Roysia 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

People’s immediate and ongoing needs were comprehensively assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing. People were advised what to do if their condition got worse and where to seek further help and support. People were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. The needs of carers of people using services were assessed and met. Patients with long term conditions were reviewed and monitored regularly and medication reviews were overall exceptionally managed by clinicians with the use of a structured medicine template.

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 using the service was positive. People felt involved in assessments of their needs and felt they were treated with dignity and respect. Respondents to the national GP patient survey indicated higher satisfaction than the national averages for being involved in decisions about care and treatment. 51% said the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment. 86% felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment and 79% were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. 85% felt their needs were met during their last general practice appointment.

Clinical staff used recognised electronic templates when assessing people’s health care needs. The practice had effective systems to identify when people needed to be referred to other services for care and treatment. In addition to this, the practice had recently employed another salaried GP to create more availability for peoples needs to be assessed should they deteriorate. The staff were aware of the needs of their patients and made reasonable adjustments to enable patients to make appointments who may not have access to technology, or did not have anyone to assist them to complete the online consultation request form.

Staff would use the most current national and local guidance in order to deliver the best practices. Staff would have regular developmental training sessions and given protected time to be able to Keep up to date with clinical practices. Practitioners with a prescribing qualification also were audited externally by the clinical lead for Malling Health and the organisation had designed and developed an auditing clinical notes tool to randomly audit clinicians notes. Themes would be collated monthly and a SBAR (situation, background, assessment recommendation tool) would be used to record thematic reviews and learning would be shared throughout the Malling Health group. We were shown a demonstration of this audit tool and provided examples of shared learning that included testicular torsion. There was an organisation wide audit that had found there had been 4 missed diagnosis for testicular torsion The tool explained why this was significant and gave a detailed flow chart for an improved process for any male under the age of 25 presenting with abdominal pain. It included these patients must have a testicular examination. This was documented in the patient record and marked as urgent.

As part of our assessment, a GP specialist advisor completed remote clinical searches of medicines. Overall there were no concerns with medicines monitoring. We saw an exceptional medicine review process in place and the provider used a designated template for all patient medicine reviews. Long term conditions were monitored well and we saw evidence of strong thorough medicine reviews. The practice had also completed an audit of patients who had an acute presentation with an exacerbation of Asthma who were identified for the months of May and June 2024. A re-audit was then performed 3 months later to see if improvements had occurred. Findings of the audit showed the recording of peak flow measurements supported the severity of exacerbation, a recommended dose for steroid use was 40mg, previous admissions would support any GP patient consultation and clear safety netting for worsening symptoms would be clearly recorded. These recommendations had shown a 17% increase in more accurate diagnosis of exacerbation of asthma patients.

People were provided with care and treatment from an appropriate clinician. For example, from a GP, the nursing team or an advanced nurse practitioner. The national GP survey showed 90% of respondents had confidence and trust in the health care professional seen at their last appointment. This was in line with the England average of 92%.

Staff worked well together and liaised and communicated with external professionals. Systems and processes had been developed to share information to promote the coordination of care and treatment. Staff said they felt able to raise concerns without fear of retribution.

Patients received consistent, coordinated, person centred care when they moved between services. Information relating to individual patients from external health providers was uploaded to their clinical records in a timely way. On the day of inspection there were 25 clinic letters to process which included the days daily download of letters from secondary care providers. The records awaiting processing had arrived in the practice over the previous week and it was anticipated all information would be dealt with by the end of the day. Staff were able to help each other with their roles. Information was shared by email and meetings to keep staff up to date with any changes. Staff told us leaders were receptive to the ideas and changes were implemented and rolled out across Malling Health, not just at provider level. An example of this was a learning tool following significant event analysis.

Staff would use every possible opportunity to promote health and wellbeing. There was support to encourage patients from vulnerable groups to access health screening and vaccines. The provider had also completed a diabetes audit and improved weight loss for 66% of their population with pharmacological and non-pharmacological weight loss support. The practice noticed a reduction in blood pressure by 11% and cholesterol levels by 2% following this work.

The provider would review mental capacity decisions annually unless the patient needs changed and then this would be completed sooner. All applicable patients had a DNAR form and this was reviewed with each consultation to ensure patients views were documented. Care plans and advanced directives were reviewed thoroughly within the patient consultation and all changes would be documented. Care homes were liaised with weekly and the practice would hold meetings to discuss care changes when required and annually. Medicines were reviewed as part of care planning and where a patient was deteriorating in health, just in case medicines were prescribed should this be required. Immunisations were in line with expected national averages. Cervical screening was mostly aligned with national averages. There had been 18 out of 20 (89%) of learning disability checks completed during 2024. they would offer 50 minute appointments and any non responders would be followed up . There were 1606 patients eligible for an NHS health check. During 2023-2024 when the provider had taken over this practice, they had seen a backlog for health checks. To date there had been 161 health checks completed (10%) and the practice had recalled patients who were eligible and scheduled for these all to be completed. The practice had a carers register of 154 adults and 3 child carers. Carer support offered included a carers champion and completion of a carers toolkit, local authority connections and useful contacts, health checks, vaccinations and appointment flexibility.

Patients were reviewed or monitored at appropriate intervals to ensure their health outcomes where positive. Staff identified opportunities to refer patients to social prescribers' to improve their quality of life. GPs' followed up patients who had received treatment in hospital and acted on information received in discharge summaries. The provider followed a process to encourage people invited for cervical screening to attend appointments. Nursing staff were provided with support and additional training to enable them to carry out this procedure. The system alerted staff to specific care and support needs people had. For example, homeless patients. Staff had access to specialist support through the primary care network and external organisations when needed. People experiencing mental health issues were invited for an annual review but were able to request support from a clinician when needed. An example of this is patients with mental health concerns were flagged immediately as priority patients. Patients living with long term conditions were monitored and recalled for review. This was monitored monthly by audit. Staff completed a personalised care plan for each patient provided opportunities for them to discuss their care and treatment at their annual review. The practice had met the World Health Organisation targets for administering baby and child immunisations. Children who were not brought to appointments were followed up with contact made with their parent or carers. The practice was above the national target for cervical smears at 83%.

To improve the outcomes of diabetic patients, the practice identified and targeted patients with diabetes that were not meeting their 3 diabetic treatment targets. The provider created a pathway of referral from the practice diabetes nurse to a GP led diabetic clinic which offered intensified management of the patients, using non-pharmacological and pharmacological approaches. Patients had dedicated time and follow up with the diabetic GP to look at all parameters and agree a care plan. During the period January 2024 to November 2024, in those patients receiving the intensified GP Led input, there was a 66% improvement on all targets. The provider looked to improve outcomes for bowel screening. Between April 2022 to November 2024, (71%) 623 out of 925 patients took part in bowel screening. The 237 patients who did not take part were contacted and of these 49 people (21%) took part in bowel screening ad found 6% people had abnormal results and were referred on for treatment. Every 6 months, the provider would follow up non responder patients to invite them again. To further monitor outcomes for people, the provider had developed a situation, background, assess, recommend (SBAR) tool and would thematic review the audit results of patient consultation records. This SBAR tool had supported clinicians to be more aware of conditions such as failed contact, note keeping, patient consultation, as well as clinical conditions such as asthma patients monitoring. The provider was also working in close partnership with Meridian primary care network to improve health inequalities for patients requiring support with maternity, chronic kidney disease, mental health in adults and children, early cancer diagnosis testing and early diagnosis of hypertension. The primary care network had also begun to host menopause cafes which had received positive feedback from patients to the helpfulness of these sessions.

Our clinical searches reviewed consent processes and there were no concerns found with consent processes or documentation of consent.