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Inspection Summary


Overall summary & rating

Good

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castleford Medical Practice on 27 June 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.
  • 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.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had developed a whole team approach to clinical areas of work which included long- term conditions. A GP, nurse and health care assistant had been allocated to focus on each long- term condition such as chronic pulmonary obstructive disease (COPD), heart disease, asthma and stroke, and worked closely together to meet the specific needs of these patients. This developed and spread knowledge across all tiers of the practice.
  • The practice offered electronic-consultations with secondary care specialist consultants (an e-consultation is a mechanism that enables primary care providers such as GPs to obtain specialists' inputs into a patient's care treatment without requiring the patient to go to a face-to-face visit by using IT based communication links and data sharing).
  • The practice participated in a number of programmes to improve health and wellbeing locally, these included:

    • Participation in a local Vanguard programme which aimed to improve delivery of health care and care planning for patients in residential and nursing home settings (Vanguard programmes seek to develop new care models which support the improvement and integration of services for patients).
    • Past participation from April 2015 to March 2016 in a project aimed at reducing health inequalities in the Castleford area. It sought to achieve this by the provision of targeted clinical, emotional and care support to hard to reach patients with long term conditions. Actions included longer appointments, proactively following up non-attenders and providing additional home visits.

  • 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. In addition open access appointments were available on a Monday when patients could call the surgery and receive an appointment that 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 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.

We saw one area of outstanding practice:

The practice operated a “One Stop” service for elderly patients. When an elderly patient has had a consultation appointment but required additional tests such as blood tests these were organised and delivered as part of the same visit. This meant the patient did not need to return to have these carried out.

We saw one area where the provider should make improvement:

The practice should develop and adopt a system to confirm that appropriate action has been taken by staff following patient safety and other alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events, in addition the practice had carried out an analysis of data from the previous five years. No trends were identified for significant events over this period.

  • 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.

  • Risks to patients were assessed and well managed.

  • Alerts and other information was cascaded to staff via the practice IT system. During the inspection we identified that there was limited evidence to show that all alerts were being opened and acted upon following their dissemination. The practice said it would examine this further.

Effective

Good

Updated 4 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages.

  • 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.

  • The practice had developed a comprehensive support and induction pack for locum GPs.
  • The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. As an example, receptionists had received training to promote and raise awareness of breast screening.

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

Caring

Good

Updated 4 August 2016

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.

Responsive

Good

Updated 4 August 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. Activities and services delivered included:

    • Delivery of specialist diabetic clinics which enabled them to initiate insulin and other injectable treatments for patients with diabetes.

    • Provision of a service that worked to reduce unplanned admissions to hospital. Patients who were identified as being at high risk of admission received comprehensive care planning, regular reviews and were contacted following discharge from hospital to assess any ongoing need.

    • Weight management and smoking cessation support was available in-house and was delivered by the nursing team.

  • The practice operated a “One Stop” service for elderly patients. When an elderly patient has had a consultation appointment but required additional tests such as blood tests these were organised and delivered as part of the same visit. This meant the patient did not need to return to have these carried out.

  • Open access appointments were available on a Monday when patients could call the surgery and receive an appointment that day. 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.

  • The practice offered electronic-consultations with secondary care specialist consultants.

  • 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 August 2016

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 felt supported by management. The practice had a number of comprehensive policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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 notifying 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.

Checks on specific services

Older people

Good

Updated 4 August 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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice participated in a local Vanguard programme and offered proactive care and treatment sessions to care home patients.

  • Patients within care homes  were offered either telephone consultation or visits and could call the practice via a priority contact number.

People with long term conditions

Good

Updated 4 August 2016

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

  • The practice had developed a whole team approach to clinical areas of work which included long- term conditions. A GP, nurse and health care assistant had been allocated to focus on each long- term condition such as chronic pulmonary obstructive disease (COPD), heart disease, asthma and stroke and worked closely together to meet the specific needs of these patients. This developed and spread knowledge across all tiers of the practice. Patients at risk of hospital admission were identified as a priority.

  • All patients on a long-term conditions register had documented care plans and were invited to attend annual (or more frequent) reviews. These recalls for reviews were organised to be offered in the month of the patient’s birthday.

  • The practice had identified the needs of diabetic patients and had developed a specialist diabetic clinic. In addition, a diabetic consultant attended the practice to support diabetic patients with complex needs.

  • Due to the high prevalence of COPD in the practice population the practice actively promoted smoking cessation and offered an in-house smoking cessation clinic.

  • Longer appointments and home visits were available when needed.

  • For those patients with the most complex needs, the GP/nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 4 August 2016

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. GPs held regular monthly meetings with the health visitor team to discuss safeguarding issues affecting children registered within the practice.

  • Immunisation rates were high for all standard childhood immunisations.

  • A mother and baby clinic was held on a Wednesday afternoons.

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

  • There was a policy to offer same day appointments to all babies and children under ten years old.

  • The practice was  working toward attaining young person friendly status, and at the time of inspection was carrying out a survey amongst this group of patients to identify specific needs.

Working age people (including those recently retired and students)

Good

Updated 4 August 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, flexible and offered continuity of care. For example, the practice offered telephone consultations for patients who could not access the practice during working hours. In addition pre-bookable appointments were available from 8.30am every morning and 12 pre-bookable appointments were available for the Tuesday evening extended hours surgery from 6.30pm to 8pm.

  • The practice was proactive in offering online services such as appointment booking and ordering repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice took a proactive stance in relation to health and lifestyle improvement and opportunistically offered NHS Health Checks to patients, even when patients  presented with an unrelated problem.

People whose circumstances may make them vulnerable

Good

Updated 4 August 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 and the frail elderly with complex needs.

  • The practice offered longer appointments for patients with a learning disability and for those with additional needs such as patients who do not have English as a first language.

  • Learning disability health checks were promoted, and personal appointments were made for them at a time that was convenient to the patient and their carers. Since this approach was adopted there had been an increase in uptake from eight which were carried out in 2013/2014 to 24 which were carried out in 2015/2016. At the time of inspection the practice had already completed 19 health checks in the first quarter of the year.

  • The practice met regularly with and 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 provided a service that worked to reduce unplanned admissions to hospital. Patients who were identified as being at high risk of admission received comprehensive care planning, regular reviews and were contacted following discharge from hospital to assess any ongoing need.

  • The practice recognised the specific needs of patients with a disability and these were  highlighted in the patient notes. For example, patients who were visually impaired were personally called and escorted from the waiting room to the consulting room by the clinician.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 August 2016

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 patients experiencing poor mental health, including those with dementia.

  • The practice maintained a mental health register and used this to offer annual health checks. These checks are widely promoted to patients. Of 39 patients on the mental health register 29 had received care plans in 2015/2016.

  • The practice carried out advance care planning for patients with dementia. Although data showed in 2014/2015 only 70% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months, which was below the CCG and national averages of 84%.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. The waiting room had themed information displayed regarding mental health, dementia and support for carers.