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Inspection Summary


Overall summary & rating

Good

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elm Hayes Surgery on 2 November 2016. Overall the practice is rated as good.

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

  • The practice recognised the value of learning from significant events and had a system to review them regularly and as part of everyday practice. The practice carried out a thorough analysis of the significant events to look for root cause, ways to prevent any reoccurrence and identify any improvements needed. The significant events were a standing agenda item in meetings and learning was shared across the whole practice.

  • 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. The practice had supported many staff and provided training including National Vocational Qualifications (NVQ) in customer service and team leadership, NVQ in dispensing, practice managers diploma, NVQ in health care and diabetes and respiratory programmes.
  • The practice had a clear vision to provide patients with the traditional values of personal, high quality, patient focussed, responsive health care delivered from modern premises.
  • 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 undertaken a number of analyses of the patient’s satisfaction and experience; they had looked at the difficulty with regards to patient telephone access, and implemented additional phones lines and advertised the benefit of online appointment booking to improve access.

  • 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 had good facilities and was well equipped to treat patients and meet their needs. At Elm Hayes Surgery patients could access a number of services provided by other care providers including; counselling, audiology, podiatry, community paediatricians and a drugs and alcohol team.
  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system 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 to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 6 December 2016

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 the national average.

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

  • Clinical audits demonstrated quality improvement.

  • We saw evidence that the practice was consistently one of the leading practices in the locality for being a high user of electronic prescribing.

  • 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 6 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as comparable to 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.

  • The practice had arranged a monthly carer’s drop in clinic at the practice hosted by the local carer’s network which was scheduled to start on the 28th November 2016.

  • 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 6 December 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 (CCG) to secure improvements to services where these were identified. For example, the practice participated in a Bath and North East Somerset Enhanced Medical Service (BEMS) focussed weekend working initiative whereby the practice offered clinics on Sundays every week.

  • 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 had excellent facilities and was well equipped to treat patients and meet their needs.

  • The practice participated in a local social prescribing initiative whereby patients with non-medical issues, such as debt or social isolation could be referred by the practice to a single hub for assessment as to which alternative service might be of most benefit.

  • The practice provided a regular GP visiting service and urgent care to two local care homes. A named GP or deputy visited weekly to provide a “ward round review” and assess all new residents on admission.

  • The practice was training two nurses in diabetes management and had monthly meetings with the diabetes integrated service to facilitate training and provide virtual clinic reviews.

  • 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 6 December 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 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 for managing 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. There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

Older people

Good

Updated 6 December 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

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

  • The practice visited local care homes on a weekly basis.

  • The practice held monthly meetings with community based staff to discuss the care of patients in this population group including those receiving palliative care.

People with long term conditions

Good

Updated 6 December 2016

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

  • Nursing staff had lead roles in chronic disease management and ran the following clinics: diabetes, asthma and chronic obstructive pulmonary disease (COPD - a range of chronic lung conditions). Patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was higher than local and national averages. The percentage of patients with diabetes, on the register, in whom the last blood test was within target range in the preceding 12 months (2014 to 2015) was 86% compared to a local average of 81% and a national average of 78%.

  • The practice had implemented regular meetings to commence in November 2016 with the diabetes integrated service to facilitate training and education and provide “virtual” clinic reviews of patients with diabetes

  • 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 6 December 2016

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

  • 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 patients who had a high number of Accident and Emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • Childhood immunisation clinics were run by two nurses with administration support to minimise the distress to children and additional childhood immunisation clinics were held at intervals throughout the year on Saturday mornings or weekday afternoons to provide flexible appointments.

  • The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 85% which was higher than both the clinical commissioning group average of 83% and the national average of 82%.

  • Community paediatrician clinics were held on site.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. There were baby changing and feeding rooms available.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • The practice offered a family planning and sexual health service with a sexual health nurse and a GP with specialised interest in women’s health and family planning who assessed patient need, initiated treatments and offered ongoing monitoring of all family planning and sexual health needs.

Working age people (including those recently retired and students)

Good

Updated 6 December 2016

The practice is rated as good for the care of working-age patients (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.

  • 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.

  • Extended hours appointments were available from 6.30pm to 7.30pm on Monday evenings for patients to attend outside of routine working hours. A Saturday morning clinic was available once a month.

  • The practice offered telephone consultations for all patients which was useful for working patients.

People whose circumstances may make them vulnerable

Good

Updated 6 December 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability and 91% of these patients on their register had received an annual health check and a written care plan in 2015/16.

  • 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 held monthly multi-disciplinary meetings with the health visiting team to discuss at risk children.

  • The practice participated in a local social prescribing initiative whereby patients with non-medical issues, such as debt or social isolation could be referred by a the practice to a single hub for assessment as to which alternative service might be of most benefit.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 December 2016

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

  • 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (2014 to 2015), which is above both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

  • 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 to follow up patients who had attended emergency A&E 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.