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Shropshire Doctors Co-Operative - Longbow Close Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shropshire Doctors Co-operative Limited on 8th February 2017. Overall the service is rated as outstanding.

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

  • There was an open and transparent approach to safety and an effective system in place for recording, reporting and learning from significant events.
  • Risks to patients and staff were comprehensively assessed and well managed.
  • Patients’ care needs were assessed and delivered in a timely way according to need. The service met the National Quality Requirements (NQRs).
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • There was a system in place that enabled staff access to patient records, and the out of hours staff provided other services, for example the local GP and hospital, with information following contact with patients as was appropriate.
  • The service managed patients’ care and treatment in a timely way.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The service worked proactively with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate and improved the patient experience.
  • The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
  • There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour. Staff training in the duty of candour had resulted in increased recording of significant events.

We saw areas of outstanding service:

  • Risk management and complaints were comprehensively managed through an integrated system and every opportunity was used to learn from incidents and events. Learning was shared with other healthcare providers, Clinical Commissioning Groups (CCGs) as well as to all staff internally. Educational sessions were arranged internally to promote the safety of patients following a significant event.
  • Comprehensive systems and processes were in place to promote the safe transport of medication and equipment. These included controlled drugs stored in boxes with fob access for GPs and temperature control measures within vehicles that carried medication and equipment.
  • The provider consistently demonstrated that responsive actions were taken to safeguard patient safety as well as improve patient experience. This was supported by consistent and highly positive data from patients when asked questions relating to the responsiveness of the service. 

  • Shropdoc demonstrated a proactive approach when responding to the needs of patients that could not be met by other health providers, commissioned to provide that service.

  • There were examples of how an innovative approach had been used to improve the patient experience and support other healthcare providers particularly those in secondary care. These included an oncology service, clinical support to local GP practices and the implementation of a Patient Aligned Care team (PACT).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 June 2017

The service is rated as good for providing safe services.

  • The service used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation.
  • Information about safety was highly valued and was used to promote learning and improvement.
  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. For example, comprehensive infection control audits and risk assessments were carried out annually at each of the primary care centres. Equipment check sheets completed daily, included pictorial aids to assist the member of staff who carried out the checks.
  • Medicine usage was monitored and prescriptions controlled to minimise risk of fraud.
  • When things went wrong patients were informed in keeping with the Duty of Candour. They were given an explanation based on facts, an apology if appropriate and, wherever possible, a summary of learning from the event in the preferred method of communication by the patient. They were told about any actions to improve processes to prevent the same thing happening again.
  • The out-of-hours service had clearly defined and embedded system and processes in place to keep patients safe and safeguarded from abuse.
  • When patients could not be contacted at the time of their home visit or if they did not attend for their appointment, there was a documented process in place that informed staff of the follow up procedure. For patients who were frail and vulnerable, the procedure included contacting A&E to try and locate the patient and contact to the police to carry out a ‘safe and well’ check.
  • There were systems in place to support staff undertaking home visits. For example, staff rotas included a ‘complex needs person’, on duty as a standby for advice and a list of contact numbers provided included consultants, the ambulance service, mental health crisis teams and community professionals.
  • Staff 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.
  • Risks to patients and staff were assessed and well managed through an integrated risk management system that collated information from complaints, incidents (near misses) and significant events.

Effective

Good

Updated 20 June 2017

The service is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We saw evidence to confirm that the service used these guidelines to positively influence and improve service and outcomes for patients.
  • The service was consistently meeting most of the National Quality Requirements (performance standards) for GP out of hours services to ensure patient needs were met in a timely way.
  • The service used innovative and proactive methods to improve patient outcomes and working with other local providers to share best service.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Clinicians provided urgent care to walk-in patients based on current evidence based guidance.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 20 June 2017

The service is rated as outstanding for providing caring services.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, the provider continued to support the NHS 111 service through a duty of care to their patients and a ‘selfie’ (teledermatolgy) service facilitated the care for patients in their own home.
  • Views of external stakeholders were very positive.

  • Feedback from the large majority of patients through external patient surveys commissioned by the provider were very positive.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Patients were kept informed with regard to their care and treatment throughout their visit to the out-of-hours service.

Responsive

Outstanding

Updated 20 June 2017

The service is rated as outstanding for providing responsive services.

  • The service worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, Shropdoc acted as a care coordination centre, a 24 hour service that supported GP surgeries in Shropshire and Powys.
  • Service staff reviewed the needs of its local population and engaged with its commissioners to secure improvements to services where these were identified. For example, a ‘selfie’ service was introduced to facilitate a dermatology assessment by telephone.
  • Shropdoc demonstrated a proactive approach when responding to the needs of patients that could not be met by other health providers, commissioned to provide that service.

  • The service had good facilities and was well equipped to treat patients and meet their needs.
  • The service had systems in place to ensure patients received care and treatment in a timely way and according to the urgency of need.
  • Data from an independent survey into the responsiveness to patients was consistently and highly positive.

  • Information about how to complain was available and easy to understand and evidence showed the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 20 June 2017

The service is rated as outstanding for being well-led.

  • The service had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • High standards were promoted and owned by all service staff and teams worked together across all roles.
  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best service.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty. The service had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • There was a strong focus on continuous learning and improvement at all levels.