Matching Green Surgery

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 a total of 6 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was inadequate. Our rating for this key question is good. We found staff involved people in decisions about their care and treatment and provided them with advice and support. People told us they felt involved in their care and treatment. Staff regularly reviewed people’s care and worked with other services to achieve this. The provider used information about care and treatment to make improvements. We identified areas for improvement in the management of long-term conditions, in particular asthma management.

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.

A review of the information we hold found that 89% of respondents to the National GP patient survey for the practice stated that during their last GP appointment they were involved as much as they wanted to be in decisions about their care and treatment.

Leaders shared examples of assessing needs, this included treating people with dignity and respect and identifying any protected characteristics and adjustments. There was a process in place for health checks for people with a learning disability; care planning processes; local support group access for carers and young carers and interpreting services available. Leaders told us the practice used codes and alerts on patients records to highlight any communication needs and any impairments.

The practice discussed the needs of patients at clinical meetings, we saw minutes detailing discussions and action to ensure people with a learning disability were recalled for their annual review. Cervical cancer screening targets were met. At the last assessment breast and bowel cancer screening targets were below local and England averages at 46% & 59% respectively, we saw that these were still below the England averages but had improved for bowel screening to 69% just below the England average of 72%, and breast screening to 63% just below the England average of 67%. The provider had met 4 out of 5 childhood immunisations uptake targets in line with local and national averages. The practice described the systems in place to support uptake. Clinical search review identified 350 patients on the asthma register, 14 patients with asthma had been prescribed 2 or more course of rescue steroids. We reviewed 5 records and found the clinical details at issue point of treatment overall good, however we identified some issues of missing data which would be beneficial in supporting decision to prescribe steroids included respiratory rate, degree of chest wall movement and peak flow rate. Clinical search review identified 225 patients on the diabetes register. 31 patients with diabetes who's latest HbA1c was >75mmol/l: 31. We reviewed 3 of these patients and found 2 of the 3 reviews were very good. We identified 1 patient who required a rapid review due to a rapid rise in levels, the Lead GP was unaware of this finding. The practice took immediate action provided assurances. No patient harm had been identified.

69% of respondents to the National 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. 86% 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.

At the last inspection we found that patients consent to share information was not always recorded. At this assessment leaders shared policies and processes to monitor information sharing arrangements. We saw information was displayed in the reception area for patients. Staff described systems and processes in place to recall and review people with long-term conditions according to their requirements. At the last inspection improvements were identified for patients with asthma. At this assessment whilst we found improvements overall in the management of these patients, we identified areas that still required strengthening, in particular issuing steroid cards to patients prescribed two or more courses of rescue steroids in the last 12 months. Leaders shared action plans implemented after the last inspection, this detailed peoples’ roles and responsibilities for monitoring long term conditions and intended outcomes. Staff described audit processes implemented to ensure patients on repeats medicines had appropriate review as part of their long term condition management.

We observed from the clinical searches we carried out that the service delivered evidence-based care, however some recording of risk advice and follow up management required review. We reviewed long-term condition management to ensure safe care and treatment was given to patients. At the last inspection we found patients with asthma were not always followed up in line with guidelines. At this assessment we reviewed 5 patient records of patients prescribed two or more courses of rescue steroid in the last 12 months. We identified 4 patients had not been issued steroid cards in line with national guidance, the practice took immediate action following the clinical searches exercise. In addition, patients were not followed up in 48 hours in line with NICE guidance following an exacerbation and contacted directly by the practice, the practice requested patients to contact the practice which is a widely adopted alternative. Leaders confirmed the follow up process for these patients should be to contact them and an appointment booked with a clinician for review. We reviewed the management of patients with diabetes who’s latest HbA1c was >75mmol/l. Overall we found management was in line with national guidance for the management/monitoring of diabetes.

We did not receive feedback from patients about how they provider worked with other services.

Staff described systems in place to work with other organisation, for example to follow up patients, including ensuring vulnerable and children were followed up if they failed to attend appointments. Staff employed through the Primary Care Network (PCN) described systems and communication models to keep people safe. Appointment schedules were coordinated between pharmacists and reception. Patients had access to musculoskeletal first contact physiotherapy, staff had worked together to set up soft tissue and joint injections for patients. Leaders told us that multidisciplinary team (MDT) meetings to discuss end of life care within the network were being relaunched. Leaders told us that patients on the end of life care register were appropriately identified and support by the practice team. Meetings with the local hospice had been cancelled due to external issues. Out of hours services had full access to medical records to support patients on end of life care pathways. Leaders told us a new paediatric psychiatric nurse had been employed by the Primary Care Network (PCN) to reduce waiting times for patients and provide local community support. Mental health checks were managed directly with commissioners with 70% compliance, the practice had requested 100% compliance.

External partners told us they had not received any concerns from people about how staff and services worked together.

The practice worked effectively across teams and services to support people. The practice held regular meetings and shared information between teams and services to ensure continuity of care, for example when clinical tasks were delegated. The practice had identified actions to strengthen information sharing with local safeguarding teams. Information sharing agreements were in place in accordance with the UK General Data Protection Regulation (UK GDPR) to assist in improving the quality and standards of care provided, monitor safety and planning of services.

We did not receive feedback from patients about how the provider supported patients to live healthier lives.

Leaders were able to describe initiatives to support people to live healthier lives, for example referrals to the diabetes prevention programme. Leaders told us that patients had access to health prevention material in the reception area and on the practice website. During the onsite inspection we saw that patients had access to a folder at the front reception desk with an extensive selection of leaflets and support for patients , for example bowel screening, wellbeing services and social prescribing.

The practice identified patients who may need extra support and directed them to relevant services. Patients had access to appropriate health assessments and checks.

The National Patient Survey does not have questions specific to this question. We received 1 Give Feedback on Care review which raised concerns regarding the referral process to community support services. The practice shared evidence to demonstrate learning had been discussed at practice team meetings and action taken. Family and Friends test (FFT) showed a high satisfaction rate by patients.

We interviewed staff members including Nurses, reception staff, Pharmacists, social prescriber, as well as the practice manager and lead GP. They told us about their involvement in meetings, including clinical meetings, and attending training ensured they were kept up to date with best practice. We spoke with the clinical pharmacy team as part on the offsite interviews, the team confirmed there was an audit programme in place for medicines monitoring and improvements. Staff had undertaken a range of second cycle audits. For example, a second cycle audit to ensure all patients prescribed direct oral anti-coagulants (DOACs) were taking the correct dosage, regular reviews, blood test and weight checks to ensure creatinine clearance were within range. The first audit undertaken in January 2024 identified 13 patients who needed to be contacted for review. A second audit was undertaken in May 2024, this identified 2 patient who needed to be contacted and demonstrated an improvement.

At the last inspection clinical audits and quality improvement activity was limited due to the COVID 19 pandemic, in line with national guidance. At this assessment, the provider had a comprehensive programme of quality improvement activity and reviewed the effectiveness and appropriateness of care provided. This included second cycle audits. We reviewed five clinical audits that had been carried out. The audits indicated where improvements had been made and monitored for their effectiveness. Findings were discussed at team meetings to improve services. For example, the provider completed regular auditing on referrals generated by the practice. The audits analysed the number of routine, urgent and two week wait referrals to secondary care; and in addition, reviewed the number of community referrals made. The results demonstrated that all referrals had been accepted and no referrals had been rejected. The provider had arrangements for following up failed attendance of children’s appointments, for example, childhood immunisations.

At the previous inspection audit activity had been limited due to the pandemic, at this inspection the practice shared a range of clinical and non clinical audits, including second cycle audits. Audits had been undertaken to ensure referral pathways and medicines management monitoring was safe. 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 patients records for long term conditions and found a small number of patients whose test results indicated potential of a long-term condition had not been appropriately followed up and additional tests completed. This included patients with asthma and diabetes. During the assessment, the provider took immediate action to contact these patients, and no patient harm was identified.

People's experience feedback did not identify any concerns related to consent and respect.

Leaders told us staff completed mandatory training in consent, mental capacity, and Deprivation of Liberty Safeguards (DoLS). We saw evidence of monitoring and compliance for all staff.

During the onsite assessment, a review of 4 medical records for patients with a coded Do not attempt cardiopulmonary resuscitation (DNACPR) decision. Two decisions were made within secondary care and were in line with national guidance and 2 decisions had been made in primary care with a GP. We found that the DNACPR form was not included in the patient records for these patients. We discussed the findings with the Lead GP who confirmed that this was not in line with the practice processes. Immediately after the inspection the Lead GP undertook an audit of all DNACPR decisions recorded within the medical records and took action to improve the record keeping for these decisions. The practice had a chaperone policy in place and patients were offered a chaperone when conducting examinations. Staff who performed chaperone duties were trained for the role and had received a disclosure and barring (DBS) check.