What is the Quality of Care at St Thomas Road Surgery

Positive

"• Unverified data for childhood immunisations and cancer screening was showing an overall improved performance but further emphasis was required to improve uptake and for this to be reflected in outcomes when these are next published."

Neutral

"• Promote and drive the uptake of childhood immunisations and cancer screening programmes with their patients."

Positive

"The areas where the provider should make improvements are: • Engage with the local population to improve uptake of immunisation and cancer screening."

Neutral

"• Childhood immunisations and cancer screening performance were below average with limited evidence of any work completed by the practice to improve it."

Positive

"People experiencing poor mental health including people with dementia: • The practice assessed and monitored the physical health of people with mental illness severe mental illness and personality disorder by providing access to health checks interventions for physical activity obesity diabetes heart disease cancer and access to ‘stop smoking’ services."

Positive

"• The practice should continue to work to improve QOF performance in the area of diabetes and to improve cancer screening and childhood immunisation rates."

Positive

"QOF Performance in the area of diabetes cancer screening and childhood immunisation rates continued to be a challenge for the practice."

Positive

"This is because: • We saw that QOF performance in the area of diabetes and cancer screening and childhood immunisation rates were below national averages and targets."

Positive

"• The practice’s uptake for breast and bowel cancer screening was below the national average."

Positive

"• Patients at risk of dementia were identified and offered an assessment to detect possible signs of dementia."

Positive

"When dementia was suspected there was an appropriate referral for diagnosis."

Positive

"The practice offered proactive personalised care to meet the needs of the older people in its population and had a range of enhanced services for example in dementia and end of life care."

Neutral

"The data also showed that the practice was performing as expected for its treatment of patients with preventative anticoagulation medicines as well as for those patients living with dementia who had received a facetoface review of their health needs."

Positive

"This was by means of five lockable boxes into which patients could insert a green token to indicate their choice as to whether they would recommend the practice to others on a scale from ‘definitely would’ to ‘definitely would not’."

Positive

"People experiencing poor mental health including people with dementia: • The practice assessed and monitored the physical health of people with mental illness severe mental illness and personality disorder by providing access to health checks interventions for physical activity obesity diabetes heart disease cancer and access to ‘stop smoking’ services."

Positive

"People experiencing poor mental health including people with dementia: • Staff interviewed had a good understanding of how to support patients with mental health needs and those patients living with dementia."

Positive

"• The practice’s performance on quality indicators for mental health was generally above local and national averages."

Positive

"People experiencing poor mental health including people with dementia: • Staff interviewed had a good understanding of how to support patients with mental health needs and those patients living with dementia."

Positive

"• The practice had increased access to appointments to enable patients suffering with mental health disorders to get an appointment at a time that best suited their needs."

Positive

"Everybody who experienced poor mental health had received an annual physical health check."

Neutral

"The practice regularly worked with multidisciplinary teams to support people experiencing poor mental health including those with dementia."

Neutral

"The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations."

Neutral

"Health promotion and illhealth prevention There was a range of uptodate health promotion literature available in the waiting area with information about physical and mental health and lifestyle choices."

Positive

"People experiencing poor mental health including people with dementia: • The practice assessed and monitored the physical health of people with mental illness severe mental illness and personality disorder by providing access to health checks interventions for physical activity obesity diabetes heart disease cancer and access to ‘stop smoking’ services."

Positive

"• The practice should continue to work to improve QOF performance in the area of diabetes and to improve cancer screening and childhood immunisation rates."

Positive

"QOF Performance in the area of diabetes cancer screening and childhood immunisation rates continued to be a challenge for the practice."

Positive

"People with longterm conditions: • The practice’s performance on quality indicators for diabetes was below local and national averages."

Positive

"Following the inspection the provider told us that had introduced diabetes health awareness cafes to encourage patients to attend for health checks."

Positive

"This is because: • We saw that QOF performance in the area of diabetes and cancer screening and childhood immunisation rates were below national averages and targets."

Positive

"• The practice could demonstrate how it identified patients with commonly undiagnosed conditions for example diabetes chronic obstructive pulmonary disease COPD atrial fibrillation and hypertension."

Positive

"• The assistant Practitioner AP had received training in some chronic illnesses to enable basic assessment of diabetes and asthma including spirometry testing to increase access to care for these conditions."

Positive

"The Primary Care Plus service was in the process of adding other clinics to this service in response to patient needs and would shortly be able to offer clinics for chronic illness such as asthma chronic obstructive pulmonary disease COPD and diabetes as well as dressings clinics."

Neutral

"They also had access to a diabetes expert education programme and diabetes retinopathy screening."

Neutral

"Patients whose diabetes was poorly controlled had access to ‘Expert’ which is a programme of education to help patients understand and manage their condition."

Positive

"The practice ran nurseled health promotion consultations for long term conditions such as diabetes chronic lung conditions and heart disease for its registered patients."

Neutral

"We saw that some of the GPs and the advanced nurse practitioners ANP had lead roles in specialist clinical areas such as diabetes heart disease and asthma which allowed the practice to focus on specific conditions for its population of registered patients."

Neutral

"For example nursing staff had been trained in immunisations asthma diabetes and other long term conditions; the healthcare assistant had received training in carrying out health checks and taking blood samples."

Positive

"The provider told us following the inspection that this was due to the data logger being broken and two new replacement data logger s had now been purchased."

Positive

"• The assistant Practitioner AP had received training in some chronic illnesses to enable basic assessment of diabetes and asthma including spirometry testing to increase access to care for these conditions."

Positive

"The Primary Care Plus service was in the process of adding other clinics to this service in response to patient needs and would shortly be able to offer clinics for chronic illness such as asthma chronic obstructive pulmonary disease COPD and diabetes as well as dressings clinics."

Neutral

"• The practice utilised the IMPACT asthma scheme to provide close monitoring for relevant patients."

Neutral

"For example; patients with poorly controlled asthma had access to IMPACT a local initiative that provided regular care that was tailored to their needs."

Neutral

"We saw that some of the GPs and the advanced nurse practitioners ANP had lead roles in specialist clinical areas such as diabetes heart disease and asthma which allowed the practice to focus on specific conditions for its population of registered patients."

Neutral

"For example nursing staff had been trained in immunisations asthma diabetes and other long term conditions; the healthcare assistant had received training in carrying out health checks and taking blood samples."

Positive

"• We did not see evidence of formal discussion of updates to NICE guidelines in GP meeting minutes however the advance nurse practitioner ANP had a special interest in NICE guidelines in particular for hypertension and made use of updates to inform care for patients."

Neutral

"• Influenza and shingles vaccinations were offered to older patients where relevant."

Positive

"We learned that this had also supported greater understanding and expectations about antibiotic availability among recently settled people who had migrated from those countries where prescribing practices are different."

Neutral

"We learned that this antibiotic prescribing was to become part of the parent provider’s systemwide clinical audit programme for the period following our inspection."

Positive

"This included recording of smoking status recording blood pressure cervical screening contraception and obesity indicators."

Positive

"We saw that all equipment such as blood pressure machines a spirometer and an electrocardiogram machine was tested calibrated and maintained regularly."

Positive

"This had involved a series of events at numerous venues where people’s height weight bodymass index blood pressure blood sugar and cholesterol were assessed."

Positive

"These included those for the treatment of cardiac arrest severe shock associated with an allergic reaction to a vaccine a diabetic emergency and meningitis."

Positive

"We saw that the cold chain was maintained for the storage of temperature sensitive medicines such as the flu vaccine from the time they were received at the practice to the time they were administered."

Positive

"We saw evidence that the advanced nurse practitioner used a sepsis identification tool to inform clinical decision making Information to deliver safe care and treatment Staff had the information they needed to deliver safe care and treatment to patients."

Positive

"Clinicians knew how to identify and manage patients with severe infections for example sepsis and we saw that new guidelines relating to sepsis had been discussed."

Positive

"The most recent programmes prior to our inspection were the provision of flu vaccinations and the provision of health checks at various community venues."

Positive

"The practice also supported older people through its outreach programme by providing some services such as the flu vaccination in community venues for people that could not get to the practice."

Positive

"We saw that the cold chain was maintained for the storage of temperature sensitive medicines such as the flu vaccine from the time they were received at the practice to the time they were administered."

Positive

"The practice also opportunistically used consultations with people with long term conditions to followup their need for further preventative treatment such as the flu vaccination."

Neutral

"We saw that for example the most recent programmes prior to our inspection were the provision of flu vaccinations and the provision of health checks at various community venues run by the health care assistants and the nursing team."