Beacon Primary Care

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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

Our rating for this key question remains good. We found 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 was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs.

Staff told us they received training on care navigation and the triage process. Additionally, they informed us that they had been provided with guidance, tools and flow charts to help them understand internal processes and how to prioritise people who reported symptoms which could be classed as a clinical emergency. They highlighted that clinical staff were responsible for triage.

The provider had developed policies, procedures and flowcharts to help ensure people’s immediate and ongoing needs were assessed and routinely reviewed. For example, in relation to triage, accessible information and the identification of carers. We saw evidence that the practice updated their guidance and processes on an ongoing basis in response to feedback, ongoing learning and a commitment to continuous improvement. For example, in relation to their triage process. Registers of vulnerable people and those with long term conditions were also maintained to help the practice prioritise, support and monitor the needs of their most vulnerable patients. People’s immediate and ongoing needs were assessed and routinely reviewed. This included their clinical needs and mental and physical wellbeing. Staff could add digital flags with care records to highlight any specific individual needs such as the requirement for longer appointments, communication needs or for a translator. Staff worked with other healthcare professionals to assess people’s needs and deliver coordinated packages of care. There were systems in place to ensure health reviews were undertaken for people living with long term conditions including those with a learning disability.

People had no specific feedback on this area.

Staff informed us that they were supported with their continuous professional development and that systems were in place to monitor and support clinical decision making and prescribing.

Systems were in place to ensure staff were kept up to date with national clinical guidance and evidence-based guidance. Staff attended routine meetings, training, educational sessions, supervision and appraisals. People had access to 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 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.

People had no specific feedback on this area.

Staff informed us that they had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. They informed us that they were supported by leaders and managers who were visible and approachable and that a positive culture existed within the service.

Partners had no specific feedback on this area.

The provider had established systems and processes to ensure the service worked effectively across teams and services to support people. Information about patient’s needs was shared effectively when they were referred to different services to ensure continuity of care. 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. Internally, the provider had recently established micro team meetings so that staff from a range of backgrounds could share and receive information relevant to their roles and responsibilities. Clinical meetings, study days and training sessions were also utilised to ensure staff understood how to undertake their roles and work effectively as a team. Referrals to other services were made promptly and people were also referred or signposted to local support services as appropriate to their need.

People had no specific feedback on this area.

Feedback from staff confirmed they had a good understanding of referral pathways and services that they could refer their patients to. They informed us that they maintained networks with other teams and services and directed patients who needed extra care or support to relevant services, subject to their individual need.

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. Systems had been developed to ensure patients understood how to seek further help and support and what to do if their condition deteriorated. The practice website contained a range of information for people to view covering topics such as health, living well, medicines guides and organisations that could provide help and support to patients. Practice staff were able to refer patients to social prescribing services offered locally. Examples included: debt and housing advice, volunteering, eco-therapy, arts activities, cooking and healthy eating advice.

People had no specific feedback on this area.

Leaders and staff demonstrated a commitment to monitoring and improving outcomes for people who used the service. Practice leaders reported that they recognised that monitoring performance across a larger practice was a role in itself and therefore a decision had been made to employ an Access and Quality Manager to complete the core requirements of this work. They also informed us that evaluation of performance, service safety and effectiveness of patient care was discussed in regular team meetings, to ensure information was shared and disseminated.

Systems had been established for quality audit and improvement to enable the practice to monitor the safety and effectiveness of the care and treatment provided. The provider had also produced a dynamic business recovery plan to prioritise, improve outcomes for people and drive continuous improvement in key areas of the service. The provider undertook a range of clinical and non-clinical audits on an ongoing basis as a means to improve outcomes for patients. For example, we were provided with a two-cycle clinical audit that focused on FIT (Faecal Immunochemical Test) outcomes. This a test that looks for blood in a sample of a person’s stool. We also received a single cycle audit that had been completed to help identify any patients with a missed diagnosis of Type 2 Diabetes. The results from both audits identified areas for improvement which had been acted upon by the provider to improve performance/ outcomes for patients. Training sessions had also been delivered to share learning across the team. In addition to the above, the practice undertook a range of clinical audits on a monthly basis to monitor performance in key areas.

The provider had systems in place to routinely monitor people’s care and treatment and to improve it. Insight data available to CQC at the time of our assessment highlighted that cervical cancer screening uptake was 74.9% (slightly below the target of 80%). The provider informed us that a nurse had left employment which had contributed to lower performance. Another nurse was due to be signed off as competent to undertake cervical cancer sample taking moving forward. In relation to childhood immunisation targets, the practice had met the 95% World Health Organisation (WHO) target for 3 out of 5 indicators. Of the 2 indicators that had not met the WHO targets, 1 indicator was 94% and the other 90% (both indicators achieved the minimum 90% target).

People had no specific feedback on this area.

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

The provider had developed policies and procedures on consent, the Mental Capacity Act and 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) to provide guidance for staff. Staff were supported to complete 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 under 16 is able to consent to their own medical treatment). The provider had undertaken an audit of DNACPR decisions and records to monitor performance and ensure best practice. We looked at a sample of (DNACPR) decisions in patient records as part of our assessment. No concerns about people’s experience regarding consent to care and treatment were identified. Treatment options were discussed with people so they could make an informed decision about what was best for them, and independent advocacy support was available for patients subject to their individual needs.