Eltham Palace Surgery

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

We found the service was not providing effective care. This was because patients with long term conditions were not always monitored and reviewed in line with national guidance. Uptake rates of cervical cancer screening and MMR immunisations were below national targets. At our previous inspection in May 2023 we found there was no evidence of quality assurance work. However, at this assessment in April 2024 we saw evidence of an improved clinical audit schedule.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We carried out clinical searches on the practice’s clinical system and found that patients did not always receive sufficient monitoring or review of their long term conditions.

Our clinical searches identified 18 patients as having a potential missed diagnosis of Chronic Kidney Disease (CKD) stage 3, 4 or 5. We reviewed 5 of these patients and found 1 patient did not have CKD, 1 patient needed a repeat blood test, and 3 patients had a missed diagnosis of CKD. We shared our findings with the provider. Following our assessment the provider sent us evidence to show all 18 patients identified through the clinical searches had been reviewed. The provider told us they had an action plan to review patients every 6 months. We found 4 patients with hypothyroidism were overdue monitoring tests. At our previous inspection in May 2023, we found 5 patients had not had sufficient monitoring or review to ensure safe treatment. The provider told us they would consider reducing the number of items prescribed at one time to patients who were not attending for monitoring tests, in an attempt to encourage engagement.

At our previous inspection in May 2023, we found patients requiring high dose steroid treatment for severe asthma episodes were not always followed up in line with national guidance to ensure they received appropriate care. At this inspection in April 2024, we found these issues remained. We reviewed 5 patients with asthma who had been prescribed a course of rescue steroids and found these patients had not received a follow up appointment within 1 week of being prescribed steroids in line with national guidance.

Feedback from patients raised no concerns about delivering evidence based care and treatment.

The practice completed annual reviews for patients with disabilities. Staff at the practice met with the palliative care team when required to discuss patients receiving end-of-life care. Patients received safety netting advice in case their condition deteriorated.

There were processes to ensure clinical documents were handled in a timely manner and assigned to the most appropriate person for review.

Some patient feedback referred to difficulty obtaining test results and consequently referrals to other services.

It was unclear whether staff carrying out medicine reviews had received appropriate training and supervision. Leaders at the practice told us all staff carrying out medicine reviews were competent to do so. During this assessment, we did not see evidence of supervision to oversee the competence and quality of the medicine reviews completed by non-clinical staff. However, leaders also reported that some staff carrying out reviews had fed back they had been asked to work outside of their capacity, but that this was problematic to monitor as the non-clinical staff member conducting medicine reviews often worked from home. It was reported by one of the GP partners that administrative staff booked in medicine reviews and that only non-complex reviews should have been assigned to non-clinical staff, and that complex medicine reviews should be completed by a GP (for example if medicine alterations were potentially required).

At our previous inspection in May 2023, we found there had been a breakdown in the partnership between the two GP partners which had impacted staff and patients, particularly demonstrated through recruitment issues at the practice. At this assessment in April 2024, we found that attempts had been made to improve the relationship and subsequently the working environment. We heard from external partner agencies working with the practice that although initial attempts had been made to find ways to work together, the two GP partners had not continued to engage with mediation opportunities.

There were processes to ensure information was shared with other agencies. Patients received consistent service when moving between services. Care was delivered and reviewed in a coordinated way when different teams, services or organisations were involved.

Patients told us they received healthy living advice, were invited for regular screening tests and had access to health assessments.

Patients with a learning disability were invited to attend for annual health assessments. This was a face to face appointment; patients could be accompanied by a carer or family member if they wished.

There were leaflets in the reception area with information on smoking cessation, dressing clinics and local organisations who could offer healthy living advice.

Patients told us they were invited for screening tests by the practice. Uptake rates for cervical cancer screening and childhood immunisations were below national targets. The number of new cancer cases treated was in line with national averages.

Staff told us they found some parents and carers did not wish their children to have immunisations, in particular the vaccination for measles, mumps and rubella (MMR). Staff told us they encouraged patients to speak with clinical staff to raise their concerns. Clinical staff could then offer education on immunisations.

There were processes to monitor and contact patients requiring immunisations or screening tests. For example, there was a dedicated member of staff who reviewed the patients due for cervical cancer screening in the next 3 months. If patients do not attend or miss appointments, the provider would follow up by sending a text message, a telephone call or a letter. The practice's procedures were such that each person would be contacted 3 times using at least 2 different methods. Parents who did not wish their children to have the MMR vaccine were invited to speak with a practice nurse. This allowed the opportunity to ask questions and nurses could provide information on immunisations. At our previous inspection in May 2023 we found no evidence of robust clinical audits. At this assessment in April 2024 we saw evidence of clinical which had been monitored for outcomes. For example, the provider had completed a two-cycle audit on patients prescribed antibiotics for urinary tract infections.

Published results showed the uptake rates for cervical cancer screening was below the 80% target for the national screening programme. Data from June 2023 showed uptake at 64.8%. Although performance had decreased overall since 2020, data showed a steady increase in uptake between September 2022 and June 2023. The number of new cancer cases treated was in line with national averages. Uptake rates of the MMR vaccine amongst children was lower than the 95% target set by the World Health Organisation (WHO). Data from April 2022 to March 2023 shows uptake rates of 78%. Performance for this indicator had decreased since 2020 (although performance increased from the previous year in 2022).

Patients told us they were asked for their consent for procedures and had information shared provided to them in ways they could understand.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making.

Clinicians supported patients to make decisions. Our review of clinical records showed that where appropriate, clinicians assessed and recorded a patient's mental capacity to make a decision.