Friarsgate 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 and inspected against two quality statements, assessing needs and Delivering evidence-based care and treatment. During our assessment of this key question, we found concerns around the lack of healthcare follow-up and monitoring of some patients with long-term health conditions. We found evidence that the practice worked cohesively with stakeholders and other local organisations. Patients felt involved in the assessment of their needs, and support was provided where needed to maximise their involvement including support for carers and families.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A review of the information we hold found that 95% of respondents to the GP patient survey stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment. The 3 'feedback of care' reports we received told us that people felt involved in their care and treatment and were supported by the practice.

Leaders told us that, as part of the primary care network (PCN) cancer local improvement scheme the PCN cancer care co-coordinator was now completing the work to help with patient support and improve outcomes for patients awaiting urgent 2 week wait referrals. This involved audit of the practice systems, follow up with patients and acting as the liaison between primary and secondary services. Staff told us that they had systems in place to support children and young families. Part of this was the successful immunisation programme for children. The practice worked with families to ensure good uptake of these services. Leaders told us that an annual audit on in-house minor surgery identified risk with results not always being available from secondary care. As a result of audit, a nominated administrator checked regularly for histology reports of the patients who have had surgery and manually downloads these if the report was not available. A repeat audit showed 10% of the histology results (6 specimen samples) did not come down via automated secondary care link but due to the safety net in placed, these outstanding histology results were identified and actioned promptly. We spoke with staff who were able to describe the process for coding of correspondence and care and treatment records for people. However, staff were not aware of any completed and regular auditing of clinical coding to ensure records reflected accurate care and treatment received by people. Following our remote searches and feedback to the practice we were provided with an update to demonstrate the practice took action to review patients and respond to these concerns.

The practice did not meet the minimum 80% target of eligible patient uptake of cervical screening. The provider combined health appointments with other acute or routine patient needs where possible. At the time of assessment, cervical cancer screening appointments were available to book in advance. The provider took action by inviting eligible patients when reporting had shown patients had not booked an appointment following 2 invitations by the National Cervical Screening Scheme. We noted an audit carried out in November 2023 and the practice data showed screening in the 25-49 years age group was at 78.58% and the 50-64 years age group- 85.6%. The provider worked closely with other stakeholders to achieve locally agreed aims, specifically in terms of increasing uptake of cancer screening. This included a cancer care co-ordinator and offering appointments within extended access to help with access outside core hours. The provider acknowledge that 80% is a target threshold and continued to strive towards this. The practice had a system for vaccinating people with an underlying medical condition according to the recommended schedule. The practice met childhood immunisation uptake targets in line with local and national averages. The results we saw supported this. For example, the practice had met the WHO (World Health Organisation) immunisation target for children aged 1 who have completed a primary course of immunisation. All other indicators had reached over 90% (93 – 94%).

We noted that 87% of respondents to the GP patient survey responded positively to the overall experience of their GP practice. Patients told us that they felt involved in their care and treatment. 95% of respondents to the GP patient survey stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to. Patients told us that they felt involved in their care and treatments.

Leaders were not aware that shortfalls existed within the clinical records and that patients had not received appropriate healthcare checks. Staff told us that there were processes in place to recall and review people with long-term conditions according to monitoring requirements. However, our review of clinical records found that monitoring was not always within appropriate timeframes. Staff told us that regular clinical training sessions were held which included external consultants to provide learning opportunities from various clinical specialities, in order to keep staff up to date with best practice guidance.

The remote searches undertaken of the practice’s clinical patient records system showed that there was a lack of oversight of some long-term condition management to ensure safe care and treatment was given to patients. The monitoring of patients with some long-term conditions were not always followed in line with National Institute for Health and Care Excellence (NICE) recommendations. We found that medicine reviews were overdue for patients diagnosed with Hypothyroidism (a condition resulting from decreased production of thyroid hormones). The records we reviewed showed 3 patients were coded as having had a review with no information recorded in their notes. One patient had not had a review since 2015. We noted incidents of issuing prescriptions of 2-3 months of a medicine for the treatment of this disorder with overdue medicines reviews. From the records we looked at we found patients with asthma did not always have the appropriate monitoring. For example, we looked at a sample of 5 patient records and found 4 patients were overdue an asthma review; 1 patient was last reviewed in December 2021, another November 2019, and 2 in February 2022. Two patients had an incorrect dose of a steroid prescribed (too low) on at least 1 occasion, sometimes 2 occasions. Therefore, we found that there was a potential risk of not effectively treating asthma exacerbation. We noted that 2 patients were not followed up after prescribing of steroids following exacerbation. We looked at 5 patient records identified as having diabetes and found concerns with the monitoring intervals, the level of monitoring and coding of patients. Patients with raised HbA1c levels were not always being followed up. We looked at 5 records of patients with a potential diagnosis of chronic kidney disease (CKD) and found overdue monitoring in 4 of the 5 patients. A patient with very low eGFR (measure of kidney function) had no record of action taken to recheck or refer to renal care placing them at risk.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.