Naseby Medical Centre

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

The Effective key question has been rated Requires Improvement. All quality statements for this key question were included in this assessment: Assessing needs, Delivering evidence-based care and treatment, How staff and teams work together, Supporting people to live healthier lives, Monitoring and improving outcomes, and Consent to care and treatment.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The National GP Patient survey results found 84% of patients felt their needs were met during their last general practice appointment which was slightly below the national average of 90%. However, 37% of patients felt it was easy to get through to the practice on the telephone which indicated that access was challenging to get an appointment to have their needs assessed.

Staff were aware of the needs of the local community. There were digital flags within the patient records system to highlight any specific individual needs, such as the requirement for longer appointments. Reception staff told us they received training and knew how to prioritise patients who reported symptoms which would require an urgent appointment. We reviewed the appointment diary and saw appointments were available to book the same day for urgent appointments. Staff told us they supported patients who were carers and offered them annual flu vaccinations, health checks and flexible appointments where possible. One of the GPs had been nominated as a Carers Champion. There was a carer’s notice board in the waiting area and information for carers was provided on the practice website. Staff told us they were in the process of organising coffee mornings for patients who were carers.

There was a Carers Policy in place and the practice maintained a register of patients who acted as carers for relatives. Flags were put on these patient’s records to enable staff to provide extra support for them.

As part of this assessment, we reviewed patient feedback from the National GP Patient Survey and asked the practice to share details of our Give Feedback on Care process with patients. We received no specific patient feedback relating to evidence-based care and treatment.

Staff told us they complied with national and local prescribing guidelines and participated in medicines optimisation programmes. One of the GPs was the nominated clinical prescribing lead, and we were provided with evidence of clinical audits. One of these audits was a records review to identify if prescribing was within current acceptable guidelines; and if the consultation followed formally agreed clinical practice guidelines and procedures. This audit of 12 records identified 3 examples of partial compliance but the majority of records were found to be fully compliant. As part of our assessment however, we undertook a clinical records review to identify if staff were assessing and delivering care and treatment in line with current legislation, standards and evidence-based guidance. Our clinical record searches found the care and treatment of some patients did not comply with national guidelines and some patients had been re-issued prescriptions without the prior necessary monitoring required for these medicines being undertaken. For example, patients prescribed angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) medicines should have blood pressure checks completed annually, alongside renal function monitoring. Our review identified patients who had not received this required monitoring in line with national guidance. In addition, patients prescribed Metformin medicine require regular blood tests to check their renal function and glucose control. An estimated glomerular filtration rate (eGFR) is a blood test used to indicate how well the kidneys are working to filter out waste products from the blood. National guidelines recommend that Metformin is not prescribed for patients their eGFR test result is less than 30 as patients would be put at at risk of lactic acidosis. Our review identified patients who were prescribed this medicine despite having blood tests results for which this medicine was contraindicated.

The practice’s process for keeping clinicians up to date with current evidence-based practice included one of the GPs collating guidance into a spreadsheet and this was discussed with staff at practice meetings. In addition, GPs had a subscription to a medical education provider and accessed training, education and primary care resources. Despite these processes, our clinical searches found national guidance was not always followed for the care and treatment of some patients.

The National GP Patient Survey found 53% of patients felt they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. The national average was 68%.

As part of our assessment, we were provided with minutes of internal practice meetings which included whole team and nurse meetings. Staff told us the minutes of meetings were circulated via email to ensure all staff were kept up to date in case they were unable to attend. The practice also provided us with minutes of multidisciplinary meetings with external stakeholders and services, for example health visitors and midwives. Leaders told us they attended primary care network (PCN) meetings and described work they had been engaged with as part of the PCN which included quality improvement in relation to health inequalities and deprivation; and prescribing for medicines optimisation. Systems were in place to share information about patients electronically with other services. We asked GPs to describe the processes for referrals for patients. GPs told us each GP completes their own referrals and manages their own patient lists to check patients had been seen when referred.

As part of our assessment, we received feedback about the practice from the local Integrated Care Board (ICB) who reported experiencing a lack of engagement and communication with the practice; and a resistance to change such as with regards to the national cervical screening system, and the clinical IT system and cloud-based telephony system.

We saw informative posters with screening and health promotional advice for patients in the reception area and waiting room. The practice website also provided patients with links and information about health promotion, health conditions and common health questions.

Staff encouraged patients to live healthier lives, and they told us they used consultations to opportunistically discuss health choices and provide supporting information. Staff told us patients had access remotely to a PCN social prescriber, which helped them improve their health, wellbeing and social welfare by connecting them to community services. Staff gave us examples of how the social prescriber had supported patients experiencing a housing crisis. Leaders told us that with the building extension they planned to be able to provide patients with access to a PCN social prescriber in-house.

The practice supported national health priorities and initiatives to improve the population’s health, for example, stop smoking campaigns.

Prior to our assessment CQC received four complaints from patients about the practice. One of these complaints related to a lack of clinical monitoring for an older patient with diabetes. A second complaint related to the lack of monitoring for a patient following an abnormal blood test result.

We asked staff to describe the arrangements for the management and monitoring of patients with long-term conditions. Staff told us long term condition reviews were carried out by the GPs. With regards to patients with diabetes, GPs told us patients with very high blood glucose would receive blood tests every three months; and patients with renal failure and diabetes would be monitored closely. GPs told us the majority of patients with very high blood glucose were under the care of diabetic clinics. Despite this feedback, our clinical searches found monitoring and improving outcomes for some patients required improvement.

From our review of clinical records however, we were not assured the practice was operating an effective, embedded system to ensure patients received necessary and timely monitoring, blood tests and medication reviews across a range of medical conditions. In addition, we were not assured the long-term condition needs were fully assessed for all patients. For example, our review found a lack of evidence of medication reviews and diabetic annual reviews being undertaken for patients with diabetes. In addition, our review found high numbers of patients with very high blood glucose test results which would suggest a number of patients had poor diabetic control and were at risk of diabetic complications. We also identified that when patients had very high blood glucose test results, these tests were not followed up and repeated in appropriate timescales and treatment was not always adjusted. We noted that many patients had been referred to a diabetes clinic but there was a lack of clinical oversight of these patients by the practice following this referral.

As part of our assessment, we reviewed the practice performance data for childhood immunisations and cervical cancer screening. The World Health Organisation (WHO) recommends a rate of 95% for all routine childhood vaccinations. Published data indicated the practice’s performance for childhood immunisations was significantly below national targets however the practice told us they had experienced a data extraction issue related to the clinical system and when they became aware of this, they took action to ensure coding was done correctly and sent us updated childhood immunisation data which was unverified. The national target for cervical cancer screening coverage is 80%. Early detection of cervical abnormalities means that less invasive interventions can take place in out-patient settings, often at a pre-cancerous stage, and the long-term adverse impact on (often younger) women’s lives is reduced. We found the practice’s performance for cervical cancer screening was significantly below this national target. The service was aware of the low cervical screening uptake and had developed an action plan to improve uptake.

The National GP Patient Survey found 86% 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. The national average was 91%.

Staff sought patients’ consent to care and treatment in line with legislation and guidance. Clinical staff carried out chaperone duties and were trained for the role. Patients were offered a chaperone when carrying out examinations and we saw posters displayed in the waiting area informing patients of this service. GPs told us appointments had been and could be arranged with a locum GP if patients preferred to be seen by a female GP.

The practice had a Consent policy in place to provide staff with information on the importance of obtaining patient consent when providing care, treatment and support whilst maintaining choice and patients’ rights not to consent. Consent forms were available on the electronic patient record system.