Wonersh Surgery

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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 reviewed 3 quality statement in the Effective key question – Assessing needs, Delivering evidence based care and treatment and Monitoring and improving outcomes. The scores for the other quality statements are based on the previous rating for this key question. Patients were assessed using a range of assessment tools. We saw evidence of audits carried out to ensure patients care was appropriate. Communication needs of patients were considered, and we saw that the provider could support patients with translation requirements, or hearing or visual disabilities. The needs of carers of patients were also considered. Staff were able to use social prescribing and could sign post patients and their carers to additional support. Our review of the remote searches of patient records showed that care and treatment was evidence-based and in line with good practice standards. Staff were up to date with national legislation, evidence-based good practice and required standards. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals. Our review of the remote searches of patient records showed that patients with long terms conditions were being routinely monitored and re-called when required. The provider shared clear and accurate information with relevant professionals when deciding care delivery for patients with long-term conditions. Medicine alerts were discussed at meetings and audits created to ensure patients were receiving the most up to date care. The provider routinely monitored patient’s care and treatment and their outcomes. These meet agreed expectations as set out in legislation, standards, and evidence-based clinical guidance.

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.

During staff interviews we were told how they could support patients with translation requirements, or hearing or visual disabilities. Patients with learning disabilities were offered longer appointments and at time that suited the patient. Staff we spoke with told us they completed training to ensure they were up to date with any new practice or innovations in healthcare. Interviews with clinical staff showed that the culture in the practice was that patients were cared for and treated based on need and the provider took account of patient’s age, gender, race, and culture as appropriate.

Results from the National GP Patient Survey showed positive results. Patient feedback from the National GP Patient Survey showed that 88% of patients said last time they had a general practice appointment, the healthcare professional was good or very good at treating them with care and concern. The national average was 84%. The National GP Patient Survey showed that 97%% of patients said the healthcare professional was good or very good at listening to them. The national average was 85%. The National GP Patient Survey showed that 99% of patients said they had confidence and trust in the healthcare professional they saw or spoke to. The national average was 93%.

The provider assessed needs and delivered care in line with relevant and current evidence-based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines. Staff used these guidelines to deliver care and treatment that met patient’s needs. Patients had been appropriately assessed and their needs understood. Patients had access to appropriate health assessments. There was appropriate and timely follow up on the outcome of health assessments and checks where abnormalities or risk factors were identified. Patients were assessed using a range of assessment tools. For example, the provider used a clinical tool to identify older patients who were living with moderate or severe frailty. Audits were carried out to ensure patients care was appropriately managed in line with current guidance. The needs of carers of patients were also considered. Staff were able to use social prescribing and signpost patients and their carers to additional support. All patients with a learning disability were offered an annual health check. The provider had a system for vaccinating patients with an underlying medical condition according to the recommended schedule. Flu, shingles, and pneumonia vaccinations were offered to relevant patients.

The provider had systems and processes to keep clinicians up to date with current evidence-based practice. Care and treatment were delivered in line with legislation, standards, and evidence-based guidance, including NICE and other expert professional bodies, to achieve effective outcomes. The provider had up to date and relevant policies and standard operating procedures. The provider participated in relevant local and national audits which were based on national guidance. Our review of the remote searches of patient records showed that patients were being effectively and safely managed.

Staff we spoke with told us that they had regular learning opportunities. The provider ensured that staff were up to date with national legislation, evidence-based good practice and required standards. Nurses were able to access training in order to keep up date with their skill base. GPs and clinical staff were able to access information regarding National Institute for Health and Care Excellence (NICE) guidance.

The National GP Patient Survey does not have questions specific to this question. We received 4 CQC Give Feedback on Care forms from patients. These were all positive about the provider, however, did not give specific details about this key question. Referrals to specialist services were documented, contained the required information and there was a system to monitor delays in referrals.

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.

The National GP Patient Survey does not have questions specific to this question. We received 4 CQC Give Feedback on Care forms from patients. These were all positive about the provider, however, did not give specific details about this key question. The family and friends test (FFT) showed a high satisfaction rate by patients. For example, in April 2024, 175 patients had responded to the FFT in regard to their experience at the practice - 135 patients responded as very good, 30 as good, 4 as neither good nor bad and 6 patients as poor or very poor. In March 369 patients had responded to the FFT - 303 patients responded as very good, 45 as good, 4 as neither good nor bad and 4 patients as poor or very poor. In February 151 patients had responded to the FFT - 127 patients responded as very good, 19 as good, 2 as neither good nor bad and 3 patients as poor or very poor.

The provider had a comprehensive programme of quality improvement activity and reviewed the effectiveness and appropriateness of care provided. Patients who used the service consistently experience positive outcomes. These meet agreed expectations as set out in legislation, standards, and evidence-based clinical guidance. The provider employed an administrator whose role was solely to contact patients for monitoring activities. The provider had arrangements for following up failed attendance of children’s appointments. For example, childhood immunisation. There were effective approaches to monitor patients care and treatment and their outcomes. We found there was a comprehensive programme of clinical audit and second cycle audits. Patients were encouraged to provide feedback on their care. Patients were sent a text 24hrs after their appointment with a link to the provider’s friends and family feedback. For those patients unable to use a mobile device, copies of the feedback forms were at reception. All feedback was monitored weekly by the practice manager. Staff were able provide feedback to improve care on an ad hoc basis. There was also a suggestions box in the staff area for staff to submit feedback anonymously. We saw evidence of where suggestions from staff had been acted upon which had improved how care was delivered to patients. We saw evidence of continuous improvements made to patients care and treatment.

We interviewed staff members including health care assistants (HCA), Nurses, Paramedic, reception staff, and administrators, as well as the practice manager and GPs. They told us that their involvement in meetings, including clinical meetings, and attending training ensured they were kept up to date with best practice. Staff told us that safety alerts were discussed at meetings and where necessary audits created. They also told us they were involved in the investigation of significant events investigated and outcomes were discussed at team meetings.

Clinical audits were carried out to demonstrate quality improvement and all relevant staff were involved to improve care and treatment and patients’ outcomes. We reviewed 5 clinical audits that had been carried out. The audits indicated where improvements had been made and monitored for their effectiveness. Findings were used by the provider to improve services. For example, the provider has completed an audit on patients who failed to attend screening for cervical cancer, breast cancer and bowel cancer. A new policy and process was created to improve uptake. The results of the audit completed in January 2024 compared to 2020 showed a marked improvement for the uptake of cancer screening. The provider used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. We reviewed patient records for long term conditions and found patients whose test results indicated a potential of a long-term condition was appropriately followed up and additional tests completed. This included patients with hypothyroidism, asthma, chronic kidney disease and diabetes.

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.