The Dove 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

Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools. Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.

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 feedback we received from patients was limited regarding assessment of needs. However, the information we did receive was positive demonstrating that patient’s needs were being met. Feedback from care homes representatives was also positive about the service received from the practice.

Leaders and staff told us the practice used a series of codes and alerts on the patient record to highlight people’s communication needs and any impairments. The practice had systems and processes to identify people’s needs and preferences during the registration process. Staff told us they checked people’s health, care, wellbeing and communication needs during health reviews.

A remote review of the patient record system showed that most patients received appropriate long-term condition reviews. Where there were gaps in reviews of patients the practice was aware and had processes in place to manage risks. For example, our searches identified 2 patients with poorly controlled diabetes who were overdue annual reviews. Evidence reviewed demonstrated the practice had made several attempts to contact these patients, including attempted home visits. Clinical leads were aware of these patients and advised us that they would continue with efforts to encourage these patients to attend. Our searches showed there were a total of 235 patients treated for Hypothyroidism (under active thyroid). Of these we 2 patients were overdue reviews. Immediately following our assessment, the practice advised these patients had been contacted and review appointments arranged. For patients with the most complex needs, the GPs worked with other health and care professionals to deliver a coordinated package of care. Registers were kept of patients with different health requirements. The practice identified patients with caring responsibilities and had signposting and policies in place to support their needs. This information was available through new patient registration, notice boards and leaflets.

We could not collect specific evidence from patient feedback to score this evidence category. Our observations raised no concerns. The evidence we reviewed did not show any concerns about people’s experience regarding delivering evidence-based care and treatment.

Feedback from leaders showed they worked to ensure all clinical correspondence and tasks were up to date. Patients had access to appropriate health checks and assessments and were directed to relevant services when they needed extra support, such as those at risk of developing a long-term condition. Patients were encouraged to be involved in monitoring and managing their own health and were referred to additional services if needed.

We undertook a series of searches on the practice’s clinical records system to review if care and treatment was delivered in line with best practice. Our searches demonstrated that systems worked effectively to support safe and effective care for patients prescribed high-risk medicine or medicines that required regular monitoring. Our searches did identify 29 patients with asthma who had been prescribed 2 or more ‘rescue packs’ in the last year. These packs contain medicines used to treat flare ups of asthma. Repeated use of these medicines can indicate the patient’s asthma could be better controlled. We looked at the patient records for 5 of these patients and found that for 3 patients there was no clear evidence they had been provided with steroid treatment emergency cards was not evident. The practice advised that they would take immediate action to remedy this and update systems to ensure where appropriate patients received steroid treatment emergency cards. The practice had systems and processes to ensure that staff were up to date with national legislation, evidence-based good practice and required standards. For example, clinical staff we spoke with told us that regular meetings were held among clinicians to discuss cases, new guidelines and share learning. The practice also facilitated a range of staff meetings which included multi-disciplinary clinical meetings and involved clinicians from other health services. Staff also told us that they were able to attend updates and learning events and had access to evidence based guidance, such as those from the National Institute for Health and Care Excellence (NICE). These were used to support audits of clinical care.

Patients we spoke with and feedback we reviewed demonstrated patients were positive about their experiences of being referred to other services.

Staff and leaders were confident in sharing how they worked together and with other services to support patients. They said they had access to the information they needed to appropriately assess, plan and deliver patient’s care, treatment and support.

Feedback from partners was positive in relation to how the practice worked collaboratively to support vulnerable patients, for example those on the safeguarding register and those residing in a local care home.

Evidence demonstrated there were effective systems to share information between teams and services to ensure continuity of care, such as when clinical tasks were delegated or when people were referred between services. Multidisciplinary teams met regularly to discuss and support vulnerable patients. These meetings were documented to ensure actions were completed as required.

We could not collect specific evidence from patient feedback to score this evidence category. Our observations raised no concerns. The evidence we reviewed did not show any concerns about people’s experience regarding the practice supporting people to live healthier lives.

Staff and leaders told us they included and encouraged patients to take an active approach to reviewing their own health and wellbeing. This included identifying risks to patient’s health and wellbeing early on to support them and prevent deterioration. Patients who required social support could be signposted to the social prescriber. At the time of our assessment there was no social prescriber in post however, the practice’s Primary Care Network (PCN) had recruited a replacement who was due to start the week following our assessment.

The practice identified patients who may need extra support and directed them to relevant services, including carers. The practice had embedded recall systems to support patients to manage their health. During our clinical searches we found recall systems in place for long term conditions and medicine reviews and medical records showed us how patients had been supported.

We could not collect specific evidence from patient feedback to score this evidence category. Our observations raised no concerns. The practice shared with us examples of how they routinely monitored people’s care and treatment to continuously improve, including in response to patient’s feedback. The evidence we reviewed did not show any concerns about people’s experience regarding monitoring and improving outcomes.

Staff and leaders demonstrated effective systems and processes to monitor and improve outcomes. Staff told us of incidents and complaints which had led to improvements from shared learning. Documentation was informative and all staff had access to meeting minutes. Clinicians spoke to us about processes in place for auditing, supervision and support of clinical practice and described a culture of learning and improvement.

We found robust processes including those for complaints, incidents reporting and supervision. We found documented evidence of shared learning throughout these systems which improved outcomes for patients. The practice was aware of the high prevalence of diabetes amongst their patient population. They employed a specialist diabetic nurse to support patients particularly at risk. In addition, they were training one of the practice nurses to be able to initiate insulin treatment and support diabetic patients. The practice staff were knowledgeable within their roles and referred to specialist services when appropriate.

The practice maintained a register of patients with a learning disability and these patients were offered an annual health check. There was a dedicated lead and support from the primary care network care co-ordinator team. We found the practice was not meeting national targets for the number of children aged 2 and 5 immunised against various infectious diseases such as Measles, Mumps and Rubella. For example, the percentage of children aged 2 who have received their immunisation for Haemophilus influenza type b (Hib) and Meningitis C (MenC) (i.e. received Hib/MenC booster) was 87% compared to the 90% national minimum. Staff we spoke with advised us that they supported the national vaccination programme and made attempts to follow up on patients who did not attend for vaccines. Childhood immunisations were available at flexible times to suit parents and guardians. Children who were not brought to appointments in secondary care were also followed up. Repeated failed attendances were monitored and safeguarding procedures triggered if needed. The percentage of persons eligible for cervical cancer screening who were screened adequately within 3.5 years for persons aged 25 to 49, and within 5.5 years for persons aged 50 to 64 was 67.6% which was below the expected target of 80%. Staff we spoke with advised of measures in place to support uptake of the cervical screening programme, including flexibility with appointments, opportunistic discussions and follow ups to failed appointments.

Patients we spoke with did not raise any concerns around consent. Our observations raised no concerns. The evidence we reviewed did not show any concerns about people’s experience in relation to consent to care and treatment.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. Clinicians supported patients to make decisions ensuring their views and wishes were taken into account during care planning. Assessments of mental capacity were conducted when needed and were decision specific. Staff told us they were able to adapt information about care and treatment in a way the patient would understand to support them making informed decisions.

We saw that consent was documented and processes were in place for chaperones to be present if requested. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were made in line with relevant legislation and were appropriate.