Alum Rock Medical Centre

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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 carried out an announced assessment of 6 quality statements (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 and Consent to care and treatment) under the effective key question and found:

People’s needs were assessed. Their care, support and treatment reflected these needs. Leaders demonstrated some evidence of monitoring outcomes and making improvements to quality of services however we identified areas that required improvement for example, the provider could not demonstrate that Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were reviewed and the practice did not provide evidence to show they audited whether DNACPR decisions had been recorded correctly.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We had received negative feedback from people using the service about receiving care and treatment from an appropriate clinician and not receiving a home visit or telephone appointment when one was indicated.

Data from the 2024 National GP patient survey showed that 64% of people completing the survey felt the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last GP appointment. This was lower than local (69%) and national averages (73%).

The practice had received 18 reviews on the Healthwatch website between October 2023 and September 2024. We found that feedback was mixed about the service with some patients reporting they had received good care and others commenting they didn’t feel listened to or supported in the way they needed to be.

Staff were aware of the needs of the local community. Staff used digital flags within the care records system to highlight any specific individual needs and where reasonable adjustments were needed, such as the requirement for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews.

Staff described the processes they used to invite patients in for their reviews and action they took if patients did not attend.

The practice had identified 155 patients as carers. This was 3% of their practice list.

The social prescriber supported the practice in contacting carers to offer relevant advice and support.

Clinical staff used templates when conducting care reviews to support the assessment of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions.

Our record reviews indicated that patients presenting with symptoms which could indicate serious illness were followed up in a timely and appropriate way.

Care reviews were thorough including those carried out by the healthcare assistant (HCA) and physician associate (PA) and processes allowed HCAs, PAs and non-medical prescribers to identify if concerns needed to be escalated to a GP. Our review of records indicated that records were not always coded correctly and the processes to audit records to assess quality of record keeping needed to improve. For example, some patient records had been coded to indicate a medicine review had been completed when it had not and other records had not been coded to indicate that a medicine review had been carried out. Patients newly diagnosed with diabetes had received the correct treatment, however their records were not always coded to reflect the new diagnosis. Of the 5 records we viewed, in 2 records it was not documented that a discussion had taken place with the patient to inform them of their diagnosis. The provider took immediate action to code these identified records and update their processes.

Patients were told when they needed to seek further help and what to do if their condition deteriorated.

The practice had a palliative care lead and kept a register of patients who were palliative. Patients on the register had all been assessed and assigned a priority score. Patients were discussed in practice meetings and/or reviewed according to need.

The practice had a register of patients with a learning disability. The register was reviewed monthly to ensure that patients were being invited and attending for their reviews.

Data from the 2024 National GP patient survey showed that of those people that responded to the survey, 87% felt their needs were met during their last general practice appointment. This was similar to local and national averages.

Staff told us they had access to up-to-date guidelines. The practice was a training practice for trainee GPs; this helped to ensure that practice staff’s knowledge was up to date.

Staff told us because of the higher than average prevalence of diabetes in their patient population staff had been upskilled to improve the quality of services being delivered to this patient population.

To support more complex patients staff worked with external organisations such as a consultant specialist in Diabetes and mental health practitioners.

The practice had systems in place to share new guidelines and updates in clinical care.

Physician associates and non-medical prescribers received clinical supervision. This allowed staff the opportunity to raise questions and for the supervisor to ensure that care and treatment was being delivered in line with guidelines.

There was evidence of audit and quality improvement processes to ensure that care was being delivered in line with best practice.

Our record reviews showed that care and treatment was mostly being delivered in line with guidelines. Where we found processes required strengthening we shared this with management. They provided assurances at the time that reduced the level of risk and told us they would be reviewing their processes further.

For example, we found that patients diagnosed with asthma who had required 2 or more courses of rescue steroids (these are medicines to treat an exacerbation of asthma) in the last 12 months, did not always receive a review within 1 week of having the rescue steroid in line with guidelines. All 5 patients records that we viewed showed that these patients had received an annual review and we found no concerns with their overall care and treatment.

We found overall, patients with Diabetes, Chronic Kidney Disease (CKD) and hypothyroidism (an underactive thyroid gland) were monitored in-line with current guidance.

Data from the 2024 National GP patient survey showed that 96% of people completing the survey felt the healthcare professional they saw had all the information they needed about them during their last GP appointment.

However, patient feedback we received indicated that patients did not always have care and support that was co-ordinated.

Staff told us that all staff within the different teams at the practice worked well together.

Advice and support was available to staff when it was needed.

Through the use of the same locum GP staff, the practice tried to ensure continuity in care for patients where possible.

Staff told us the midwife held clinics at the practice every Friday and the mental health practitioner every Wednesday.

Non clinical staff monitored that referrals into other services were made and accepted.

Staff referred patients to the social prescriber, when additional support with social issues were needed.

We did not receive any feedback from partners.

There were processes in place for managing information flowing from and to the practice from external organisations.

There were systems in place to support the effective assessment and treatment of patients with more complex needs.

However, we found evidence that records were not always coded correctly, either with safeguarding information, or information relating to medicine reviews. This meant that when people moved in between services, their records were not correct or complete.

Staff told us that the practice held regular Gold Standard meetings to discuss palliative care patients. however from evidence we viewed we saw the most recent meeting was held in June 2024 and before that the last meeting was in 2022.

The practice could not evidence regular safeguarding meetings. We were told they were every 6 months, however, the last meeting had been held in February 2024.

Patients did not always feel supported to manage their health and wellbeing. Patient feedback we viewed was mixed about advice and guidance provided by clinical staff.

People did not always have care and support that was co-ordinated or from the most appropriate clinician.

Data from the 2024 National GP patient survey showed that only 57% of people completing the survey felt they received enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was lower than local (61%) and national averages (68%). Sixty-four percent said the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment,

The practice had carried out their own in-house patient survey in August 2024. All those who responded to the survey felt the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment. 24 out of 29 patients felt they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses.

Patients were signposted to additional external services as needed.

Staff told us about projects they were involved in to improve uptake with cancer screening and children’s immunisations.

The practice website was being updated at the time of the assessment. The current website did not contain up to date information to support healthier living or that would inform people about support groups.

The practice had appropriate processes in place to invite patients in for their immunisations/cancer screening and health screening. Staff monitored if patients had attended and took action when patients did not attend.

Staff referred patients to the social prescriber. We saw that audits had been carried out in previous years to monitor the impact of social prescribing as part a patient’s care and treatment plans. However, no further audits since 2022 had been carried out to monitor the impact of social prescribing .

We found there was lots of health promotion information displayed within the practice, however mostly it was in English. Staff also told us that many patients required an interpreter and we observed that many patients spoke languages other than English.

Uptake of breast and bowel cancer screening was low when compared with national averages and the uptake of cervical cancer screening was also below targets. Staff told us of the actions that were planned to improve and of audits to monitor if uptake had improved. However, they could not demonstrate these actions had improved uptake at the time of the assessment.

We viewed patient feedback from a range of sources and saw that it was mixed.

Data from the 2024 National GP patient survey showed that 87% of people completing the survey felt their needs were met during their last GP appointment. This was similar to local and national averages.

We had received 11 complaints indicating that people’s expectations had not been met.

Feedback on Healthwatch was mixed with both positive and negative comments about the care and treatment received.

Feedback through the practice’s in-house patient survey in August 2024 showed that 39 out of 40 (98%) people who completed the survey felt their needs had been met at their last appointment.

Staff discussed performance, patient experience and outcomes during practice meetings. This included palliative care patients, to see if they had met patients’ wishes.

Findings from audits were shared with staff to help identify further areas for improvement.

Leaders told us they had carried out an audit in 2023 of patients with diabetes. The audit showed that diabetes management had improved following intervention from practice staff.

There were approaches to monitor people’s care and treatment in relation to long-term conditions and patients on high-risk medicines.

There was some evidence of quality improvement audits that allowed the practice to assess quality of care and ensure that improvements were made to people’s care and treatment.

The practice did not monitor the impact and outcomes of referrals to the social prescriber.

Processes to monitor quality of record keeping were not effective. The provider had not identified that records were not always coded correctly and the impact this would have on people’s experience and outcomes.

The leadership team had discussed the results of the 2024 National GP patient survey, however, they had not formed an action plan to improve patient satisfaction. They had not analysed the results of the in-house survey at the time of the assessment.

Our review of clinical records indicated that patients with long term conditions, a mental health diagnosis, learning disability or those with dementia received thorough reviews in line with guidelines.

However, we found processes to monitor patients and review outcomes where safeguarding concerns had been identified were not effective.

We identified a concern with the quality of care for one patient who had complex needs. This patient was no longer registered with this practice and staff agreed to contact the GP practice that the patient was now registered with.

We did not collect evidence from patients to score this evidence category. Our findings did raise concerns with consent, we raised these concerns with the provider.

Staff helped patients to understand the care and treatment being offered or recommended and to make an informed decision.

Staff gave patients information about care and treatment in a way they could understand and offered appropriate support and time to make decisions.

All staff we spoke to reported having completed appropriate training. However, not all staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent and recording it before they delivered care or treatment.

Information we viewed during the assessment showed that completion of consent training was not monitored for all staff.

We reviewed a random sample of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. Our review of these records showed that where a DNACPR decision had been recorded, where possible the patient’s views had been sought and respected. However, we found that these decisions had not been reviewed by the GP after the patient had moved care setting.

The practice did not provide evidence to show they audited whether DNACPR decisions had been recorded correctly.

The practice had a policy for consent. However, the policy did not say how the provider would monitor that consent was being sought appropriately.