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Inspection Summary


Overall summary & rating

Good

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Homewell.Curlew practice on 2nd July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. The practice is also rated as good for the six population groups which are older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • The practice had recently merged and involved patient groups to minimise disruption to care.
  • Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • 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 proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 September 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement.

Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep patients safe.

Effective

Good

Updated 10 September 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health.

Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 10 September 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. 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. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 10 September 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 September 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management.

The practice had policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

Older people

Good

Updated 10 September 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

Patients over 75 have a named GP and are invited to have a health check when they reach their 75th birthday. The GP would screen the patient’s notes and decide what, if any, blood tests or other tests may be required.

The practice had a telephone hub that was staffed by a Nurse Practitioner or GP during the day. This provided direct contact with a clinician throughout the day.

Older patients were encouraged to see their regular GP and the reception staff and clinicians in the hub assisted with booking appointments appropriately. This included organising preliminary tests prior to appointments.

For example: if an elderly person called up with a new onset of shortness of breath then an ECG and full set of observations would be recorded by the health care assistant (HCA) prior to seeing the GP that day, or it may be at the time of booking staff notice that some blood tests are outstanding the practice would fit them in with the HCA on the same day they were attending to see the GP to ease the difficulty of accessing other services for this group

For urgent care, patients were seen on the day either at the practice or at home. The practice had a register of patients who were unable to attend the practice.

The practice had recently invested in a visiting GP service. A GP would start visiting patients at their home in the morning as visit requests are coming in. This has helped patients receive care sooner than previously and sometimes helped prevent hospital admissions by having more time in the day to organise care via other agencies. This in turn has provided GPs with protective time at lunchtimes when they traditionally would have visited. They can use the time to organise referrals, plan care, prescriptions, attend meetings.

Seasonal Influenza, Pneumococcal and Shingles vaccination clinics were arranged and the practice visited patients at home if required to vaccinate.

People with long term conditions

Good

Updated 10 September 2015

The practice is rated as good for the care of people with long-term conditions.

The practice maintained a Case Management Register (CMR) for patients with complex needs or those at high risk of admission.

Patients on this register had care plans and direct line access to the practice. Meetings were held monthly to discuss care for these patients within the multidisciplinary team (MDT).

The practice also maintained a gold standards framework (GSF) register for palliative care patients and monthly MDT meetings with the integrated care team and external organisations.

The practice maintained a register of people with long term conditions. Patients on this register were invited to attend annual clinics for reviews.

One GP has a special interest in these clinics and supported the Nurse Practitioners with weekly clinical case review meetings.

Patient care was planned according to individual needs. Care was based according to local and NICE guidelines.

The practice participated in a local incentive service for supporting patients with diabetes.

The telephone hub clinician helped identify when patients with long term conditions needed urgent access and provided them with an on the day appointment if required.

Patients with long term conditions had direct telephone access to the practice and urgent care was arranged to try and avoid hospital admissions.

Families, children and young people

Good

Updated 10 September 2015

The practice is rated as good for the care of families, children and young people. 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 was suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

The practice offered shared antenatal care and offered post-natal visits.

The practice provided baby vaccination clinics and offered an invite and recall system for those clinics and had processes in place for chasing non-attenders to improve uptake figures.

Safeguarding procedures were in place and there was a lead safeguarding GP. This GP co-ordinated the care of vulnerable families with external agencies and also at the practice and advised on any safeguarding issues for colleagues.

There was open clinical access to young families via the telephone hub system to ensure same day access was provided when needed.

Working age people (including those recently retired and students)

Good

Updated 10 September 2015

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

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

The practice was part of the extended hour’s scheme. A recent patient survey showed patients preferred early morning or late evening appointments and the practice changed its times to accommodate this.

Online appointment booking and prescribing services were available.

Electronic prescription service was in place to help reduce the need for workers to attend the practice for their prescription.

Telephone consultations were available for patients if they were unable to attend the practice.

People whose circumstances may make them vulnerable

Good

Updated 10 September 2015

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 homeless people, travellers and those with a learning disability.

There was an open access policy for patients who were vulnerable and the practice signposted or booked them in to the most appropriate health care professional or external agency.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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 normal working hours and out of hours.

The practice had links with local voluntary services via the local church and used this service to refer patients to food banks and other help.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 September 2015

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

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice had a register for patients experiencing poor mental health (including those with dementia). These patients were invited into the practice for an annual health check.

The practice has taken part in a research study with University College London to offer patients with severe mental health problems help to manage cardiovascular risk.

The Patient Participation Group was currently working to develop the practice into a dementia friendly practice. They  had identified local agencies for support and dementia friendly places to visit including a local café.