You are here

Inspection Summary


Overall summary & rating

Good

Updated 5 February 2015

Letter from the Chief Inspector of General Practice

Standish Medical Practice was inspected on the 18 November 2014. This was a comprehensive inspection.

We rated Standish Medical Practice as good in relation to being safe, effective, caring, responsive and well-led.

Our key findings were as follows:

The practice had systems in place to ensure best practice was followed. This was to ensure that people’s care, treatment and support achieved good outcomes and was based on the best available evidence.

Information we received from patients reflected that practice staff interacted with them in a positive and empathetic way. They said that were treated with respect, in a polite manner and as individuals.

A system was in place to ensure the practice was regularly cleaned. We found the practice to be clean at the time of our visit. A system was in place for managing Infection prevention and control.

Patients had good access to medical care and we were assured that if a patient needed to be seen they could access a GP appointment on the same day. To improve patient access an open surgery was provided each day between 815am and 1015am where patients were able to see one of five GPs without an appointment. Afternoon GP surgeries were also provided by appointment. A late GP surgery was provided on Tuesday evenings. This was particularly helpful to patients who worked. Consultations with the practice nurses were by appointment.

We saw areas of outstanding practice including;

We looked at records relating to how the practice team learnt from incidents and subsequently improved safety standards. The examples we looked at showed how incidents were investigated by defining the issue clearly and identifying what actions needed to be taken to address the risk and minimise or prevent it from happening again. One of the examples we looked at highlighted a clinical issue which resulted in action being taken to improve safety for patients at the practice and within the Wigan area. This had been achieved by the practice working closely with colleagues in the wider health community to bring about the improvements.

In addition the provider should:

Clinical staff we spoke with clearly understood the importance of obtaining consent from patients and of supporting those who did not have the mental capacity to make a decision in relation to their care and treatment. However staff training records and discussion with staff reflected that they had not been provided with any formal training in respect of the Mental Capacity Act 2005. The provider should ensure relevant staff are enabled to access such training to maximise their effectiveness in supporting patients who do not have the mental capacity to make a decision in relation to their care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 February 2015

The practice is safe. Staff understood and fulfilled their responsibilities to raise concerns, and 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 people safe.

Effective

Good

Updated 5 February 2015

The practice is effective. Data showed patient outcomes were at or above average for the locality. National Institute for Health and Care Excellence (NICE) guidance was referenced and used routinely. People’s needs were assessed and care was planned and delivered in line with current legislation. This included assessment of capacity and the promotion of good health. Staff had received training appropriate to their roles and further training needs had been identified and planned. The practice could identify all appraisals and the personal development plans for all staff. Multidisciplinary working was evidenced.

Caring

Good

Updated 5 February 2015

The practice is caring. Data 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 care and treatment decisions. Accessible information was provided to help patients understand the care available to them. We also saw that staff treated patients with kindness and respect ensuring confidentiality was maintained.

Responsive

Good

Updated 5 February 2015

The practice is responsive. The practice reviewed the needs of their local population and engaged with the NHS Local Area Team (LAT) and Clinical Commissioning Group (CCG) to secure service improvements where these were identified. Patients reported good access to the practice and a named GP and 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. There was an accessible complaints system with evidence demonstrating that the practice responded quickly to issues raised. There was evidence of shared learning from complaints with staff and other stakeholders.

Well-led

Good

Updated 5 February 2015

The practice is well-led. The practice had a clear vision and strategy to deliver this. 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 a number of policies and procedures to govern activity and regular governance meeting had taken place. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients and this had been acted upon. The practice had an active patient participation group (PPG). Staff had received inductions, regular performance reviews and attended staff meetings.

Checks on specific services

Older people

Good

Updated 5 February 2015

The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example in dementia and end of life care. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments.

People with long term conditions

Good

Updated 5 February 2015

Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had a named GP and structured annual reviews to check their health and medication needs were being met. For those people 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 5 February 2015

Systems were in place for identifying and following-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. Appointments were available outside of school hours and the premises was suitable for children and babies. We were provided with good examples of joint working with midwives, health visitors and school nurses. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health.

Working age people (including those recently retired and students)

Good

Updated 5 February 2015

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.

People whose circumstances may make them vulnerable

Good

Updated 5 February 2015

The practice had carried out annual health checks for people with learning disabilities and offered longer appointments for people with learning disabilities. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours. People in vulnerable circumstances were able to register with the practice, including those with ‘no fixed abode’.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 February 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). The practice had carried out annual health checks for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations such as MIND. The practice had a system in place to follow up on patients who did not attend practice appointments or had attended accident and emergency where there may have been mental health needs.