Northfield 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

At our previous inspection, the practice was rated inadequate at providing an effective service because, they were unable to demonstrate that action taken to address below target uptake for childhood immunisation and cervical screening had led to any improvements. At this assessment we have rated the practice as good for providing an effective service. We looked at the most available data and found that childhood immunisations and cervical screening was below national targets. The practice were able to demonstrate how they were attempting to engage with the practice population in order to increase uptake, however this had had a limited success rate. Through clinical searches we completed we saw that the service delivered evidence-based care. They monitored and improved outcomes for patients by carrying out clinical audits, examples of these were chronic kidney disease (CKD) and diabetes. However we found that the practice had to do further work to improve structured medicine reviews, and medicines and healthcare products regulatory agency alert (MHRA) for women of childbearing age on teratogenic drugs.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A carer of a patient told us they had experienced issues accessing the practice as individual needs of a patient with learning disabilities (LD) had not been assessed by the practice. We fed this back to the practice; they planned on carrying out refresher training with administration staff to improve this.

Leaders and staff told us the practice used codes and alerts on patients records to highlight any communication needs and any impairments. The practice had systems and processes in place to identify people’s needs and preferences during the registration process. However, feedback received from patients indicated that their needs were not always being met as they could not access the practice sufficiently.

The practice had a system in place to identify people with caring responsibilities. The practice had a carers lead in place and worked with other organisations including Age UK and other social care groups. The practice produced questionnaires for carers to identify their individual needs. The practice also had a lead for patients with LD. At our previous inspection the provider was unable to provide assurances that LD patients received annual health checks. We found that the practice had a register of these patients, they had put processes in place to try and improve systems for accessing care and health checks, this included a quiet room, easy read materials and providing double appointment times.

We did not receive any concerns from patients about evidence-based care and treatment.

Staff told us that they had regular guest speakers at clinical meetings and training events, such as speaks on chronic kidney disease (CKD). Ahead of the assessment the provider sent us a clinical audit on managing CKD. When we ran our clinical searches, we found that recall systems and monitoring of these patients was good. However, attainment for the management of childhood immunisation and cervical cytology screening was below national targets. Childhood immunisation data did not meet the national WHO (World Health Organisation) target of 90% in 3 of the 5 categories. The practice achieved 61.7% for cervical cancer screening, the national target for this was 80%. The practice had an action plan in place to improve this, however they were finding it difficult to increase uptake. Staff told us how they worked with a local children’s soft play centre to increase awareness of childhood immunisations and ran competitions to try and increase uptake in vaccines.

We observed from the clinical searches we carried out that the service delivered evidence-based care however some recording of risk advice and monitoring processes required review. For example women of childbearing age on teratogenic drugs, we identified that patients were sent a generic non-specific text to warn about the risks of this medication. We discussed this with the provider, they provided evidence to show this had been updated to provide patients with more information about the risks associated with this type of medicine. Searches also identified that patients on gabapentinoids were not receiving structured medicine reviews effectively. We looked at 5 patient records and 3 patient reviews had been carried out without the patient present. This was fed back to the practice at the assessment, they updated their medicines management policy to ensure patients on gabapentinoids received effective structured medicine reviews. As these processes was newly formed and would take time to fully embed and show sustained improvements for these patients. Following our previous inspection the practice had updated how asthma reviews were carried out, from our searches we saw that patients were receiving good quality reviews.

We did not receive feedback from patients about how the provider worked with other services.

At our previous inspection the provider had limited engagement with external agencies and partners. At this assessment staff told us they attended regular multidisciplinary team (MDT) meetings to discuss patients whose circumstances may make them vulnerable. We saw examples of meetings with patients being discussed with external partners such as district nurses being consulted.

The practice was part of a primary care network (PCN) of practices who shared staff for the benefit of patients. For example, the provider worked with their PCN in order to provide vaccine clinics for patients.

The provider had a GDPR (general data protection regulation) policy in place and safe processes for information sharing. Referral letters were completed in a timely manner and there was a procedure for staff to follow to action incoming letters and discharge summaries. When we completed our searches, we found that there was a backlog of letters waiting to be actioned. After the assessment the provider provided evidence to show that this backlog had been cleared, however, we were not assured that the systems were sufficient to ensure effective oversight of letters waiting to be actioned in a timely way.

We did not receive feedback from patients about how the provider supported patients to live healthier lives.

Staff told us that they were able to signpost patients to social prescribing teams, and that they also had good connections with the local council and other agencies such as wellbeing officers and Be Well Doncaster. They also told us about other programmes they ran such as diabetes prevention and stop smoking campaigns.

Patients at the practice were able to access social prescribers through the PCN. The practice had built up networks with other local health and social care providers and where able to refer patients to these organisations.

We did not receive feedback from patients about their treatment received.

At our previous inspection we did not have assurances that staff received any role specific training, such as diabetes care. At this assessment staff carrying out long-term condition reviews had received appropriate training for their role, however we found that diabetes care could be improved further. Through our clinical searches we looked at 5 patients records with diabetes. Only 2 of these patients had received a structured medicine review. We found that annual diabetes reviews were happening, but medicine reviews and follow-up of patients with abnormal HbA1cs (a blood test to look at average sugar levels) needed improving.

Clinical searches we completed showed systems in place for monitoring patients with long term conditions and those on high-risk medicines. There was a structured system in place for inviting patients in for their long term conditions annual review. However, diabetes care could be improved further as we found patients were having annual reviews, but structured medicine reviews were not always being completed. We observed that test results on the practice clinical system were handled in a timely way. We did find that there was a delay for documents to be filed. The practice explained this was due to a member of staff leaving shortly before the assessment. After the assessment the practice provided evidence to show that this backlog had been cleared.

At our previous inspection we identified there was not a structured system in place to manage patients with chronic kidney disease (CKD) appropriately. The provider had monitored and improved outcomes for patients by carrying out clinical audits. One of these audits was on CKD care. Through our clinical searches we identified that patients with CKD received good monitoring from the practice.

We did not receive any concerns from patients relating to consent to care and treatment.

Staff we spoke to had a good understanding of consent and had received appropriate training.

The practice had a chaperone policy in place and patients were offered a chaperone when carrying out examinations. Staff who carried out chaperone duties were trained for the role and had received a disclosure and baring (DBS) check.