Thornbury Medical Practice

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

Overall, we found that the practice provided effective care and treatment. Following the last comprehensive inspection of the service in September 2023, the provider was rated inadequate for providing effective care and treatment. Issues identified included low uptake of childhood immunisations and cervical screening and no evidence of quality improvement activity. This assessment showed that steps had been taken to improve in these areas. In addition, searches undertaken on the practices clinical system demonstrated there were good systems in place to ensure people with long-term conditions were supported and managed in line with evidence based guidance. However, we found there were some areas where the practice should steps to improve. This included: Improving the processes for capturing do not attempt resuscitation (DNACPR) decisions for palliative care patient and the system for reviewing decisions made. Reviewing the care navigation and triage policy to have clear guidance to include clear reference to clinical triage and continue to work to improve childhood immunisations uptake.

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.

Feedback from representatives of the patient participation group confirmed that they were regularly called for health screening. We were advised that GPs were very thorough during appointments. We received feedback from 62 patients via the give feedback on care form on our website. Of these 38 were positive regarding the service they had received from the practice. We heard examples of how same day emergency appointments had been provided, avoiding the need to attend the hospital accident and emergency department and prompt assessment and treatment of infection. The less positive feedback from 24 patients generally related to access and experience of making an appointment.

We spoke with members of the management team who were able to explain how patients requiring monitoring were supported and managed. This included inviting for annual health reviews and monitoring checks. Patients who did not attend were discussed at clinical meetings to ensure appropriate follow up and action were taken.

The practice had a care navigation and triage policy in place. Reception staff act in the role of care navigators and receive training to support them when commencing the role. There is a template to support staff which outlines conditions and type of appointment however, this could be improved. For example, it states children should be offered face to face appointment as soon as possible if requested or offer telephone appointment with clinician if requested. Elderly or infirm patients with mobility problems were to have morning telephone appointment with clinician. Telephone appointments may not always be suitable, dependent on clinicial need. There was no reference to direct route to clinical triage. The practice held a register of all patients receiving palliative care. We saw that all patients had up to date reviews. However, of the 16 patients on the register, 7 did not have a do not attempt resuscitation (DNACPR) decision recorded on the register. In addition, the 9 patients with DNACPR decisions recorded did not have a date recorded for a review of decision. The practice had a process in place to review all patients upon discharge following hospital admission.

We saw no indication of any concern in this area. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

Staff we spoke with told us they had access to learning opportunities. The provider ensured that staff were up to date with national legislation and required standards.

The provider had systems and processes to keep clinicians up to date with current evidence-based practice. Our review of the remote clinical searches of patient records showed that patients were being effectively and safely managed.

We received positive feedback from members of the patient participation group regarding how the practice engaged with them and kept them informed about developments. However, of the 62 responses we received from patients via the give feedback on care form on our website, 24 contained negative or less positive comments. We looked at these in detail and found themes around accessing appointments and staff attitude.

Feedback we received from staff informed us of other services the practice worked closely with. This included the stop smoking service, drug and alcohol service and arrangement of multidisciplinary team meetings to discuss vulnerable patients such as those on the palliative care register. Partners told us how they had engaged with external bodies to drive improvement within the practice. This included the NHS West Yorkshire Integrated Care Board, the local medical committee and the Royal College of General Practitioners.

We received positive feedback from the NHS West Yorkshire Integrated Care Board (ICB) regarding steps the practice had taken to engage with them following the previous inspection.

The practice hosted various services in-house. This included the drug and alcohol service and the stop smoking service. The practice worked closely with the Primary Care Network (PCN) unplanned care team. This enabled them to refer urgent requests for acute home visits and enable patients to be seen the same day. We were able to review minutes of multidisciplinary team meetings with other providers such as district nurses, palliative care and physiotherapy services. However these were often poorly attended by other services and the minutes did not always document any reviews undertaken by the practice. There was no system to routinely share minutes with those that had not attended.

Patients had access to a social prescriber at the practice to support with any issues around health and wellbeing. This included signposting to relevant services and activities for practical, social and emotional support to improve their health and wellbeing.

Staff were committed to promoting and encouraging patients to live healthier lives. They explained how they proactively engaged with patients to encourage attendance at appointments. Staff were aware of areas where performance was, or had previously been, lower than local and national averages and had taken steps to improve this. They explained how evening and weekend appointments were available for childhood immunisations and cervical screening.

There were processes in place to invite patients for relevant health checks. For example; a total of 518 patients were eligible for NHS health check, we saw that the practice had undertaken 332 in the last 12 months. The practice promoted in-house activities for patients such as coffee mornings and weekly walks. In addition, they had worked in conjunction with the PCN to hold a women’s only event to educate women about health services in the local area. Patients could attend and access free health checks, refreshments and holistic massage therapy.

Feedback from representatives of the patient participation group confirmed that they were regularly called for health reviews. We were advised that GPs were very thorough during appointments. Feedback we received via the give feedback on care form on our website was generally positive about care and treatment at the practice. However, 2 patients raised concerns regarding long term conditions reviews for chronic obstructive pulmonary disease. We reviewed this as part of our assessment and found the practice had appropriate processes in place.

Feedback from staff and leaders was positive about monitoring and improving outcomes. Staff could clearly outline the systems in place to recall patients and understood their specific involvement in this. Leaders explained how a more proactive approach had been introduced to encourage patients to attend for screening and preventative measures such as cervical cancer screening and childhood immunisations.

The provider had processes in place to actively encourage patients to attend for reviews, screening and preventative purposes. As part of the assessment, we conducted a series of remote clinical searches to assess the practices procedures for the management of patients with long-term conditions. We found that the management of patients with long-term conditions which included asthma, chronic kidney disease, diabetes and hypothyroidism was generally good. We found some issues with follow up of patients who were prescribed two or more rescue steroids. However, the practice responded quickly to this by implementing an action plan to avoid future reoccurrence. The practice had improved the process for encouraging patients to attend for cervical screening and childhood immunisations. This included offering appointments at a time to suit the patient, text message at the time of booking, and the day before the appointment, telephone call from the nurse to any patients who do not attend during the scheduled appointment time, implementation of a pop-up reminder box when patients record is retrieved. Non-attenders for screening and immunisation were escalated to the clinical meeting for discussion and escalation to other parties, for example health visitors.

Our review of the remote clinical searches of patient records showed the practice worked with patients to monitor and improve outcomes. We saw that regular reviews were undertaken for those patients with long-term conditions. Appropriate registers were held to ensure monitoring of specific groups such as safeguarding, palliative care and learning disabilities. Information published by Office for Health Improvement and Disparities showed the practice had an overall uptake of 61% for cervical screening. At the time of our assessment the practice could demonstrate that 87% of patients aged 25 to 49 years had attended for screening and 96% of patients aged 50-64 years had attended for screening. However, at the time of our assessment this information had not been published or validated. Uptake for childhood immunisations remained below national targets

We saw no indication of any concern in this area.

Staff we spoke with were able to give example of how consent was considered, sought and recorded (where appropriate). For example, consent for minor surgery was obtained in writing and recorded on the clinical system. Staff also outlined how they obtained verbal consent prior to referring to other services.

We saw no indication of any concern in this area.