The Humbleyard Practice

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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 6 quality statements from this key question. We have combined the scores for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good. We found staff involved people in decisions about their care and treatment and provided them with advice and support. Staff supported people to live healthy lives and provided them with support and information on their care and treatment. Leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of everyday work. Our clinical searches highlighted some instances where care was overdue but overall, staff reviewed people’s care and worked with other services to achieve this.

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.

People told us they felt their individual needs were appropriately and regularly assessed; and fully understood. They felt involved in the assessment of their needs.

Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or texting patients instead of phoning them. Staff checked people’s health, care and wellbeing needs during health and medicine reviews. They were also proactive; for example, offering vaccinations and cervical screening when patients attended for other reasons.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. Staff could refer people with social needs to a social prescriber. For example, those experiencing social isolation. Our clinical searches reviews highlighted that the provider had effective systems to identify people with previously undiagnosed diabetes and that patients with chronic kidney disease were being appropriately monitored. We also saw that the frequency of medication reviews was in line with national guidance. However, we identified some instances where blood tests, blood pressure readings and weight monitoring were overdue. In addition, 4 out of the 5 patient records reviewed of people prescribed oral Non-steroidal anti-inflammatory drugs (NSAIDs) pain relief medication had not also been co-prescribed NICE recommended Proton Pump Inhibitor medication (to reduce the amount of stomach acid). When these concerns were highlighted, the provider took immediate action to contact patients. Action had been taken since our last inspection such that the practice’s cervical screening system had a failsafe in place to ensure a result was received for each test taken and that appropriate action was taken based on the result. This included samples undertaken by locum nurses. An audit had recently taken place which we noted did not identify any missing results. Unverified data provided by the practice indicated that cervical screening uptake rates were 78% (age 25-49) and 80% (age 50-64).

People spoke positively about how clinicians highlighted current good practice that was relevant to their care and also explained risks/side effects and benefits of medicines in a way they understood.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way the practice delivered care. For example, hormone replacement therapy (HRT) prescribing had recently been audited to ensure it was in accordance with National Institute for Health and Care Excellence (NICE) best practice guidelines.

The provider’s systems ensured that staff were up to date with national legislation, evidence-based good practice and required standards. For example, weekly operations meetings covered topics such as a review of the practice’s cold chain protocols and a ‘sharing learning’ exercise following the practice’s Respiratory Syncytial Virus clinic. We saw evidence that people received care, treatment and support that was evidence-based and in line with good practice standards.

People told us that referrals considered their individual needs, circumstances and ongoing care arrangements. We also heard that when people received care from different services, it was effectively co-ordinated.

Staff spoke positively about good working relationships: both between the practice’s administrative and clinical teams; and also with local community based services.

The practice had partnered with a local community pharmacy to raise patients’ awareness about common conditions that could be treated by local pharmacies. A local community pharmacist spoke positively about the initiative and how information was shared between teams and services to ensure continuity of care.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services.

People told us they were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. They were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary.

Staff told us that the provider focused on encouraging and supporting people to make healthier choices to help promote and maintain their health and wellbeing. This included opportunistic approaches such as offering cervical screening, blood pressure checks and advising about smoking or drinking habits when the patient attended for other reasons.

Systems were in place to focus on identifying risks to people’s health and wellbeing early and on how to support people to prevent deterioration. For example, proactive appointment recall processes for patients with long term conditions. The practice also had a range of processes to support people to live healthier lives. e.g. offering home visits to patients with a learning disability and for patients experiencing poor mental health who found it difficult to attend for appointments. The practice also engaged with the local ‘Together for Mental Wellbeing team’ to accompany patients to their annual health reviews.

People spoke positively about effective approaches to monitoring their care, treatment and outcomes. For example, proactive medications reviews and blood tests for people with long term conditions.

Staff told us that there were effective approaches to monitor people’s care and treatment and their outcomes. For example, nursing staff explained arrangements for encouraging attendance for child immunisations and cervical screening and opportunistic interventions.

There were processes to monitor people’s care and treatment and improve outcomes. For example, the provider routinely undertook clinical audits: initially identifying improvement areas, undertaking improvement activity and then re-assessing for evidence of improved outcomes. We noted a lead GP was also routinely quality assuring nurses’ and physician associates record keeping.

Leaders sought to ensure that continuous improvements were made to people’s care and treatment. For example, hormone replacement therapy (HRT) prescribing had recently been audited to ensure patients were being safely prescribed HRT in accordance with best practice guidelines. The two cycle audit saw the percentage of appropriately coded records increase from 26% to 53%.

People told us they received information about care and treatment in a way they could understand and had appropriate support and time to make decisions.

Staff understood the importance of ensuring that people fully understand what they were consenting to and the importance of obtaining consent before they delivered care or treatment (for example regarding minor surgery). They had received training on the requirements of the Mental Capacity Act 2005, including for example the duty to consult others such as carers, families and/or advocates, where appropriate.

There were systems and practices to support clinicians in determining the patient’s ability to consent to any proposed treatment, medication or referral and which ensured that people understood the care and treatment being offered or recommended.