The Osmaston Surgery Also known as Dr I R Shand & Partners

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

There continued to be a breach of Regulation. We found ongoing concerns in the quality statements for assessing needs; delivering evidence-based care and treatment; supporting people to live healthier lives; and monitoring and improving outcomes. Systems for assessing the management of patients with long-term conditions were not fully embedded into practice. We continued to find issues regarding the management of patients with asthma, hypothyroidism and diabetes. Systems to support patients to live healthier lives were restricted because there were still not enough practice nursing hours to provide adequate cervical screening or childhood immunisations. There continued to be limited evidence that clinical audits were being followed up and used to drive improvements in patient outcomes The uptake of childhood immunisations for 5 year olds continued to be below the national target and the uptake of cervical screening remained significantly below the national target. However, there had been some improvements in the delivery of effective care and treatment since our previous assessment. Clinical and multi-disciplinary meetings were now in place and there were systems in place to review patients at the end of their life. Systems were in place to obtain patient consent to care and treatment.

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 spoke with a patient who told us they had unsuccessfully been trying to get an appointment for a review of their long-term condition for 8 weeks. This meant they had not received the health review they required.

Leaders told us they had implemented a new system for the management and assessment of patients with long-term conditions. Patients were called for an assessment in their birth month and monthly searches were undertaken by a dedicated team of staff to monitor this. Leaders told us they used structured templates to assist them which simplified the process and made it easier to identify patients who needed to be assessed. Most patients were invited for their assessment by text message, which included a link to directly book their blood tests before attending their assessment. Staff told us there were systems in place to support and assess patients experiencing poor mental health.

There were policies in place to support clinical staff in the management and assessment of patients. However, the policy for patients with long-term conditions did not include advice on how to deal with patients who were non-compliant with assessment. Systems for assessing the management of patients with long-term conditions were not fully embedded into practice. Our remote clinical searches found that patients did not always attend for blood tests or assessments and medicine reviews had not been completed as required. There had been multiple attempts to recall these patients however, further management options had not been considered. We reviewed the records of 5 patients who had received 2 or more courses of rescue steroids to treat an exacerbation of their asthma. None of these patients had received a follow up consultation within 48 hours and steroid cards had not been provided, in line with national guidance. Two patients had not had an asthma review within the previous 12 months. The GP partners told us the nurse responsible for asthma reviews had left in January 2024 and had not yet been replaced. We reviewed the records of 5 patients diagnosed with hypothyroidism. None of these patients had attended for routine blood monitoring within the last 18 months or, had a medicine review coded in their records within the last 12 months. We reviewed the records of 5 patients with diabetes. The practice had tried to recall these patients however, a clear process for reviewing them was not in place. Only 1 of the 5 patients’ records we looked at had their diabetes and diabetic medicine assessment completed since their last blood test.

Compliments received by the practice showed that some patients felt confident with how their care was managed and that time was taken to explain everything thoroughly. This was in contrast to comments received by Healthwatch which suggested that patients did not always feel what was important to them was taken into account. Two patients felt the GP they had seen had been dismissive of their symptoms and not listened to their concerns. One patient stated they did not receive appropriate care following their consultation and were not referred to secondary care immediately in line with the condition they presented with.

Leaders told us the service followed best practice guidance and standards. They told us that evidence based clinical templates, which were updated regularly to support the care and treatment of patients, had been implemented into practice since our previous assessment. They told us that the practice followed the Derbyshire medicines management and clinical policies to ensure consistency and best practice when prescribing.

National guidance had not always been adhered to in the management of patients with asthma, hypothyroidism and diabetes to ensure care and treatment was evidenced based. However, systems were in place to act up Medicines and Healthcare products Regulatory Agency (MHRA) alerts and other safety alerts. These were overseen by the provider. Primary Care Network pharmacy staff supported the practice to take action as required. Our remote clinical searches showed that action had been taken where required and patients had been contacted in relation to specific safety alerts.

End of life care was delivered in a coordinated way. The practice worked with the multi-disciplinary community support team to review the care and treatment for this group of patients. From the minutes we reveiwed, we found examples where patients had been supported to die in their chosen location for example, at home.

Staff told us that receptionists were provided with standard operating procedures to support them to triage patients to the most appropriate clinician. There were clear guidelines for the types of ailments the advanced care practitioners could and could not see.

A representative from a care home where the practice provided care and treatment told us that the systems put in place by the practice to support collaborative working and care had been ineffective. However, since July 2023, these systems had been reviewed and there had been a significant improvement. They told us that a GP partner oversaw the care provided at the home and that they were responsive to any concerns they had regarding people living at the home. A weekly ward round was provided at the care home and staff had access to the home visiting team and the GPs if people required care in between ward rounds. A member of the Derbyshire Health Inequalities Partnership told us the practice and the social prescriber had put plans in place to work with the partnership to address health inequalities for ethnic minority groups in the local area. For example, to increase the uptake of cervical screening and childhood immunisations. This partnership had recently started and needed to be embedded into practice before the effectiveness could be assessed.

There were processes in place to support the practice to work effectively across teams and services to support patients. The practice worked closely with the Primary Care Network (PCN) hub and patients had access to the same services as available at the practice. Staff working at the hub were able, with consent, to access patients’ clinical records and past medical history and treatment. The practice also worked with the complex needs service, which offered services such as social care, physiotherapy, occupational therapy and mental health support.

A member of the Derbyshire Health Inequalities Partnership told us that the practice and the social prescriber had put plans in place to work with the partnership to address health inequalities for ethnic minority groups. For example, a GP partner was attending a meeting at the community centre in May 2024 to engage with women and discuss the importance of cervical screening. They also had plans in place to raise the importance of childhood immunisation.

A member of the nursing team told us they were responsible for completing assessments for patients with diabetes and used evidence based clinical templates to support them. Where appropriate, they referred patients to the specialist diabetic nurses and the Expert Patient Programme for diabetes. The nursing team provided childhood immunisations however, this was restricted due to the lack of practice nursing hours. The nursing team did not routinely offer cervical screening at the practice. Patients were booked into the extended access hub instead. Leaders told us the practice had used text messaging to invite patients for their annual flu vaccine. They told us that a positive consequence of this was an increase in the uptake of the flu vaccine in the over 85 year old population.

There were systems in place to support patients to live healthier lives however, these were restricted due to not enough practice nursing hours to provide all of the services required. For example, cervical screening.

Our remote clinical searches identified that patients’ care and treatment had not always been monitored to assess if there had been an improvement in patients’ health. For example, patients with asthma, who had received 2 or more courses of rescue steroids to treat an asthma exacerbation, had not received a review within 48 hours to monitor that the treatment had been effective.

A member of the nursing team told us that they were not aware of any clinical audits taking place and they did not audit any aspects of the nursing service delivered at the practice.

During our assessment we did not see any evidence that the provider monitored and improved outcomes for patients by carrying out clinical audits. The provider had carried out audits to monitor and review the most frequent attendees over the previous 12 months and patients without a copy of a Do Not Attempt Cardiopulmonary Resuscitation plan in their records. However, there was no second cycle to review the effectiveness of these audits. Following our assessment the provider did complete a second cycle of this audit and sent evidence to the CQC.

National data showed that there had been an increase from 87% to 91% in the percentage of children aged 1 year who had received the appropriate immunisations since our previous assessment. There had been a slight decrease in the uptake of childhood immunisations for 2 years old children. The uptake of childhood immunisations for children aged 5 years was 78% which remained below the national target of 90%. Data showed that the uptake of cervical screening was 57% and remained significantly below the national target of 80%. The practice had started to engage with Derbyshire Health Inequalities Partnership to address health inequalities for ethnic minority groups to improve the uptake of cervical screening and childhood immunisations. However as yet there had been no impact on patient outcomes for this group of patients.

We did not receive any feedback from patients regarding peoples’ experiences of consent to care and treatment as part of this assessment.

The practice was aware that copies of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) plans were not available in all of the appropriate records. In response to this they had carried out a search of patients with a DNACPR in place and requested a copy of the DNACPRs so they could be scanned into patients’ records. The search showed that 47 patients had a DNACPR plan in place. A copy of this was held in the records of 20 of these patients. A copy of the DNACPR form was not available in the records of 26 of these patients, the practice had requested a copy of the missing plans to scan into the patients’ records. One patient needed their DNACPR reviewing. This meant that an accurate record of consent for a DNACPR plan was not always in place. Following our assessment, the provider sent us a repeated search which showed that most of the plans were not in patients’ records. A member of the nursing team told us that the template for childhood immunisations included a section to record consent.

There were policies in place to support staff when obtaining consent from adults, children and patients that lacked mental capacity. DNACPR decisions were made in line with relevant legislation. We found that clear discussions were recorded in the patients’ electronic records regarding the decision to put a DNACPR plan in place if this had been initiated or reviewed by the practice.