The Chesser Surgery

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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 assessed all quality statements from this key question. Our rating for this key question remains good. We found that the service was providing effective services because the provider assessed patient needs in line with best practice guidance, and ensured all staff were aware of the service’s protocols and procedures. The service had a comprehensive programme of quality improvement activity and routinely received the effectiveness and appropriateness of the care provided. Staff worked together and worked well with other organisations to deliver effective care and treatment. The service obtained consent to care and treatment in line with legislation and guidance. However, we found that medicines reviews were not always clearly documented.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff whom we spoke to were aware of how best to assess patients’ needs. Leaders told us that guidelines were in place, of which staff were aware.

The service utilised local and national guidance to determine how patient needs should be addressed. We undertook a review of patient records at the service and found that these guidelines were being followed in the large majority of cases. Patients’ immediate and ongoing needs were fully assessed. Where appropriate this included their clinical needs and their mental and physical wellbeing.

Staff told us they received regular updates from leaders at the service. Where there were changes in process guided by learning at the service, staff told us that they were informed and involved in implementing changes.

Clinical staff had access to relevant national and local guidelines and used this information to help ensure that people's needs were met. The provider monitored that these guidelines were followed.

As part of our assessment a number of set clinical record searches were undertaken by a CQC GP Specialist Advisor. These search criteria are freely available for practices to access at any time. We noted, however, that medicines reviews were not clearly documented, and occasionally only reflected that a review had taken place. On this basis, it was not always possible to determine whether or not evidence-based care had been provided.

Care and treatment were delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

Staff were aware of the need to complete accurate and full records, such that information did not need to be repeated by patients.

Patients received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. Care and treatment for patients in vulnerable circumstances was coordinated with other services. There were established pathways for staff to follow to ensure patients’ needs were met.

There was no feedback of concern in relation to how staff, teams and other services worked together from partner organisations.

The service ensured that care was delivered in a coordinated way and took into account the needs of different patients, including those who may be vulnerable because of their circumstances.

There were clear and effective arrangements for booking appointments and transfers to other services.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Leaders told us that the uptake of patient monitoring for long term health conditions was discussed at monthly clinical meetings, and the results were compared with other practices in their primary care network or commissioning area. Leaders and staff told us that audits were discussed at clinical meetings; this was confirmed in the minutes of the meetings we reviewed.

The provider submitted clinical and management audits. These covered medicines and health condition monitoring, which they had carried out to improve outcomes for patients. Leaders held regular clinical and all staff meetings which monitored patients’ outcomes, where the findings were shared with the local integrated care system.

We found no concerns regarding outcomes showing that the service was monitoring and improving patient outcomes.

Patients did not raise any concerns regarding the practice seeking their consent to care and treatment.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

Relevant staff had been provided with training in the Mental Capacity Act. The service monitored the process for seeking consent appropriately and patient record searches demonstrated that consent was recorded appropriately. We reviewed Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions for two patients and found they were made in line with relevant legislation and were appropriate.