Albany 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

Albany Practice was last assessed in 2021, and key question effective was rated as requires improvement. Albany Practice was assessed using our single assessment framework on 10 September 2024 and the clinical remote searches were completed by a GP Specialist Advisor on 9 September 2024. At this comprehensive assessment, it was found that Albany Practice had made significant improvements and the practice’s approach to managing risks was very proactive, lessons learned from incidents were shared with staff and measures put in place to prevent recurrence.

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 people was mixed. However, people generally felt that the health care staff understood their responsibilities and shared information with the patients to help them make an informed decision.

Staff were aware of patient needs and supported them to improve their health. Staff knew to urgently refer patients to other services and to follow up as needed. Health check reviews were done, and patients were encouraged to attend such health reviews.

The practice had policies that covered access, supporting carers, supporting patients regarding end-of-life care and bereavement. Other policies included supervision of staff on the additional roles reimbursement schemes, and staff training. There was a clinical governance plan and a business continuity plan. In addition, the practice conducted analysis of the GP Patient survey and formed an action plan to improve on areas where performance was poor. However, more work is needed to ensure patient reviews were completed in a timely manner to ensure that needs were reflected in the care given. Following our assessment, the practice was in the process of facilitating the configuration of the IT clinical system used to ensure the system was adequate to promote patient care and safety.

People we spoke to did not have any concerns relating to evidence-based care and treatment.

Staff at the practice regularly completed quality improvement work to ensure patients received care and treatment in line with recognised guidelines such as National Institute for Health and Care Excellence (NICE) guidelines and relevant legislation. Patients with complex needs were discussed at clinical meetings and decisions made that met the needs of the patients. There was an action plan developed to improve childhood immunisation uptake, cervical cancer screening uptake and to improve patient access.

Our remote clinical searches showed that the practice had processes to ensure care and treatment were delivered as guided by the legislation. During the search we identified areas that needed to be effectively configured in the clinical IT system for better and effective management of service delivery. The practice had since the clinical searches completed a significant event analysis report and drawn up actions to ensure the system works effectively.

People we spoke to during the assessment did not have any concerns relating to how staff, teams and services work together.

Staff told the assessment team that the practice held weekly clinical staff meetings, weekly administrative staff meetings and monthly staff meetings for the whole practice to discuss changes, improvement plans, and concerns. In addition, a monthly multi-disciplinary team (MDT) meeting also occurred where safeguarding cases were discussed. In attendance of the MDT meetings were health visitor, district nurse manager, care coordinator, social prescriber, social prescribing link worker lead, assistant practice manager, practice manager and the GP.

Feedback from partners did not show any concerns about this practice on service delivered to patients.

There were regular meetings attended by all relevant health care personnel and the practice staff with the minutes documented and shared. The practice continued to work in partnership with other healthcare professionals and all documentation was recorded and shared accordingly.

Feedback from people did not reveal any concerns relating to the support from the practice to live healthier lives.

The practice supported their patients to live healthier lives. The practice conducted a breast cancer awareness week in 2023.

As part of supporting people to live healthier lives, the practice completed in the last 12 months a total of 424 NHS health checks for their patients out of 950 eligible and offered. Patients with a learning disability (LD) were offered health checks and a total of 42 LD health checks were completed out of 62 eligible and offered.

People did not have any concerns with the monitoring of their conditions.

Staff told us that they carried out reviews of people’s health conditions at regular intervals.

Our remote clinical searches showed that the practice had ineffective systems which resulted in staff missing patient medications reviews, chronic disease follow-up for example asthma, diabetes and routine preventative care such as cervical screening and child immunisations. However, the practice was proactive in their approach to our findings and completed a significant event analysis report and created an action plan in conjunction with the Integrated Care Board (ICB) and Primary Care Network (PCN) to improve workflow efficiency and patient care delivery.

The practice regularly monitored how services were delivered to patients and looked for ways to improve patient satisfaction. In addition, the practice completed clinical audits on medicines prescribed for patients with heart failure, mood disorders, inflammatory arthritis, and bone-related conditions. Also, there was quality improvement activity completed on automated tasks for 2 week wait referrals to prevent delays caused by staff not being reminded to send such referrals. The practice has plans to improve uptake of cervical screening and child immunisations.

Feedback from people did not show any concerns about consent to care and treatment.

Staff we spoke to explained how they sought for consent from patients.

The practice took into account the wishes of patients and respected their preferences. Patients’ capacity to consent was lawfully respected and when a judgement was made about a lack of mental capacity, a best interests meeting was held with all relevant personnel involved in the care of the patient and documented. Regular reviews took place to reflect the changing needs of the patient. Patients’ relatives and carers were included in the decision-making process where appropriate including Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions.