Dr Berni

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

Feedback from people who used the service indicted that they felt they received effective care and treatment, they felt listened to, treated with care and concern, were referred to other services promptly for tests and investigations and had been given good explanations as to their conditions and treatment options and involved in decisions about their care and treatment. Staff worked together and collaboratively with other services to make sure patients could access other services easily. Multi-disciplinary meetings were held on a regular basis where the needs of patients with complex needs or those approaching the end of life could be discussed, reviewed and planned for. The provider had introduced a new clinical governance framework since our last inspection this included closer monitoring of outcomes for patients and taking action to improve these if required. 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. A small number of areas for improvement were noted. This was in relation to reviews for asthma patients linked to the frequency of medicines prescribed and follow up of patients who were potentially pre-diabetic. The provider confirmed that they were working on improving in these areas. We noted some good examples of detailed consultation records, however we noted others that lacked detail as to the examination of patients and any safety netting advice provided to patients. The provider had introduced a system of quality assurance to review consultation notes and this was in progress at the time of the assessment. The provider had systems and processes to keep clinicians up to date with current evidence-based practice. Staff were aware of the requirements for patient consent to care and treatment and had been provided with training where relevant to their role.

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.

People felt involved in decisions about their care and treatment and had confidence in the healthcare professionals treating them. Feedback from patient surveys, including the National GP Patient Survey and the NHS Friends and Family Test, were positive and did not highlight any concerns relating to the assessment of people's needs.

Staff told us they received training and knew how to prioritise people who reported symptoms which could be classed as a clinical emergency. Staff were confident that people’s care records and prescriptions were updated to reflect any extra or changed needs as requested by the patient or secondary care.

The provider had systems and processes in place to ensure people’s immediate and ongoing needs were assessed. People’s health and 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. Staff worked with other healthcare professionals to assess people’s needs and deliver coordinated packages of care. A number of clinical related 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 provider intended to develop the programme of audits. People who were the most clinically vulnerable were prioritised. We saw examples in consultation records of where people had been told when they needed to seek further help and what to do if their condition deteriorated. However, we noted that this was not documented in all of the consultation notes we looked at. The provider had introduced a new governance framework to review the appropriateness/ quality of clinical consultations and was in the process of ensuring improvements were made in this area.

We reviewed feedback from people using the service from several sources, including complaints and patient surveys, and did not see any concerns raised regarding the delivery of evidence based care and treatment. People’s experience as indicated in the national GP patient survey showed that people had confidence in the healthcare professionals treating them. People’s comments in the NHS Friends and Family test included; that they had undergone a ‘thorough examination’, had received a ‘clear explanation as to the next steps’ an ‘explanation of symptoms’, they had been referred in a timely way, had received timely follow up to tests and received ‘good aftercare’.

Our review of the clinical record system indicted that overall people received care, treatment and support that was evidence-based and in line with good practice standards. The series of searches we completed showed people prescribed high-risk medicine or medicines that required regular monitoring were in the majority of cases, completed according to best practice guidance. The results of the clinical searches for the management of people living with long term conditions were good overall and did not identify any significant gaps in monitoring people. However, some areas for improvement were noted in relation to reviews for people with asthma and checks on a small number of patients who were pre-diabetic/ borderline diabetic. The provider told us they had already put in place a mechanism to follow up these people but it was not always met due to people’s non-compliance and delays in community blood clinic appointments. The provider confirmed that people in the borderline category had since been reviewed. The provider told us they had been working to unify the assessment criteria of people with asthma including the safety netting component and the use of oral and inhaled steroids and steroid treatment cards. Following our assessment the provider confirmed that people who had been identified as requiring action in relation to blood glucose monitoring in our searches, had been called and recalled for tests but had failed to attend. These people had been contacted again and the required tests had since been scheduled.

Systems were in place to ensure staff were up-to-date with national guidance, evidence-based guidance. Staff attended regular meetings, training, educational sessions and underwent regular appraisal. People had access to appropriate health checks and assessments, and they were directed to relevant services when they needed extra support. For example, people assessed as at risk of developing a long-term condition. People were encouraged to be involved in monitoring and managing their own health and were being referred to other services in line with their needs. We looked at the workflow for managing clinical correspondence and tasks and found these were up to date. The provider had responded promptly to the feedback from our last inspection with regards to concerns about some of the clinical care and treatment provided. They had introduced a new clinical governance framework and submitted a comprehensive action plan, at our request, detailing their response to our findings and the actions they planned to take to make the required improvements. We viewed a sample of consultation records for people who used the service as part of our review of the clinical system. We found some good examples of appropriately detailed records that included all the required information such as presenting symptoms, examinations, findings, actions and safety netting. However, we saw a small number of records that included minimal information. The provider told us they had introduced a governance process for review of consultation notes which included auditing the records.

We reviewed feedback from people using the service from several sources, including complaints and patient surveys, and did not see any concerns relating to how staff and teams worked together to meet people’s needs.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Referrals to other services were made promptly and people were also referred or signposted to local support services as appropriate to their need. Staff told us they felt very well supported in their role. Staff had undergone an induction process, they had regular appraisals and were supported to complete ongoing training and development opportunities. They gave examples of how they were encouraged to develop as individuals and as a team, for example by attending training to support them in additional roles and support team work. Staff told us there was an open culture and the practice manager had an open-door approach. They told us the whole leadership team were approachable and supportive. Staff told us teamwork was good and without exception, they enjoyed working at the practice. Staff told us they were confident and comfortable approaching the management team for any reason. Staff in all roles were clear about their roles and responsibilities and the limitations of these. Alongside this, there were clear lines of accountability.

Leaders and staff told us they worked closely with colleagues in the local Primary Care Network (PCN) to meet the needs of the patient population.

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. Multi- disciplinary meetings were held on a regular basis so that when people received care from a range of different staff, teams or services, this was co-ordinated effectively.

Feedback from people who used the service indicated that they were provided with advice and support to prevent ill health, improve outcomes and manage their health conditions.

The provider has systems in place to monitor the effectiveness of the care and treatment provided so as to support people to live healthier lives.

Our review of the clinical record system indicted that people received care, treatment that supported them to live healthier lives. People received regular monitoring of long term health conditions. 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. 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 were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. People who did not attend were contacted by the practice to encourage uptake of these services. Data about outcomes for people who used the service was used to monitor the effectiveness of the service. The service was performing in line with other practices locally and nationally.

Feedback from people who used the service was positive and people's comments did not include any issues or concerns relating to the monitoring of their care and treatment.

Leaders demonstrated that monitoring and improving outcomes for people who used the service was important.

There were systems in place for quality improvement and the provider had produced and was working to a detailed action plan to improve outcomes for people. When incidents happened within the service, the provider took steps to rectify these efficiently and to ensure people were satisfied with the outcome.

The provider had systems in place to routinely monitor people’s care and treatment and to improve it. People who required monitoring underwent regular checks on their health. The service was in line with other services within the locality and nationally for outcomes for patients. Clinical and non clinical audits were carried out as a means to improve outcomes for patients. Overall the results of the clinical searches we carried out were good. Where we found some minor issues the provider told us they had already identified these and were taking action to address them.

Feedback from people who used the service indicated that they were involved in decisions about their care and treatment.

Staff were clear on the importance of ensuring that people understood what they are consenting to and of the importance of obtaining consent before they delivered care or treatment.

Treatment options were discussed with people so they could make an informed decision about what was best for them. 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, for example, Gillick competence (deciding whether a child under16 is able to consent to their own medical treatment). We looked at a sample of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in patient records. These were as required and raised no concerns about people’s experience regarding consent to care and treatment.