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Inspection Summary


Overall summary & rating

Good

Updated 13 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Penny’s Hill Practice on 19 October 2016. Overall the practice is rated as good.

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

  • There was a strong commitment to providing co-ordinated, responsive and compassionate care for patients, particularly patients with long term conditions and older people who are frail and at risk of social isolation. Examples included a celebratory party with all patients who reached their 90th birthday in 2016.
  • Patients experienced flexible services that aimed to provide choice and continuity of care.The practice had three times the national average of patients over 75 years and had developed services to meet their needs. Examples included individualised approach to triage by the patients own GP. Named secretaries liaising with patients for continuity of communication. Fast track and longer appointments for carers and patients receiving care.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • There was a holistic approach to assessing, planning and delivering care and treatment to people using services. Examples included: risks to patients were assessed and well managed by a tracker nursing team who worked closely with GPs.
  • 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.
  • All of the 47 patients, who used the service, family members and carers, and stakeholders who gave feedback at the inspection were continuously positive about the way staff treated them and other patients. Patient’s told us that it was easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
  • 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.
  • Penny’s Hill Practice was proactive in identifying carers and had a comprehensive overview of their needs and created ways to provide timely support for them.
  • The practice had adapted facilities that were dementia friendly. The practice and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision which had 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.

The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice was innovative in trialling the use of encrypted hand held devices for accessing realtime patient information during home visits. GPs reported this facilitated diagnosis, treatment and immediate recording of the outcome of the consultation with patients ensuring more detailed patient records were maintained.

A proactive approach to managing vulnerable patients and had reduced the number of unplanned hospital admissions for vulnerable patients with chronic health conditions. Data from the provider showed the practice had exceeded the target of 3.5% reduction set by the Clinical Commissioning Group with a 5.4% reduction, which equated to 31 fewer unplanned patient admissions in 2015/16 compared with the previous year.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • 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.

Effective

Good

Updated 13 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • 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.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 13 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • We observed a strong patient-centred culture, illustrated by events during the year to celebrate the birthdays of all patients reaching 90 years and a party to launch the dementia friendly services.

Responsive

Good

Updated 13 March 2017

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 focussed on providing resilient, proactive and responsive services for patients registered with it. The services were developed taking account of the much higher percentage of frail and vulnerable older people. Examples included: tracker nurses (carrying out home visits) working closely with GPs to support vulnerable patients resulting in a reduction of unplanned hospital admissions.

  • The individual needs and preferences of patients were central to the planning and delivery of tailored services. All 8320 patients had a named GP. The practice introduced a GP buddy system to promote patient continuity of care. There was an individualised approach to appointment triage, where the patient’s GP or GP buddy telephoned the patient and/or their carer where appropriate to discuss their needs.

  • Innovative approaches to providing person centred care involving other providers were evident. Examples included: collaboration and support from the friends of the practice, the GP partnership worked closely with the volunteers to ensure vulnerable patients received additional support, which was risk assessed such as befriending and transport help to appointments.

  • The practice had achieved Dementia Friendly status with adaptions made throughout the building. All staff and patient participation group members having been trained in this area. Appropriate signage had been fitted throughout the building to enable patients to find their way around it easily.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

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

Well-led

Good

Updated 13 March 2017

The practice is rated as good 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.

  • There was a clear leadership structure and staff said they felt supported by management. For example, The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • Penny’s Hill practice provided a positive experience for GP registrars and medical students. Through a good reputation of support with trainees and an approachable and dynamic leadership team. This then had a positive impact on attracting new staff when staff retired or left.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.

  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels. Penny’s Hill practice is a training practice providing placements for GP registrars.

Checks on specific services

Older people

Outstanding

Updated 13 March 2017

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

  • Penny’s Hill practice had three times more patients over 75 years (28.4% of the practice list) compared with the national average of 10.1%.There was a higher prevalence of chronic disease and life limiting illness for patients, with associated risks of isolation and vulnerability in old age.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.This was illustrated by proactive searches of patient lists to identify unmet needs and risk, particularly for the most vulnerable 2% of patients over 65 years and 75 years.

  • All of the patients had a named GP and their health needs closely monitored.

  • The practice was responsive to the needs of older people. They had a well resourced team with two dedicated nurses (tracker nurses) providing anticipatory care support for vulnerable people. Patients had comprehensive care plans, which the tracker team monitored. The team provided home visits and proactive monitoring to avoid unplanned hospital admissions.

  • The practice had a named member of staff as the carer lead who was proactive in identifying any carers, signposting and providing support to them were needed.

  • Weekly virtual ward rounds were undertaken to monitor the care and support needs of patients living in 12 adult social care homes.

  • All GPs provided twice daily over 75 years clinics for patients with longer appointments, which enabled them to carry out a thorough assessment of needs including support for carers.

  • Patients were able to access an emergency telephone line for priority assistance.

  • The practice demonstrated high regard and valuing older people, illustrated by events during the year to celebrate the birthdays of all patients reaching 90 years.

People with long term conditions

Good

Updated 13 March 2017

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

  • There was a high prevalence of complex health needs amongst the patient population registered with the practice. The practice had a co-ordinated system for recalling patients for reviews and provided single longer appointments for reviews of multiple conditions.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was above the national average. For example, 94.7% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (national average 88.5%).

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 13 March 2017

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. Immunisation rates were relatively high for all standard childhood immunisations.

  • 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.

  • Data for 2014/15 showed the practice uptake for the cervical screening programme was 80.6%, which was comparable to the CCG average of 83.7% and the national average of 81.8%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses. For example, the practice co-ordinated post-natal mother and baby checks with first immunisation appointments for babies.

  • Family planning services were available for women including the fitting of contraceptive devices.

Working age people (including those recently retired and students)

Good

Updated 13 March 2017

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, flexible and offered continuity of care including. Patients were able to access appointments on-line and have telephone consultations every weekday. Patients could receive SMS text prompts for appointments if they registered for this service.

  • Extended opening hours made appointments more accessible for working people and were available: Monday and Tuesday mornings from 7am to 8am and evenings on Tuesdays and Thursdays from 6.30pm to 7.30pm.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Examples included repeat prescription requests, advance booking of routine appointments up to three months ahead.

People whose circumstances may make them vulnerable

Good

Updated 13 March 2017

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

  • The practice had a proactive approach to managing vulnerable patients and had reduced the number of unplanned hospital admissions for vulnerable patients with chronic health conditions. Data showed that the practice had exceeded the target of 3.5% reduction set by the Clinical Commissioning Group with a 5.4% reduction, which equated to 31 fewer unplanned patient admissions in 2015/16 compared with the previous year.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. Patients who had no fixed abode were able to receive health correspondence through the practice address.

  • The practice offered longer appointments for patients with a learning disability. Annual health checks were undertaken in conjunction with the learning disability nurse specialist.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed 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 was proactive in identifying patients who were cared for and those who were carers. There was a named carers champion who maintained network links with services supporting patients and their carers. Information and support was readily available for carers and adjustments made so that they were able to access appointments to suit their needs.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 March 2017

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

  • Data for 2015/16 showed 78.3% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

  • Performance for mental health related indicators was above the national average. For example, in 2015/16, 97.9% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (national average 88.8%)

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice 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 patients with mental health needs and dementia. All staff and patient participation group members were trained in dementia care. Appropriate signage had been fitted throughout the building to enable patients to find their way around it easily. Events promoting dementia services involved patients, carers and community members to raise awareness of these.