Trent View Medical Practice

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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

We assessed 6 quality statements from this key question. We have combined the scores for this area with scores based on the rating from the last inspection, which was Requires Improvement. Our rating for this key question is Good. The service had made improvements and is no longer in breach of regulations. We found improvements had been made in care of patients with long term conditions such as asthma care and diabetes. Improved systems for recall, monitoring and auditing long term condition outcomes had been implemented. However, the new systems were not totally embedded, and we found patients with diabetes had not always been identified and those with hypothyroidism had not always been monitored effectively. Staff training had been improved and systems to monitor training had been implemented. 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.

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 people using the service was mixed. Most patients told us they received good clinical care. Two patients told us how they had been directed to staff with specific clinical skills to provide care and treatment for their condition. One patient told us they had not had positive experiences due to the GP not listening to them.

Reception and call centre staff were aware of the needs of patients. The care records system highlighted any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked health, care, and wellbeing needs during health reviews.

Clinical staff used templates in consultations and care reviews to support the review of people’s wider health and wellbeing. A member of staff was the practice lead for carers. Processes were in place to identify carers, record their needs and signpost them to local organisations for support. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Most patients told us they received good clinical care. Two patients told us how they had been directed to staff with specific clinical skills to provide care and treatment for their condition.

Staff told us they worked to current best practice guidance, such as National Institute for Health and Care excellence (NICE) guidelines, Gold Standard Framework standards for palliative care and local clinical protocols.

The practice monitored and improved outcomes for patients by carrying out clinical audits. The practice had developed an audit plan for 2024/25. We did not see any completed 2 cycle clinical audits to confirm actions taken from the first cycle had improved care, however, the audits showed how the practice considered and implemented evidence-based practice. Good practice and new guidelines were shared with staff in meetings.

Most patients told us they received good clinical care. Two patients told us how they had been directed to staff with specific clinical skills to provide care and treatment for their condition. Some patients told us they had not had positive experiences due to delays due to management of referrals and blood test results.

Palliative and supportive care was delivered in care homes aligned with the practice. The palliative care team worked closely with the district nursing team and the Integrated Care Board (ICB). All aligned care homes had a named GP and the urgent care GP or named GP attended joint visits and meetings. Information received into the practice about palliative care patients was shared with the palliative care team. The practice was part of a primary care network (PCN) of practices who shared staff for the benefit of patients. For example, they had employed a pharmacist and pharmacy technicians who worked at the practice. Referral letters were completed in a timely manner. Significant improvement had been made to procedures to action incoming letters and discharge summaries. One member of staff felt their work relating to medicines was sometimes delayed due to delays from external services sending information such as updates to patients' prescriptions and delays in processing some information in the practice.

The provider had maintained good working relationship with the commissioners and had kept them informed of improvements they had made.

The practice was part of a primary care network (PCN) of practices who shared staff for the benefit of patients. For example, they employed a pharmacist who assisted with medicines reviews. There were processes for the management and overview of referral letters which were completed in a timely manner. There was an improved procedure to manage incoming letters and discharge summaries and the outstanding work from the last inspection had been addressed. We observed staff were knowledgeable about their role and work streams were efficiently managed. We observed there was minimal delay in sharing information within the practice. There were procedures for summarising records and systems to ensure coding was correct.

Most patients told us they received good clinical care. Two patients told us how they had been directed to staff with specific clinical skills to provide care and treatment for their condition.

Patients were supported by staff to manage their own health, care and wellbeing needs. For example, the provider had developed a reception champion role at each site. This person was responsible for identifying and promoting health awareness campaigns, for example, cancer awareness week, through posters and liaision with patients. They had also supported patients to access new technology and had an NHS App ambassador supporting patients and staff in the NHS app functionality. The practice had a social prescriber, employed through an external company, who staff could refer to for support in the community. Patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. Staff could also refer to local smoking cessation and weight loss management programmes

Patients were involved in regularly reviewing their health and wellbeing needs where appropriate and necessary. Services focused on identifying risks to patients’ health and wellbeing early and patients were signposted to lead staff and specialists within the practice. Patients were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary with health and care professionals. For example, patients with a learning disability were offered an annual review. An audit showed 20% of patients who met the criteria for a learning disability review had had had a review in quarter one in 2024/25 and 70% had had a review in 2023/24.

Most patients told us they received good clinical care. Some patients told us they had had delays to treatment due to management of referrals and blood test results.

Staff carrying out long-term condition reviews had received appropriate training for the role. The palliative care team were working to Gold Standard Framework Standards. Significant improvements had been made in the management of clinical letters and relevant information about changes to patient care was shared.

Systems to monitor people’s care and treatment and their outcomes were in place including systems to invite patients for regular reviews of their long-term conditions. A new recall system had been implemented for long term condition monitoring. A register was maintained, and patients’ notes had been coded to enable patients to be identified for appropriate recall. Monthly data reports were completed to identify patients due for review and they were provided with a link to book their appointment via mobile phone message. Patients were contacted by a member of staff if they did not have a mobile phone. An audit policy and audit plan for 2024/25 had been developed. The provider had completed some clinical audits which identified areas for improvement and action plans had been implemented. However, audits to review that the actions taken had been sustained and patient care improved had not been completed.

There were systems to monitor people’s care and treatment and their outcomes. Clinical reviews of patient records showed improvement, good care and appropriate monitoring of patients with long term conditions and those on high-risk medicine. However, clinical searches found not all patients with hypothyroidism had had a thyroid function test in the previous 18 months and some patients had not been appropriately diagnosed with diabetes or their records had not been coded with a diabetes diagnosis where this was indicated in their test results. This means patients may not be receiving appropriate treatment and follow-up. The lead GP told us they would review our findings as these issues should be identified and addressed through the new monthly data quality reports and patients should be invited for regular monitoring tests via the new recall system.

We received no specific comments from patients about this area.

An audit of patient records relating to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions had been undertaken to review if decisions relating to DNACPRs were appropriate and correctly coded. Records had been updated where required after speaking to the patient and family.

Very detailed and personalised records were seen in patient records relating to DNACPR decisions which had been completed in consultation with the family. The practice did not carry out any minor surgical procedures that required written consent. Patients were offered a chaperone when carrying out examinations, we saw posters displayed in the practice informing patients of this. Staff who carried out chaperone duties were trained for the role.