High Green Medical Practice

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 all quality statements from this key question. Our rating for this key question is good. People’s needs were assessed including their medical, mental, physical wellbeing. Safety netting advice was provided, and people knew what to do if their condition deteriorated. People were involved in decision making regarding their care and the needs of carers of people using services were met. Staff involved the person to make care and treatment decisions and provided advice and support following evidence-based good practice standards. Staff regularly 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.

Data from the national GP survey (unverified by CQC) showed 83% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment, compared to a local and national average of 92%.

Staff we spoke with demonstrated an awareness of the needs of their local community. Reception staff told us they used digital flags within the care records systems to highlight any specific individual needs, such as translation services required. Nurses referred people with long term conditions to the in-house social prescriber who provided them with information about support services such as weight management and housing support.

There were standardised templates within the health records system used by clinicians when they conducted appointments. These enabled them to assess patients effectively and recommend medicines in line with local and national guidelines. The practice employed a social prescriber who supported people experiencing social needs impacting on their health, such as those experiencing social isolation and housing difficulties.

Results from the latest national GP patient survey (unverified by CQC) showed 87% of the respondents had confidence and trust in the healthcare professional they saw or spoke to during their last general practice appointment, compared to a local and national average of 92%.

Staff we spoke with told us they held clinics to support people with long term conditions such as asthma, diabetes and chronic heart disease. They told us they used local and national guidelines, and kept up to date with them through training and updates circulated within the practice.

Staff had access to local and national guidelines which could be accessed easily through online platforms with links to guidance also available through their clinical system. Updates to guidance were shared with all relevant staff at meetings whose minutes were circulated to ensure all staff were aware. Clinical audits were conducted to ensure care was delivered in line with legislation and recommended guidelines. For example, the practice carried out regular audits of women of childbearing age receiving sodium valproate (a medicine used to treat epilepsy and bipolar disorder which if taken during pregnancy, can cause birth defects). Women identified were contacted and consulted regarding contraception advice or medication changes if they wanted to get pregnant. We carried out remote clinical searches during our assessment to review the monitoring of people with long term conditions in line with recommended guidelines. We found only one patient with chronic kidney disease was overdue monitoring. thirteen patients with hypothyroidism had not had thyroid function test monitoring for 18 months; we reviewed five of these and found they all been invited for review and not complied.

Results from the national GP survey (unverified by CQC) showed 59% of respondents said they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses, compared to the local and national average of 68%. We spoke with three people in the waiting room during our assessment who told us they were unhappy they had to travel to have blood tests as the practice did not provide this service. Feedback received from Healthwatch about people's experience showed some people felt they could not afford the cost of travel to obtain blood tests, which resulted in delayed or non-attendance.

Staff told us the medical secretary referred patients to external services and audited urgent referrals to ensure that patients were seen in a timely manner. Non-clinical staff told us they worked well with clinicians within the team and held all staff meetings every month which improved communication between the teams.

Data from the Nottingham and Nottinghamshire Integrated Care Board's quality monitoring system showed negative performance in national cancer indicators for breast, bowel and cervical cancers. These indicators were also highlighted in our previous inspection report dated February 2018. Feedback from them indicated the practice engaged with them to review performance and ways to improve. During our assessment we were assured the practice continued to engage people by encouraging them to participate in cancer screening programmes in different ways. For example, people whose first language was not English were sent information in their preferred language and interpreters were used where appropriate.

There were regular meetings with community nurses, palliative care nurses and specialist nurses to review patient care of vulnerable people. There was a process for auditing referrals to other services to ensure they were received and acted on in a timely manner. Additionally, patients were advised to contact the practice if they had not received communication from the onward referral within a specified timescale.

Results from the national GP survey (unverified by CQC) showed 88% of respondents said were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, compared the local average of 90% and national average of 91%. 63% of respondents said the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment, compared to a local average of 71% and national average of 73%.

Staff we spoke with told us people with long term conditions were supported to live healthier lives by referring them to lifestyle support services such as smoking cessation and weight management services.

There were call and recall processes for people who required reviews periodically, for example people with long term conditions or those receiving medicines which require regular monitoring. People were invited three times using a variety of different communication modes, and all invitations were communicated in the patient’s preferred language. If they did not engage, this was escalated to GPs to contact them directly.

Clinical pharmacists based at the practice monitored registered patients who lived in residential and care homes. They told us they reviewed all patient medication and any concerns found were communicated to the GPs.

Pharmacists told us they had debriefing sessions with GPs, which promoted safety and consistency in managing people's medicines. Leaders told us they were aware of their performance in cancer screening and childhood immunisations. They were able to demonstrate how they invited eligible patients and used alerts on clinical records so that any member of staff interacting with them reminded them. The practice also collaborated with neighbouring practices within their primary care network to improve cervical cytology uptake through educating people in the importance of early screening.

There was a system for ensuring all clinicians were aware of medication changes made within the clinical system by flagging this to the prescribing task group. Clinical pharmacists had an audit programme in place to monitor medicines. For example, they audited all patients on repeat antibiotics and identified those where medicines should have been stopped as they would no longer be effective. Learning from the audit was shared with all prescribing clinicians to ensure the antibiotics were prescribed as needed only.

National data showed the uptake of cervical screening was 40.8% in June 2023, below the national target of 80% and a significant decline since our last inspection. Published data on breast and bowel cancer remained significantly below local averages. There had been a slight decrease in the percentage of children aged 1 year and 5 year old children who had received the appropriate immunisations resulting in the national minimum target of 90% not being achieved in March 2023. The practice adopted a good practice checklist, developed by the local ICB in collaboration with local Cancer Research UK colleagues, which had been designed to support practices improve cervical screening uptake and self-assess that all appropriate measures were being taken to encourage and support women to attend the practice for cervical screening. The checklist was completed in May 2024 with dates set for a review of their progress in May 2025. Therefore improvements were yet to be observed in this area.

People we spoke with were aware they could have a chaperone present at appointments if they needed one. They told us their consent was sought for specific procedures, for example, intimate examinations.

We spoke to staff regarding obtaining consent to provide care and treatment to people. The practice nurse told us that they use a consent template provided within the clinical computer system for every person they consult with. This template is then saved within the person’s medical record. The nurse also told us that they were aware of their responsibilities if they consulted with a child who was not accompanied with their parent or guardian and assessing if the child was competent to be seen alone and treatment provided to the child following Gillick and Fraser guidelines. GPs we spoke with understood the requirements of legislation and guidance when considering consent and decision making where a patient is lacking capacity and always consider what is in the persons best interest and that the past views of the person are taken into account.

We saw evidence of a comprehensive consent guidance policy which detailed Gillick and Fraser guidelines and when a child is deemed competent to make a decision on their treatment and guidelines for people who lacked capacity. We reviewed three peoples’ records who had a Do Not Attempt CPR (DNACPR) decision recorded in their medical record. The DNACPR forms detailed the person’s wishes, and if they wanted CPR or not. There were clearly documented decisions with clinical information, details when the decisions were made, and who was present when the decisions were made, evidencing that the decisions were not discriminatory. The decisions were all approved by a GP Partner who knows the person. We saw that all three people also had a ReSPECT form completed. ReSPECT means, “Recommended Summary Plan for Emergency Care & Treatment”, which explores the person’s preferences and records the agreed clinical recommendations for their care and realistic treatment in the event of a future emergency in which they cannot make or express decisions at the time.