The Andover Health Centre 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 and inspected against three quality statements, Assessing needs; Delivering evidence-based care and treatment; How staff, teams and services work together. During our assessment of this key question, we found concerns around the management of unactioned workflow, lack of treatment follow-up and monitoring of patients with long-term health conditions. This resulted in a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. The practice did not always meet the requirements of the Mental Capacity Act 2005 in relation to the completion of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT). We found evidence that the practice worked cohesively with stakeholders and other local organisations, including developing a new protocol for working with attached care homes.

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.

We reviewed the practice’s results in the 2023 national GP patient survey taken from 1 January to 3 April 2023. This demonstrated that 93% of people who used the service felt they received person-centred care, in line with local and national averages. This included clinicians involving people in treatment decisions, listening to the needs of people and the confidence and trust in healthcare professionals at the practice.

Following our review of clinical searches, the registered manager told us they would take immediate action in relation to outstanding workflow, which included blood monitoring and invites for medicines reviews. Staff we spoke to were unaware of the unactioned workflow we identified during our clinical searches and therefore people’s care was not always assessed effectively and communicated to them to inform treatment planning. The registered manager identified that clinical leaders did not have the appropriate oversight to identify the outstanding laboratory results in the first instance. The registered manager told us they would take immediate action to review the outstanding laboratory results. Clinical staff we spoke to were able to demonstrate how the practice provided further education to assist young families in the importance of immunisations. Staff had the appropriate skills and training to carry out reviews for this population group. Staff we spoke to were not aware of any further plans to improve patient engagement and education for cervical cancer screening. After the assessment, leaders told us that that information was available for people in relation to cervical screening within the practice waiting area on television software; practice website and easy read SMS text advice for those with learning disabilities. 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.

We reviewed 4 people with a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) record to consider whether they had been prepared and agreed appropriately. The Recommended Summary Plan for Emergency Care and Treatment (RESPECT) forms did not have mental capacity information completed or recorded within people’s records in line with national guidance. This meant people were at risk of not receiving care at the end of their life in line with their wishes if they lacked mental capacity to make these decisions independently. There were a lack of effective systems in place to ensure that staff had the sufficient information to inform treatment decisions. We identified incoming pathology, cytology and other results via workflow had not always been stored correctly for clinicians to review in a timely manner. We found 197 outstanding laboratory results of which 87 results were abnormal, with the oldest dated from November 2021, some of which were stored in an unactioned administrative mailbox. Upon review, leaders told us that 145 results had been received on the day of inspection and were awaiting viewing and filing by GPs. 8 had been incorrectly placed in a non-GP inbox, 2 results were not picked up until 3 months after the results had been received and 2 results were normal but had not been reviewed at all. However, we were unable to verify this as we no longer had access to the clinical system after the inspection. Although leaders had informed us that no harm had been identified to people, they had not been aware of all of the lab reports which had not been correctly processed. There was a risk that abnormal results could be missed as there was no system in place to check global workflow views. The practice did not meet the minimum 80% target of eligible patient uptake of cervical screening. However, the provider combined health appointments with other routine patient needs where possible. Cervical cancer screening appointments were available to book in advance.

Although the GP patient survey demonstrated that 93% of people were satisfied they received person-centred care in line with local and national averages. The information we gathered about people’s feedback about the service was not sufficient to score people's experience of receiving evidence-based care and treatment.

Staff told us that the practice could be doing more clinical audits to compliment quality improvement, assessing people’s needs and checking care is consistently provided in line with guidance. Leaders told us that a two-cycle medicine audit had been completed within the last 12 months in relation to haematuria (blood in urine), to improve the urology referral uptake for people aged 60 and over. The practice was working with secondary care services to improve the local urology care pathway to ensure people were appropriately referred in line with national guidelines. 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. Staff told us that there were processes in place to recall and review people with long-term conditions according to monitoring requirements and national guidelines. However, during our remote clinical searches we identified issues in relation to overdue asthma reviews, people presenting with exacerbations of asthma, diabetes reviews and medication reviews. Staff told us they received appropriate training and guidance in relation to medicines administered through Patient Group Directions or Patient Specific Directions.

We found people with long-term conditions were not always offered a structured annual review to check their health and medicines needs were being met. We identified issues with patient medicine reviews and the process for outstanding monitoring of long-term conditions. The remote clinical searches that we undertook of the practice’s clinical records system showed that there was a lack of oversight of some long-term condition management to ensure safe care and treatment for people. The monitoring of people with some long-term conditions were not always followed in line with National Institute for Health and Care Excellence (NICE) recommendations. For example, we identified 491 people with hypothyroidism, a condition which results in low activity of the thyroid gland. Of those, 11 people had not received the appropriate blood monitoring and some patients still being prescribed medicine without the appropriate monitoring in place. This meant that people were not always receiving safe and effective treatment in line with national guidance in relation to hypothyroidism. During our clinical records review, we identified 782 people with diabetes, some of these people were at high-risk and were not being reviewed and monitored appropriately. There was a risk that these people did not receive safe and effective care and treatment in relation to the management of diabetes. We found people with acute exacerbations of asthma were not always followed-up in line with national guidelines to provide safe and effective care and treatment. Staff had the appropriate authorisations to administer medicines through Patient Group Directions or Patient Specific Directions. 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 practice worked with the Patient Participation Group (PPG), who gathered feedback from people using the service. They shared that people experienced good continuity of care and joined up treatment when they moved between services. PPG fed back that staff worked as a friendly and happy team.

Staff told us that they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support. In particular, people transitioning between services. Staff told us they had enough information to plan and refer people and receive subsequent results and information people following referral. Leaders told us that practice communication such as service updates and pathways with local care providers were sent to staff via email. The practice had demonstrated that views from staff and people were listened to and acted upon, such as actions taken in response to feedback from people. For example, feedback from people who used the service stated that relevant staff and teams were involved in planning and delivering people's care and treatment. Staff told us they worked collaboratively to understand and meet people's needs. We saw evidence of this through the review of surveys about preferences of accessing care and how continuity was managed between staff.

Feedback from a local care home highlighted clinicians at the practice carried out a regular ward round and overall staff and people received a good level of service from the practice. The practice worked closely with the Integrated Care Board (ICB) in order to facilitate quality improvement activity.

The practice had 12 GPs who provided care and treatment at the practice. The provider had further clinical support from 2 GP registrars and 3 practice nurses. The primary care network (PCN) helped to support the practice by providing links to pharmacists, dieticians, mental health practitioners and social prescribers. People were able to receive co-ordinated care between the practice and the PCN. Information was shared between teams and services to ensure continuity of care, for example when people were referred between services or required follow-up care. The practice developed a protocol shared with the 2 local care homes attached to the practice in response to a significant incident, in order to provide clear escalation procedures for when people became unwell.

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.