Billinge 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

We assessed all the quality statements from this key question. Our rating for this key question has improved from requires improvement to good. At this inspection we found improved systems to share information and to manage test results. There was clear evidence that staff were supported in their work with relevant training, appraisal and supervision. Feedback from people who used the service indicated that they felt they felt listened to, treated with care and concern and had confidence and trust in the clinical team. Staff worked together and collaboratively with other services to support peoples care and treatment. Multi-disciplinary meetings were held where the needs of patients with complex needs or those approaching the end of life could be discussed, reviewed and planned for. Our review of the clinical patient record system showed that there were clear systems in place to review patients with long term health conditions to ensure they were receiving appropriate care and treatment. The provider had systems and processes to keep clinicians up to date with current evidence-based practice. Staff were aware of the requirements for patient consent to care and treatment. Audits were carried out to identify what was working well and where improvements were needed. Audits for the last 12 months had focused on medication management, and we noted that a broader range of audits could be introduced to further support effective care and treatment. People were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. The most up to date published data for childhood immunisations and cancer screening was prior to the current provider operating the medical practice and was below the recommended targets in some areas. The provider told us of the steps they had taken to increase and monitor this take -up. It was evident from discussions with the staff that they understood the requirements of their patient population.

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 patient surveys undertaken by the Patient Participation Group (PPG) and the National GP Patient Survey were positive. The National GP Survey indicated 83% of people said they had confidence and trust in the clinician they saw or spoke to. The PPG survey found 96% of people responded positively to this question. The National GP Survey indicated 82% of people were involved as much as they wanted to be in decisions about their care and treatment. The PPG survey indicated 93% of patients gave positive responses to this question.

Staff and leaders were aware of the needs of the local community. Staff told us how they checked people’s health, care, and wellbeing needs during health reviews. We discussed the way in which patients’ needs were assessed and the provider was able to demonstrate that the practice staff shared clear and accurate information with relevant professionals when deciding care delivery for patients. The provider demonstrated that they used registers to identify people with specific needs, for example, people with learning disabilities, mental health conditions, long term conditions, palliative care and carers to ensure that needs were assessed and managed appropriately. Digital flags were used within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

The practice had systems and processes to keep clinicians up to date with current evidence-based guidelines and clinical tools. There were systems in place to ensure people’s immediate and ongoing needs were assessed. Staff worked with other healthcare professionals to assess people’s needs and deliver coordinated packages of care. There was a system to offer structured annual medicines reviews for patients with long-term health conditions. The provider had effective systems to identify people with previously undiagnosed conditions. The provider had worked with specialist services to review patients with diabetes, chronic obstructive pulmonary disease (COPD) asthma and atrial fibrillation with a view to improving peoples care and treatment and increase learning amongst the clinical team.

Feedback gathered by the provider through the Patient Participation Group (PPG) survey indicated that people had confidence in the healthcare professionals treating them. People told us that the healthcare professional had all the information they needed about the patient at their most recent appointment and that they considered their healthcare needs to have been met.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence shows can improve the way their service delivers care. Staff told us how clinical meetings were used to ensure evidence-based care was followed. There were also informal weekly clinical meetings where patients were discussed with peers to ensure best practice was being followed.

Our review of the clinical record system indicated that best practice was being followed when reviewing the management of patients with long term conditions. We found that where patients were overdue a review the provider was aware of this and had taken steps to address this. Systems were in place to ensure staff were up to date with national guidance and evidence-based practice. Staff attended regular meetings, training, educational sessions and underwent regular appraisal. People had access to appropriate health checks and assessments, and they were directed to relevant services when they needed extra support. People were being referred to other services in line with their needs. A system was in place to review consultation records for people who used the service to ensure that they contained the required information and were appropriately detailed. We looked at the workflow for managing clinical correspondence and tasks and found these were up to date. There was a back-log of historical patient record summarising. The provider had a plan in place to address this.

There was no specific feedback from people who used the service about how staff, teams and services work together.

Staff told us that they had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Referrals to other services were made promptly and people were also referred or signposted to local support services as appropriate to their need. Staff told us they were well supported in their role by having the training they required and access to clear procedures. Staff felt their ideas about how to improve the service were listened to. Staff told us they were good arrangements to keep them up to date such as through practice meetings and emails.

Leaders and staff told us they worked closely with colleagues in the local Primary Care Network (PCN) to meet the needs of the patient population. The Integrated Care Board (ICB) Cheshire and Merseyside told us how the provider worked well with them to keep them informed about the changes made to improve the service and seek support when needed.

Systems were in place to ensure the provider worked effectively across teams and services to support people. There were systems to effectively share information about patients’ needs when they were referred to different services. 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 coordinated effectively. The provider had regular in-house meetings to ensure all staff worked well together, this included partnership, practice and clinical meetings. The meetings had standardised agendas which included learning from complaints and incidents, medication management, the appointment system and practice news and updates.

There was no specific feedback from people who used the service about supporting people to live healthier lives.

Staff and leaders told us how they discussed changes to care or treatment with patients and their carers as necessary. They identified patients who may need extra support and directed them to relevant services. This included patients in the last 12 months of their lives, patients at risk of developing a long-term condition and carers. Staff referred patients to social prescribing services in order to improve their health and wellbeing. This service helped patients to access a range of support including counselling, support with isolation and financial issues. Patients had access to appropriate health assessments and checks. Staff were trained to provide lifestyle advice and support and refer people into public health commissioned services.

Patients were supported to manage their health and wellbeing and where possible reduce their need for future care and treatment. They were advised when they needed to seek further help and what to do if their condition deteriorated. People were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. The most up to date published data for childhood immunisations and cancer screening was prior to the current provider operating the medical practice. This data showed that cytology screening had not met the national target of 80%. Staff showed us more recent unverified data which showed that this target had been achieved. Immunisations for children under one were below the 90% target. The provider told us how this was being monitored and people being encouraged to take up this vaccine. It was evident from discussions with the staff that they understood the requirements of their patient population.

Feedback from people who used the service indicated that there had been a significant improvement in accessing appointments. This allowed people to access the care and treatment they required in a timely way. Feedback from patients indicated that healthcare professionals had all the information they needed about them during their last general practice appointment and that their needs were met.

Leaders and staff told us about the systems and processes that were in place to monitor and improve outcomes for people who used the service.

There were systems in place for quality improvement. The provider used benchmarking from local and national sources to monitor performance and make improvements. When incidents happened within the service, the provider took steps to rectify these efficiently and to ensure people were satisfied with the outcome.

We saw that people were able to get test results and were referred to other services without delay. There was a system to ensure people who required monitoring were recalled for checks on their health. Overall, the results of the clinical searches we carried out were good. Where we found delays to health reviews the provider had already identified these and were taking action to address them. Clinical and non-clinical audits were carried out as a means to improve outcomes for patients. Audits for the last 12 months had focused on medication management, and we noted that a broader range of audits could be introduced to further support effective care and treatment.

Feedback from people who used the service through the National GP Patient Survey and the Patient Participation Group (PPG) survey indicated that they were involved in decisions about their care and treatment.

Staff understood the importance of ensuring that people fully understand what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

Staff had undertaken 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. We looked at a sample of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in patient records. These met best practice requirements and raised no concerns about people’s experience regarding consent to care and treatment.