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We are carrying out checks at Wearside Medical Practice using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Good

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wearside Medical Practice on 31 August 2016. Overall, the practice is rated as good.

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 reporting and recording significant events. However, there was no process in place to review incidents over a period of time to identify trends and themes.
  • Risks to patients were assessed and well managed.
  • 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.
  • Data from the 2014-15 Quality and Outcomes Framework (QOF) showed patient outcomes were below average when compared to the local clinical commissioning group (CCG) and national averages. The practice provided unverified data for 2015-16, which demonstrated some improvement.
  • Data from the national GP patient survey showed although the majority of patients felt they were treated with compassion, dignity and respect, scores were variable, with some below average.
  • Information about services and how to complain was available and easy to understand. Some improvements were made to the quality of care as a result of complaints and concerns.
  • Patients told us of recent difficulty in making appointments. We found the practice had kept patients informed of recent staffing difficulties and had taken action to recruit clinical staff. The practice offered extended hours every working day and urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. However, they had not developed this into supporting business plans. The practice told us they had been through a turbulent few months, but felt they had now come through this, were in a position to move forward.
  • The practice had some governance arrangements in place, but there were areas that needed improvement.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure there are systems and processes in place to assure themselves the service operates effectively. This includes maintaining complete and accurate records, as necessary, including those related to managing the service and for staff members employed to deliver the service. Assure themselves they are appropriately registered with the Care Quality Commission (CQC), including registration for all regulated activities they plan to deliver. Consider their approach to quality improvement to ensure they make use of the full range of information available to them about the quality and safety of the service to support them to improve, including targeted use of audit and learning from complaints and significant events.

An area where the practice should make improvements is:

  • Ensure there are systems and processes in place to identify and meet the needs of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. However, there was no process in place to review incidents over a period of time to identify trends and themes.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients 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 practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. However, we found staff personnel records were disorganised and it was difficult to find information relevant to a staff members.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average when compared to the local clinical commissioning group (CCG) and national averages. Nationally reported data taken from the Quality Outcomes Framework (QOF) for 2014/15 showed the practice had achieved 82.4% of the points available to them for providing recommended treatments for the most commonly found clinical conditions. This was much lower than the national average of 94.8% and the CCG average of 95.7%. The practice recognised that staffing had previously impacted on performance across a number of areas, and they provided unverified data for 2015-16, which demonstrated some improvement.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. However, the selections of topics for audit were generated by individual clinician areas of interest and the practice had not considered how they could use audit to support them to improve as a practice.
  • 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.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 7 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed although the majority of patients felt they were treated with compassion, dignity and respect, scores were variable, with some below average.
  • 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 easy to understand and accessible.
  • The practice had identified 0.4% of their patient list as carers. They planned to improve the service offered to carers, by introducing annual health checks.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 7 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice was part of the local initiative to deliver support to patients in care homes through local integrated teams.
  • Patients told us of recent difficulty in making appointments. We found the practice had kept patients informed of recent staffing difficulties and had taken action to recruit clinical staff. The practice offered extended hours every working day and urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. However, the practice could make more use of audit and quality improvement techniques to ensure they extracted all learning from complaints.

Well-led

Requires improvement

Updated 7 November 2016

The practice is rated as requiring improvement for being well-led.

  • The practice 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. However, they had not developed this into supporting business plans. The practice told us they had been through a turbulent few months, but felt they had now come through this, were in a position to move forward.
  • The practice had some governance arrangements in place, but there were areas that needed improvement. There was a programme of clinical and internal audit. However, it was not clear how the practice used this to demonstrate quality improvement. Practice specific policies were implemented and were available to all staff. However, the practice did not have a clear process in place for reviewing and updating these. Staff records were disorganised and not all the expected information was retained or available.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice sought feedback from staff and patients, which it acted on. The practice was taking action to reinvigorate the patient participation group.

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Checks on specific services

Older people

Good

Updated 7 November 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

People with long term conditions

Requires improvement

Updated 7 November 2016

The practice is rated as requiring improvement for the care of patients with long-term conditions.

  • The practice had lower performance on a number of indicators within the Quality Outcomes Framework (QOF) for 2014/15, when compared to local and national averages. Overall the practice had achieved 82.4% of the points available to them for providing recommended treatments for the most commonly found clinical conditions. This was much lower than the national average of 94.8 and the local clinical commissioning group (CCG) average of 95.7%. The practice achieved lower performance on groups of indicators relating to long-term conditions such as diabetes, asthma and hypertension. For example, the practice achieved 72.4% of the points available for diabetes related indicators. This compared to an average performance of 93.5% across the CCG and 89.2% national average. The practice provided unverified data for 2016-17 which showed some level of improvement.
  • Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
  • Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
  • Patients had regular reviews to check health and medicines needs were being met.
  • For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 7 November 2016

The practice is rated as good for the care of families, children and young people.

  • The practice had identified the needs of families, children and young people, and put plans in place to meet them.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice’s uptake for the cervical screening programme was 82.4%, which was slightly higher than the CCG average of 81.7% and national average of 81.8%.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Working age people (including those recently retired and students)

Good

Updated 7 November 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. Extended hours surgeries were offered each weekday from 7am for working patients who could not attend during normal opening hours.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
  • Additional services were provided such as health checks for the over 40s and travel vaccinations.

People whose circumstances may make them vulnerable

Good

Updated 7 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances, including those with a learning disability.
  • Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
  • The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.
  • The practice had systems in place for identifying carers. They planned to ensure carers were offered a health check and referred for a carer’s assessment.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 November 2016

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

  • The practice had identified 0.8% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services.
  • The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
  • Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
  • The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
  • They had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support people with mental health needs and dementia. The practice carried out advance care planning for patients with dementia.