Bousfield Health Centre

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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 2 quality statement in the Effective key question – supporting people to live healthier lives and consent to care and treatment. The scores for the other quality statements are based on the previous rating for this key question. We found the provider had reviewed systems for monitoring cervical screening and the uptake for routine childhood vaccinations and the provider presented unverified information to show improved uptake in these areas. At the last inspection the provider was advised to take action to improve the recording of information for patients who had a DNACPR decision. However, at this assessment we considered further work was needed to ensure accurate and completed records were made for patients who have a DNACPR decision in place.

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.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We reviewed the national GP patient survey, published in July 2024. Results indicated that 70% of patients said they have had enough support from local services or organisations in the last 12 months, to help manage their long-term conditions or illnesses. This was slightly higher than the England and local averages. People felt involved in decisions about their care and treatment and had confidence in the healthcare professionals treating them. Feedback from patient surveys, and the practice's NHS Friends and Family Test, were positive and did not highlight any concerns relating to supporting people to live healthier lives. There was no feedback from patients either on-line via our GFOC (give feedback on care) relating to this quality standard. .

Systems were in place to identify patients that needed extra support. This included people who were in the last 12 months of their lives and people who were at risk of or had developed a long-term condition. Once diagnosed, patients with long-term conditions were offered an annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with other health and care professionals to deliver a coordinated package of care. This helped people to be involved in monitoring their own health and on-going health needs.

At our last inspection in September 2023 recommendations were made to the provider to monitor and take action to improve the uptake for cervical cancer screening and for childhood immunisations. At this assessment we found the provider continued to monitor these. The practice was below target in their achievement and an action plan was in place to improve this. Extra appointments were made available out of hours to encourage patients to attend. The national target for cervical screening coverage is 80% and the practice had achieved 69.4% at the time of assessment. The provider gave unverified information to show this had increased to 75% at the time of our visit. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations however, the practice was below this threshold. The practice coordinator sent invitations to parents and monitored their attendance. Immunisation clinics were scheduled on a regular basis, including out of hours. The provider’s immunisation nurse was responsible for contacting parents of children who were outstanding vaccines to provide advice and book appointments. If a parent declined vaccinations the lead nurse was responsible for reporting this to the Child Health Information Services. The provider shared an action plan for how they were working to increase uptake of childhood vaccinations. This included working with other agencies to support the team. Systems were in place to support people so they could maximise their independence, choice and control. Registers for people with learning disabilities, mental health conditions, long term conditions and patients receiving palliative care were in place. Information about mental health and support services were observed in the waiting room. Social prescribing schemes were available and used by staff to support patients. Patients had access to services such as smoking cessation, obesity, drug and alcohol dependency, dementia and cancer care support.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We did not look at this quality statement for this assessment. The score for this quality statement is based on the previous inspection carried out in September 2023.

We reviewed the GP patient survey, published in July 2024. Results indicated that 85% of patients were involved as much as they wanted to be, in decisions about their care and treatment during their last general practice appointment. This was lower than the ICS result of 92% and with the national result of 91%. However, this was an improvement for the practice based on the previous year’s results. The provider undertook a patient survey in September 2023 and there were 34 patient responses. Questions related to ‘did your GP listen to you’, ‘did your GP explain your condition and treatment’ and ‘did your GP make decisions about your treatment’ were all responded to positively.

Staff told us they were aware of practice policies and procedures for when and how to gain patient consent to treatment. Clinical staff told us they understood the requirements of legislation and guidance when considering consent and decision making, example of this were discussed. They stated where appropriate, they assessed and recorded a patient’s mental capacity to make a decision. Discussions took place about consent to care and treatment when undertaking a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision for patients if needed. We were told that was sometimes a difficult discussion and staff supported each other when needed.

Policies and procedures were in place to ensure people knew their rights around consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005 and the Children's Acts 1989 and 2004. A policy was in place for supporting staff with DNACPR decisions. At our last inspection in September 2023, the provider was informed the records made of DNACPR decisions and the forms used were not completed in full. The provider initiated a new system to carry out regular audits of DNACPR. However, observations of completed patient records during this assessment showed that the recording of the discussions which took place with patients remained, incomplete for some records viewed. The provider took action at the time to review and update these records and to establish a register to monitor patients who had this in place. Systems were in place for DNACPR forms to be shared with the out of hours and ambulance services and records showed this had been completed. Processes were in place for patients to have access to advocacy agencies to support their decision making and staff signposted them to these organisations.