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Inspection Summary


Overall summary & rating

Good

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chadsfield Medical Practice on 24 August 2016. Overall the practice is rated as good.

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

  • 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 staff and stakeholders and was regularly reviewed and discussed with staff.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice had a strong commitment to supporting staff training and development.

  • Personalised patient centre care reflecting the different needs of patient population groups was evident in all aspects of the practice’s work. The high level of compassion and respect provided was highlighted in the national GP patient survey, comment cards, and from patients and external professionals we spoke with as part of the inspection.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met people’s needs.

  • Effective care planning and a responsive approach to the different needs of its patient population groups had reduced the need for unnecessary hospital admissions.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

We saw some areas of outstanding practice:

  • The practice had a Carer’s Champion who was a point of initial contact and support for carers. This was supplemented by a comprehensive carers pack and a monthly Carer’s Clinic provided at the practice by a local charity Signpost for Carers. The clinic appointments were fully booked every month and feedback from patients was that the service they received was excellent.

  • The practice had reviewed the needs of it patients with a learning disability, autism or mental health issue and created a calm quiet waiting area away from the hustle and bustle of the main waiting areas. The waiting area was decorated in autism friendly colours and a small radio was available for patients to self-select music if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 October 2016

The practice is rated as good for providing safe services.

  • Significant events and incidents were investigated and areas for improvement identified and implemented. The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on thorough analysis and investigation. The practice used a web based document management and information system which allowed all staff access to incidents and the outcome of investigations.

  • 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.

Effective

Good

Updated 7 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were consistently 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.

  • Formal clinical meetings were undertaken weekly, where patient’s health care needs were reviewed, alongside the performance of the practice.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Staff received mandatory and role specific training. Staff said they felt supported by the management team.

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

Caring

Outstanding

Updated 7 October 2016

The practice is rated as outstanding for providing caring services.

  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment. This was reflected within the most recent national GP survey which showed that patients rated the practice above local and national averages in respect of all aspects of care. For example, 95% of patients said the last GP they spoke to was good at treating them with care and concern which was above both the Clinical Commissioning Group average of 89%, and the national average of 85%.

  • Staff were very caring towards patients. We heard of examples where staff had gone the extra mile to assist patients including hand delivering prescriptions to patients homes. We observed reception staff, who were courteous and supportive towards patients and GPs and nurses came into the waiting area to personally collect patients by name.

  • The practice had a carer’s champion and facilitated a monthly Carers Clinic with the aid and support of a local charity Signpost for Carers. Feedback from patients about this service was 100% positive.

  • The practice had an ethos of caring including caring for the welfare of their employees and they told us how they had introduced the employee of the quarter to recognise where staff had gone that extra mile for patients of the service.

  • Staff supported charitable events. The practice had a monthly Dress Down Friday to support different charities including Jeans for Genes and Reuben’s trust. In addition some staff had participated in runs (half and full marathons) for cancer, dementia and Stockport without Abuse charities.

Responsive

Good

Updated 7 October 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.

  • Weekly visits to two local care homes were undertaken by an advanced nurse practitioner and a health care assistant carried out a weekly home visit to patients with complex mental health needs.

  • The two advanced nurse practitioners carried out on average 6 home visits each, daily to patients who were housebound or with a long term health condition and those identified at risk of unplanned admission to hospital at home. They carried out an assessment and recorded a care plan with the patient and or their carer.

  • Urgent appointments were available each day. Patients said they sometimes had to wait to get a routine appointment but felt this was reasonable. The practice had reviewed its patient access and had looked at ways to improve this.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice participated in pilot schemes to improve outcomes for patients. For example two GPs had received additional training and equipment to assess and treat skin lesions at the practice. In addition GPs had telephone access to a hospital consultant (for specific specialities) to discuss patients symptoms and health care needs, potentially reducing the need for the patient to be referred to secondary care.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. The practice had had very few formal complaints but evidence was available that learning from informal complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 October 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision with 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.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • 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.

Checks on specific services

Older people

Outstanding

Updated 7 October 2016

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

  • The practice’s patient population over the age of 65 years at 27% was much larger than the local average of 19% and the England average of 17%. The practice reflected on this and offered proactive, personalised care to meet the needs of the older people in its population.

  • Weekly visits to a local care home were undertaken by the same advanced nurse practitioner to promote continuity of care.

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

  • Multi-disciplinary meetings were held monthly and Gold Standard Framework (GSF) or palliative care meetings were held every second month and community health care professionals attended these. GSF is a systematic, evidence based approach to optimising care for all patients approaching the end of life.

  • Care planning for avoiding admission to hospital was person centred and we saw evidence this was effective in maintaining a patient with palliative care needs to live at home.

  • The practice had arranged for a patient ultrasound service to be available at the practice once a week to improve patient access to this particularly older people.

  • One staff member was a designated Cancer champion, who was able to offer support and guidance to patients with a diagnosis of cancer.

  • One staff member was the designated carer’s lead and they worked closely with the Stockport charity Signpost for Carers.

People with long term conditions

Good

Updated 7 October 2016

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

  • GPs were allocated a clinical lead role for chronic disease management, and they were supported by the practice nursing team.

  • Patients at risk of hospital admission were identified as a priority and detailed care plan evidence was available that demonstrated the work undertaken with patients to support them to stay at home.

  • The practice performed better than the national average in all five of the diabetes indicators outlined in the Quality of Outcomes Framework (QOF).

  • Longer appointments and home visits were available when needed.

  • Patients were referred to community support and education initiatives such as X-PERT Diabetes programme. (This is an education course for patients to increase knowledge, skills and understanding and management of diabetes).

  • 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 7 October 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. Immunisation rates were comparable or better than the CCG 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.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. A weekly baby clinic was held at the practice.

  • Data showed that the practice performed similarly to the CCG and England average for the percentage of women aged 25-64 who had received a cervical screening test in the preceding five years with 83% compared to 82% for the respective benchmarks.

  • The practice referred young patients to the community paediatric team when needed.

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

Working age people (including those recently retired and students)

Good

Updated 7 October 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.

  • The practice offered a range of early morning and evening appointments. For example from 7am three mornings each week with health care assistants (Tuesday, Thursday and Friday); from 7.30am on Wednesday with a GP and a health care assistant and later evening appointments with GPs and the advanced nurse practitioners until 7.20pm on Monday and Tuesday and a GP on Fridays until 6.55pm.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 7 October 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.

  • The practice had created a quieter separate waiting area for people with a learning disability, autism or complex mental health need. This had been painted in an autism friendly neutral colour.

  • The practice offered longer appointments for patients who were vulnerable or with a learning disability.

  • 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 such Stockport without Abuse and the Wellspring for homeless people.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 2016

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

  • Data from 2014 to 2015 showed that 81% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the Clinical Commissioning Group average of 87% and the England average of 84%. However the practice’s clinical exception reporting was 1%; much lower that the CCG’s 5% and The England average of 8 %. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months which was slightly higher than the local and the England average.

  • The advanced nurse practitioner visited housebound and vulnerable patients at home to review their needs and agree a care plan.

  • The practice had identified a small group of patients with very complex mental health needs who did not access health care checks. In response one of practice’s health care assistants undertook a weekly home visit to these patients.

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

  • Patients with a diagnosis of dementia received regular reviews.

  • 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.