care delivery for patients with specific symptoms or long-term conditions.

The practice had systems and processes in place to ensure patients’ immediate and ongoing needs were assessed. Patient’s treatment needs were routinely reviewed. For example, there were regular health reviews for people living with a long term condition or for people who have a learning disability. We saw no evidence of discrimination when staff made care and treatment decisions. People who were the most clinically vulnerable were prioritised and the practice worked with other healthcare professionals to deliver coordinated packages of care. Clinical audits were carried out to check on the quality of care and treatment to ensure it was meeting people’s assessed needs and to identify improvements and act on these.

The experience of people who used the service as indicated in the National GP Patient Survey showed that they felt involved in decisions about their care and treatment and they had confidence in the healthcare professionals treating them. Feedback from people who used the service that was shared with us directly was positive and people’s comments did not include any concerns relating to the delivery of care and treatment provided to them. There had been no particular themes of complaints linked to the delivery of care and treatment made to the provider.

Members of the staff team gave mixed feedback on the systems in place to ensure they were up-to-date with national guidance, evidence-based practice and required standards. Some staff felt these were sufficient whilst others felt they could be supported better in these areas. Regular meetings were held for clinical and non-clinical staff and standing agenda items were used to ensure important information was discussed and disseminated. We noted the attendance at clinical meetings was low for members of the clinical and leadership team.

Our review of the clinical record system for the sample of people whose care and treatment we looked at, indicated that people received care, treatment and support that was evidence-based and in line with good practice standards. The series of searches we completed showed patients prescribed high-risk medicine or medicines that required regular monitoring was in the majority of cases, completed according to best practice guidance. The results of the clinical searches for the management of patients living with long term conditions were good overall and did not identify any significant gaps in the monitoring of patients. However, some areas for improvement were noted in relation to following up patients who had received treatment for an exacerbation of asthma and patients prescribed thyroxin who had been invited in for monitoring but who had failed to attend. People had access to appropriate health checks and assessments, and they were directed to relevant services when they needed extra support. For example, patients assessed as being at risk of developing a long-term condition. We looked at the workflow for managing clinical correspondence and tasks and found these were up to date. The practice had a system for checking on people referred under the two week wait rule to ensure these people had attended the arranged appointment.

There had been no particular themes of complaints linked to how staff, teams and services work together made to the provider and no particular feedback of this nature shared with CQC generally or in the ‘give feedback on care’ link shared on the provider’s website where people were invited to share their experience of the service with CQC. Patients experienced a service where referrals to other services were made promptly. Patients were also referred or signposted to local support services as appropriate to their need.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support.

Leaders and staff worked closely with colleagues in the local primary care network (PCN) to meet the needs of the patient population. Multi- disciplinary meetings were held on a regular basis at PCN level so that when people received care from a range of different staff, teams or services, this was co-ordinated. However, the outcome/decision making from these meetings was not always clearly communicated across the clinical and leadership team.

Systems were in place to ensure the service worked effectively across teams and services to support people. Information about patients needs was shared effectively when they were referred to different services.

There had been no particular themes of complaints linked to the support people received to live healthier lives made to the provider and no particular feedback of this nature shared with CQC generally or in the ‘give feedback on care’ link shared on the provider’s website where people were invited to share their experience of the service with CQC.

Members of the clinical team provided patients with information and support to manage their own health, care and wellbeing where possible. People were also encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing and prevent deterioration.

People living with a long term health condition underwent regular monitoring. They were referred or signposted to local support services for information, education, advice and support linked to their needs. For examples referral for diabetes education, dietary advice and smoking cessation. Our review of the clinical record system indicted that patients received care and treatment that supported them to live healthier lives. Patients were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. Patients who did not attend were contacted by the practice to encourage uptake of these services. Data about outcomes for patients was used to monitor the effectiveness of the service. The service was performing in line with other practices locally and nationally.

There had been no particular themes of complaints linked to the monitoring of outcomes for patients made to the provider and no particular feedback of this nature shared with CQC generally or in the ‘give feedback on care’ link shared on the provider’s website where people were invited to share their experience of the service with CQC.

Leaders demonstrated that monitoring and improving outcomes for patients was important to them and they used the information to drive improvement.

When incidents happened within the service, the provider took steps to rectify these with people and ensure they were satisfied with the outcome.

The provider had systems in place to routinely monitor people’s care and treatment and to improve it. Clinical and non clinical audits were carried out as a means to improve outcomes for patients. Patients who required monitoring underwent regular checks on their health. The practice was in line with other services within the locality and nationally for outcomes for patients.

Patient experience of the service as indicated in the National GP Patient Survey showed that patients felt involved in decisions about their care and treatment. There had been no particular themes of complaints linked to issues of consent and no particular feedback of this nature shared with CQC generally or in the ‘give feedback on care’ link shared on the provider’s website where people were invited to share their experience of the service with CQC.

Staff were aware of the requirements to gain patient consent to care and treatment and had been provided with training where relevant to their role. Staff understood the importance of ensuring that people understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. Staff had undergone training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Leaders and staff understood the requirements of legislation and guidance when considering consent and decision making.

We looked at a sample of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in patient records. These were not always as required in relation to having the full paper work in place, sharing the decision and having appropriately signed authorisation as to the decision.