You are here

Principal Medical Limited Registered Office Good

Inspection Summary


Overall summary & rating

Good

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Principal Medical Limited on 21 and 22 March 2017. Principal Medical Limited is a GP federation providing specific services for the majority of GP practices in Oxfordshire and also South Northamptonshire. It has been owned by GPs since being created in 2004 and is run by a variety of clinical and non-clinical staff. They deliver services via associated member GP practices by sub-contracting services or directly via employed staff. Overall the provider is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open culture of learning and the provider enabled their services to be dynamic in their design and delivery.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, due to the difficulty in gathering all staff groups for meetings at one time, sharing of outcomes was not always formalised. There was good alternative communication.
  • The provider had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained and provided with the skills, resources and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke, those who left feedback and survey data showed that the level of satisfaction among those who used the service was high. This included access to staff, communication and the quality of services received.
  • The provider ensured there were the required facilities and equipment to enable staff to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The provider proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the provider complied with these requirements.

The areas where the provider should make improvement are:

  • Review the processes for ensuring relevant staff receive learning outcomes from significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 May 2017

The provider is rated as good for providing safe services.

  • We found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the provider.
  • Due to the community based nature of the services provided, some staff reported they did not frequently attend meetings where feedback from significant events was discussed. There were alternative feedback mechanisms in place.
  • When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The provider had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The provider had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 31 May 2017

The provider is rated as good for providing effective services.

  • Staff were aware of current evidence based guidance.
  • Clinicians and care staff had remote access to information required in the delivery of services. They were able to share information remotely to ensure GP providers and other services had access to care data.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Care was coordinated with external services where necessary including health, voluntary sector and social support services.

  • provider

Caring

Good

Updated 31 May 2017

The provider is rated as good for providing caring services.

  • Data from internal surveys and the friends and family test showed patients rated the services provided highly for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • Feedback showed staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 31 May 2017

The provider is rated as good for providing responsive services.

  • The provider understood its population profile and had used this understanding to meet the needs of its population.
  • Assessments of patients’ needs included impact of a patient’s condition on their daily lives, including any hospital admissions and the needs of their carers.
  • There were portfolios of local support organisations to which staff could refer patients.
  • Patients we spoke with and survey data indicated they could access the service when needed for any ongoing support needs. The provider prioritised home visits based on the type of service they were requested to provide. The staff who work on the service provided assessments of patients’ needs, diagnose problems which may require other professional care or treatment or provide care directly to those patients. This ensured patients saw the right staff at the right time.
  • Staff had access to the facilities they needed to treat patients and meet their needs.
  • Information about how to complain was available and evidence from the examples we reviewed showed the provider responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 31 May 2017

The provider is rated as good for being well-led.

  • The provider had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The provider had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The leadership team encouraged a culture of openness and honesty. The provider had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The leadership team proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. provider
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority.
Checks on specific services

Older people

Good

Updated 31 May 2017

The provider is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The provider offered proactive, personalised care to meet the needs of the older patients. The hospital at home service assessing their circumstances and delivered tailored care to meet their needs.
  • The home visiting service was organised in coordination with GP practices, enabling the information staff needed to be shared in a timely way.
  • As part of the services delivered the provider followed up on older patients discharged from hospital and ensured that their care plans met their needs and identified any additional requirements.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
  • During assessments of patients’ needs the collaborative care team and hospital at home teams assessed the impact of a patient’s condition on their daily lives including any hospital admissions and the needs of their carers.

Families, children and young people

Good

Updated 31 May 2017

The provider is rated as good for the care of Families children and young people.

  • Neighbourhood access / GP access hubs provided children with quick access to GP and nurse appointments that they may not otherwise be able to access at their own registered GP practice.
  • GPs and nurses were trained in safeguarding children and had access to information making referrals to local safeguarding teams.

  • Staff received training on obtaining consent from patients under 16 years old and had access to guidance.

Working age people (including those recently retired and students)

Good

Updated 31 May 2017

The provider is rated as good for the care of Working age people (including those recently retired and students)

  • Neighbourhood access / GP access hubs provided working age people with quick access to GP and nurse appointments that they may not otherwise be able to access at their own registered GP practice. This enabled consultations and care for acute problems that were not related to the ongoing care for any long term conditions.
  • Staff across all the services were facilitated to signpost patients to, where appropriate, to public health programmes such as smoking cessation and weight management.

People whose circumstances may make them vulnerable

Good

Updated 31 May 2017

The provider is rated as good for the care of people whose circumstances may make them vulnerable.

  • Help and information was provided to support daily living including signposting to financial help charities, allowance applications, blue badge applications for patients with disabilities, an emergency carers’ service and befriending services.
  • Staff were facilitated to signpost patients to, where appropriate, public health programmes such as smoking cessation and weight management.
  • All staff were able to access translation services for patients that required this.
  • There was access to interpreters for patients requiring signing.
  • Assessments of any patients’ sensory impairments were undertaken on or before the provision of care and access to the service. For example, the hospital at home service used warning alerts to notify if a patient was unable to utilise the phone through hearing impairment and thus how communication was facilitated.
  • The provider regularly worked with other health care professionals in the case management of vulnerable patients.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 May 2017

The provider is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The provider was taking part in an initiative along with other providers to support patients with potential mental health needs. Specifically anxiety and depression associated with specific long term conditions. This was partly aimed at identifying training that would benefit staff to support patients.