Pudding Pie Lane 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

We assessed 2 quality statements in the effective key question and found areas of good practice but also identified some concerns. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. People were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. The national GP Patient Survey results indicated patients felt involved in their care and treatment and felt their needs were met. The needs of the carers of people using services were assessed and met. However, we found some shortfalls in the systems and processes to recall patients to review and monitor their care and treatment.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from care homes where patients live told us they have regular visits from named clinicians from the practice who are supportive and listen to staff at the care home raising concerns about patients. Results of the national GP Patient survey showed patients felt the healthcare professional they saw or spoke to was good at giving them enough time and was good at listening during their last GP appointment.

Staff and leaders told us the practice had a programme of targeted quality improvement and used information about care and treatment to make improvements. Staff received regular training and updates via monthly meetings, emails and education sessions. Leaders told us recent changes have given a patient's named GP the responsibility of contacting patients that continue not to respond to review invites. There are named clinicians that work closely with local care homes where patients live to ensure their needs are assessed and met. Staff told us they have a buddy system for when they are on leave so another GP will check pathology test results. Leaders told us they are aware their hypnotic prescribing is higher than expected and had arranged for an external consultant to attend a practice meeting to provide advice and guidance to manage this. Staff had the time to spend with patients and were dedicated to provide positive outcomes.

The practice had processes and policies in place to support staff with assessing the needs of patients. There was a processes to prioritise care for their most clinically vulnerable patients. The practice had a system in place to identify people with caring responsibilities. Patients with long-term conditions were offered an annual review to check their health and medicines needs were being met. However, we found staff carrying out reviews of patients with long-term conditions had not always received specific training. We spoke to a member of staff who carried out asthma reviews who told us they had not completed any formal qualification training in asthma. Following the onsite visit, the practice provided evidence of update training which had been completed since the inspection for this member of staff. However, this was not a formal asthma qualification. Monthly searches were run to identify patients that require a medicine review or monitoring. However, our clinical searches identified the practice's searches are not always effective as we found 10 patients prescribed Methotrexate (medicine to treat autoimmune conditions) were overdue monitoring. Following the onsite visit, the practice told us 9 of these patients monitoring was recorded on an external patient reporting system. However, at the time of the onsite visit, the practice’s own patient records did not provide assurance this monitoring had been reviewed before prescribing. The practice had implemented a spreadsheet to provide an oversight of overdue reviews and monitoring but this process had not yet been fully embedded in the practice.

We received feedback from care homes where patients live. The care homes told us they have regular visits from named clinicians from the practice which supports with the continuity of care for those patients.

Staff used national frameworks and guidance to deliver care and treatment. For example, nursing staff used Patient Group Directions when administering vaccines, received monthly update emails, completed appropriate training and had access to the Green Book (information for public health professionals on immunisation). Staff and leaders told us with a consistent staff team and their named-GP approach, they are able to provide continuity of care to patients.

The practice had a prescribing protocol and a system to invite patients in for high-risk drug monitoring. However, we found this was not always effective. We found 38.6% (551 of 1391) of patients aged over 70 and prescribed antiplatelets or non-steroidal anti-inflammatory drugs (NSAIDs) should have been prescribed or considered a medication to protect their stomach lining in line with national guidance. We reviewed 5 records and found that prescriptions had not been issued or discussed placing them at increased risk. Following our onsite visit, the practice told us they the Medicine Management Lead had reviewed all these patients. Our clinical searches found 101 patients as having a potential missed diagnosis of diabetes. We discussed this with the practice who told us they were aware of coding issues and were working through the patient records to address this. The practice had carried out 4942 medicines reviews in the previous 3 months and we did not identify any concerns. We reviewed the clinical records of patients with long term conditions. We found 183 of 2987 patients with asthma had received 2 or more courses of rescue steroids in the last 12 months. We reviewed 5 of these patient records and found inconsistencies with how these patients were assessed at the time they were prescribed this medicine.

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.

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.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.