Medlock Vale Medical Practice

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

Patients' needs were assessed appropriately as seen from the information submitted by the provider, discussions with staff and leaders during the site visit, and review of clinical records by the GP specialist adviser (SpA). The SpA also reviewed 5 additional specific cases that had been identified from GFOC (Give feedback on care) as potentially patients at risk. While the feedback received expressed that people were generally concerned with their care, or the care of their relatives, our assessment found that the elements of care provided, met the expected standards.

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 received feedback via GFOC (give feedback on care) from many people whose experiences were not good from this GP practice. They reported they were not always involved in the assessment of their needs and did not feel confident that their individual needs had been appropriately assessed and were fully understood. The 2023 GP patient survey results showed that 80% of patients felt the healthcare professional was good or very good at listening to them, but this was lower than the local and national average. 90% felt they were involved as much as they wanted to be in decisions about their care and treatment and this was in line with local and national averages. However we also received positive feedback from people about their care and treatment and our assessment found that the elements of care provided met the expected standards.

We spoke to the provider and leaders of the practice about the negative information received regarding assessments of patients’ care. We discussed the way in which patients’ needs were assessed and the provider was able to demonstrate that the practice staff shared clear and accurate information with relevant professionals when deciding care delivery for patients. The provider demonstrated how they used registers for people with learning disabilities, mental health conditions, long term conditions, palliative care, carers and safeguarding to ensure that needs were assessed and managed appropriately. We found no concerns with how patients’ care and wellbeing was assessed. Other staff we spoke to told us they felt confident that patients’ care records, prescriptions and any updates were done so in a timely manner.

The practice had systems and processes to keep clinicians up to date with current evidence-based practice. We found that patients’ immediate and ongoing needs were fully assessed and these included interventions required to ensure effective care was delivered. The practice carried out structured annual medicines reviews for patients with long-term health conditions. There was a programme of clinical and non-clinical audits that were used to monitor quality and make improvement when actions were identified. The practice worked closely with the Primary Care Network (PCN) to improve health inequalities.

The percentage of patients who responded to the 2023 GP patient survey and stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them was 80% which was lower than the expected target and had declined since 2021. However, 90% of patients felt they were involved as much as they wanted to be in decisions about their care and treatment which was in line with the expected target and had improved since 2022.

The provider and lead GP demonstrated how clinical meetings were used to ensure evidence based care was followed. We saw an example where the practice had received information from the UK Health Security Agency about testing for measles which had been emailed to all clinical staff for attention and further discussed at a clinical meeting. There were also informal weekly clinical meetings where patients were discussed with peers to ensure best practice was being followed. Other staff we spoke to said they felt confident that they had all the required tools and protocols to follow to ensure best practice was achieved. Reception staff said they shared knowledge and experience with each other regularly. The clinical searches also demonstrated best practice was being followed when reviewing the management of patients with long term conditions.

We were told that each GP had individual email alerts from MHRA, NICE, Scottish SIGN and local guidelines from the local Integrated Care Board. These communications were also a regular agenda item on monthly clinical meetings for discussion. In addition, staff attended target training across the primary care network where targeted training, such as updates on long term conditions was provided. All members of staff also attended yearly general updates which were paid courses, most of the time national, where best practice was shared and information brought back inhouse. Within the clinical system leaders followed templates to ensure care was delivered in the most up to date and consistent way.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Feedback from people about support to live healthier lives was positive. They said that NHS health checks were completed and they were happy with the service received from specific members of staff. This was evidenced via GFOC (Give feedback on care) and also from information sent to the practice. We viewed 15 random from 143 positive responses, where patients said… “the nurse had visited their home for blood pressure checks”. “Staff were punctual, professional and pleasant”. “Staff were happy in their work and efficient”. There was feedback that a new patient appointment had gone well, blood tests were taken and results received within 3 days, telephone appointments had gone well and overall patients were very satisfied. One response praised the practice by saying the care provided had made a huge difference to their life by being able to access specific treatment.

The provider and lead GP told us about local initiatives and what was available to patients to support them to live healthier lives. In place the practice had NHS health Checks undertaken by nurses and assisted roles provided by the Primary Care Network (PCN) to help. All health checks had been completed to date with the help of the PCN and this had also increased engagement with/to other services such as for obesity, cholesterol and pre-diabetes (all patients are logged on the register ). We saw evidence to support this during the remote clinical searches where there were no concerns. The practice were also involved in all national screening services. We saw that cervical screening rates were low according to CQC data. When we discussed this with staff they showed us their own unverified data which was higher and within 80% of the required target. During discussion with leaders, they demonstrated how minority groups such as a homeless person was supported by being able to attend quieter Saturday clinics. The provider also told us they had trained their own pharmacist to concentrate on medication reviews for the next four months and bring those up to date. In addition, they had local community services for health and wellbeing and were focusing on a health inequalities project specific within the PCN. It was evident from discussions with the staff that they understood the requirements of their patient population which had high numbers of elderly patients and patients with diabetes and heart disease.

There were many local initiatives such as smoking cessation, weight management and drug and alcohol reduction programmes within the practice. There were also many protocols, and processes in place to help staff support people to live healthier lives and we saw that these were available for staff to follow. Examples included a falls and frailty protocol, a guide dog policy, a protocol for carers, and a policy for equality, diversion and inclusion. There were templates and standard operating procedures for staff to follow around patients’ long term conditions, audits that were regularly undertaken and forums for staff to discuss clinical concerns and share best practice information.

The feedback reviewed from patients via GFOC (Give feedback on care), feedback sent to the practice and the GP patient survey was mixed. However it was evident that this feedback was monitored and the practice was able to demonstrate that it was used to improve outcomes for patients. For example where patient experience was negative around appointments, the practice had implemented a quality improvement project. Where feedback was negative about care or members of staff, this was discussed and brought to the attention of the relevant staff involved. We saw that action was taken to make improvements around training and/or support in making decisions to ensure that patients were not negatively affected in the future.

Whilst on site we sat and spoke with staff who were all very positive about the practice. We observed the way reception staff dealt with people whilst on site. They were all passionate about their roles and wanted to do a good job. A lot of work had been done recently to improve the way reception worked. A lot of new staff had been brought in and the practice was utilising experienced staff to help and induct the new staff. There was a Quality Improvement Plan to improve the way reception and administration were working with patients and to improve the quality of the service patients were receiving. The practice demonstrated through positive feedback from patients since July 2023 and after about the changes that had been made. On site we saw further changes that were being implemented but they had not yet been embedded and some staff were initially unhappy about the changes being made.

The practice had a comprehensive programme of quality improvement and we saw on site and through evidence sent to us that they used that information about care and treatment to make improvements. The provider demonstrated regular monthly clinical audits such as medicine reviews, drug monitoring, MHRA alerts, quality improvement projects and training and support for staff. There were policies, procedures and protocols in place to support clinical audit and all clinical staff underwent the appraisal and revalidation process. There was a process for all non-clinical staff to be appraised on an annual basis. There was also a process for staff to attend national and local target training annually where best practice was shared and brought back inhouse to be shared across all sites. Clinicians received Hot Topics, followed NICE guidelines and had medicines updates. We saw that patients were discussed at clinical and GSF meetings and we saw that actions were taken to improve outcomes.

There was evidence of improved outcomes for specific groups, such as older people, homeless people, and people with long term conditions. We saw evidence that learning had improved for example through feedback received from patients and staff, where we saw they had taken action. There was also evidence that their prescribing data was good and they made changes when identified. The GP searches identified only 18 patients that required some form of action taken to improve. Each patient record was reviewed by the lead GP for the practice and some form of action was taken immediately following our feedback.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.