Mill View 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

This is the first inspection for this service since its new registration with CQC. This key question has been rated as Good. People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and considered best interest principles where they did not have capacity.

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 receive any feedback about people’s experiences in relation to assessing people’s needs. However, information reviewed demonstrated that people’s needs were assessed. For example, 89% of patients felt their needs were met during their last GP appointment and 67% of patients say the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment.

Staff told us digital flags were used on patient clinical records to highlight patients who require extra support and those with specific individual needs. Communication needs were assessed, and information requested and electronically documented at the point of the patient registering at the practice. Should the patients’ communication needs change these were updated. There was an interpretation service staff told us they could access.

Clinical staff used electronic templates when conducting care reviews to support the review of people’s wider health and wellbeing. There were systems in place to identify people with previously undiagnosed conditions. The practice identified patients living with moderate or severe frailty. They maintained registers of vulnerable patients including, adult safeguarding, learning disability and autism, palliative care and severe mental health. Practice electronic register audits were maintained in order to monitor, review and improve care and treatment. Pathology and results pathways were established with guidance in place for staff.

We did not receive any feedback about people’s experiences in relation to this quality statement. However, The GP patient survey demonstrated that 80% of patients felt they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment and 86% had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment.

GPs told us there was a range of systems, meetings and training events in place to keep them up to date. GPs said this informed their clinical practice to ensure that care and treatment was delivered following evidence-based guidelines. Clinical audits such as urgent referrals and whether patients end of life decisions and preferences had been met were completed by the GPs and used for quality improvement and learning. They completed medicine monitoring searches and audits on a monthly basis. Staff reported annual and medication reviews were managed by recalls run on patient birthdate month.

Audits were completed to improve the effectiveness of the service provided to patients. The practice reviewed and maintained its processes to ensure there was no discrimination when making care and treatment decisions. Effective systems were in place to keep clinicians up to date with current evidence-based practice.

We received no specific feedback from patients regarding their experiences of how staff teams and services work together. However, feedback from a patient participation member reported that staff were knowledgeable and prompt in referring to specialist care.

Staff were able to describe the practice document workflow and had clear roles and responsibilities. Staff knew who to contact for support and advice. Staff told us they worked in partnership with a range of health and social care professionals as well as tertiary care providers to meet patients care and treatment needs. These included for example, district nurses, their primary care network and the safeguarding team.

The local Integrated Care Board (ICB) reported information of concern had been shared with them in relation to staffing levels, staff training and the dispensary. The ICB told us the practice had cooperated with their requests for information and had engaged with the ICB processes in order to improve outcomes and patient care. The practice provided care for patients who were residents of a local care home and staff told us there was regular communication with the practice and they were responsive to the needs of their patients.

Processes were in place to ensure staff and services worked together. For example, there were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. At the time of our assessment and due to changes within the staff team we were aware that new roles and responsibilities may take some time to embed in practice.

We received no specific feedback from patients regarding their experiences of how staff supported people to live healthier lives. Patients had access to health promotion and education to support them to live healthier lives. This was provided in various formats such as screening and vaccination programmes as well as during face-to-face consultations. NHS health checks were offered to patients over 40. Eligible patients had access to the practice dispensary and community pharmacy services as well as self-help groups/advocacy services.

Clinicians told us they were involved in referring patients to initiatives which support individual behaviour change such as Diabetes Prevention Programme. They supported patients with signposting to services within the community, such as weight loss and smoking cessation programmes.

The practice had systems in place that enabled staff to signpost patients to tertiary services and carer groups support. The practice patients were signposted to community services as well as self-help groups and advocacy services.

We received no specific feedback from patients regarding their experiences of how the practice monitored and improved outcomes. However, The GP patient survey demonstrated that 56% of patients said they have had enough support from local services or organisations in the last 12 months to help manage their long-term condition(s).

Clinicians could demonstrate how they identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension. The practice supported former armed forces staff and had completed the veteran friendly GP practice accreditation, a programme run by the Royal College of General Practitioners (RCGP) and NHS England to recognise and support practices in delivering the best possible care and treatment for patients who have served in the armed forces. All veterans are entitled to priority access to NHS hospital care for any condition, as long as it's related to their service and subject to the clinical need of others.

The practice had strengthened their systems to ensure that those patients requiring medicine reviews and ongoing monitoring were actively being reviewed and recalled.

The practice had systems to ensure that those patients requiring medicine reviews and ongoing monitoring were actively being reviewed and recalled. We were able to evidence that clinical audits were being carried out to monitor and improve outcomes for patients.

We received no specific feedback from patients regarding their experiences of their consent to care and treatment practice. However, The GP survey demonstrated that 80% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment.

Staff we spoke with demonstrated their awareness of the Mental Capacity Act (MCA) and patient consent having completed online training. Leaders told us and demonstrated their awareness of the Mental Capacity Act and patient consent. We saw leaders documented their patients, families and multi-disciplinary outcomes, following discussions such as advanced end of life decisions within ReSpect forms. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a personalised recommendation for clinical care in emergency situations where the person may not be able to make decisions or express their wishes. Leaders told us they documented consent within the patient records, and this was included within some of clinical electronic templates.

The practice maintained a consent policy. The practice offered the regulated activity of surgical procedures and clinical staff conducted minor surgical procedures. Minor surgery procedures were audited annually by the clinical staff. The audits completed in May 2023 and May 2024 demonstrated patients had not experienced post-surgical complications. There were systems in place to monitor and manage completed ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form information. Records showed staff had received training in consent.