You are here

Inspection Summary


Overall summary & rating

Good

Updated 26 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Henry Moore Clinic on 8 March 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.

  • All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.

  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they found it easy to make an appointment with a GP and that 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.
  • The practice was aware of and complied with the requirements of the Duty of Candour (

  • There was a clear leadership structure with an experienced and

  • Risks to patients were assessed and well managed.

  • Information regarding the services provided by the practice was available for patients.
  • There was a complaints policy and clear information available for patients who wished to make a complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 April 2016

The practice is rated as good for providing safe services.

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

  • There was a nominated lead for safeguarding children and adults. Systems were in place to keep patients and staff safeguarded from abuse.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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. For example there were processes in place for safe medicines management and infection prevention and control.

  • Although some risk assessments in relation to occupational health and safety had been carried out the practice had not developed and implemented overarching health and safety and fire safety risk assessments. However we were assured that these would be developed by the practice and implemented over both sites.

Effective

Good

Updated 26 April 2016

The practice is rated as good for providing effective services.

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

  • Weekly clinical meetings were held between the GPs and nursing staff to discuss patient care and complex cases and monthy multi-disciplinary meetings were held to discuss palliative care.

  • 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 delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. The practice used a risk profiling tool to identify these patients. The practice then carried out advanced care planning and regular patient reviews, which involved multi-disciplinary working across health and social care providers.

Caring

Good

Updated 26 April 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.

  • The practice had a strong patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion. Additionally patients told us that 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 heard evidence that the practice actively worked with families of patients to ensure where necessary that care plans were suitable and fit for the needs of the patient.

  • Staff had received dementia awareness training.  

Responsive

Good

Updated 26 April 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.

  • The practice had offered an abdominal aortic aneurysm clinic for patients for over two years ( this screening sought to detect dangerous swellings of the aorta - the main blood vessel that runs down from the heart, down through the abdomen to the rest of the body).

  • National GP patient survey responses, and patients we spoke with 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.

  • 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.

  • The GPs from the practice had delivered a number of puberty workshops in local schools. These workshops discussed issues such as changes in the body and physical and emotional health. We were told these workshops had been well received by teaching staff and pupils.

Well-led

Good

Updated 26 April 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 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 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 practice had developed a strong ethos of staff training and development and was a training practice for GP registrars and medical students.

  • The provider was aware of and complied with the requirements of the Duty of Candour (being open and transparent with people who use the service, in relation to care and treatment provided).

  • There were systems in place for being aware of notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. The practice proactively sought feedback from patients through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
Checks on specific services

Older people

Good

Updated 26 April 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 urgent appointments for those with enhanced needs.

  • The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. The practice used a risk profiling tool to identify these patients. The practice then carried out advanced care planning and regular patient reviews, which involved multi-disciplinary working across health and social care providers.

  • The practice held carer’s details and access key codes on patient records to enable them to contact carers when required and gain easy entry for home visits.

  • The practice had begun to participate in the CCG Vanguard scheme for care homes. This scheme saw routine visits being made to care homes to review patients needs, offer treatment and update care plans.

  • The practice was liaising with local care homes to develop a DoLS register (Deprivation of Liberty Safeguards) DoLS relate to people who are placed in care homes or hospitals for their care or treatment and who lack mental capacity. The development of the register would allow the practice to recognise patients and better deliver treatment and packages of care.  

People with long term conditions

Good

Updated 26 April 2016

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

  • Clinical staff had lead roles in chronic disease management . For example, a GP partner and a practice nurse had been appointed as leads for diabetes.

  • A nurse was available who could initiate both insulin and other medication injections and a further nurse was undergoing training to increase capacity in this area work.

  • The practice maintained a chronic disease register which identified patients and allowed more effective care planning.

  • 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.

  • Regular monthly palliative care meetings were held with the lead GP, district nurses and specialist nursing staff.

  • The practice had a high referral rate to structed educational programmes such as DESMOND

  • Daily appointments were available to long term condition patients for blood and blood pressure tests.

Families, children and young people

Good

Updated 26 April 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/or who were at risk, for example, children and young people who were recognised as having concerns with regard to their safeguarding.

  • The lead GP for safeguarding held regular monthly meetings with health visitors to discuss cases.

  • Immunisation rates were consistently high for all standard childhood immunisations when compared to the CCG average.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.

  • Sexual health and contraceptive and cervical screening services were provided at both practice locations and the practice participated in the c-card scheme which gave young persons access to contraceptives.

  • 79% of eligible patients had received cervical screening in the preceding five years, compared to 82% both locally and nationally.

Working age people (including those recently retired and students)

Good

Updated 26 April 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 was proactive in offering online services such as appointment booking and prescription ordering and offered the electronic transfer of prescriptions to the patients pharmacy of choice.

  • The practice offered 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 26 April 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 circumstances that may make them vulnerable including those with a learning disability and the frail elderly.

  • The practice offered longer appointments for patients with a learning disability and had appointed a dedicated learning disability nurse to meet the needs of this population group.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. 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 26 April 2016

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

  • 80% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is slightly below the national average of 84%.

  • 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive and agreed care plan in the record in the preceding 12 months compared to a national average of 88%.

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

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

  • Staff had a good understanding of how to support patients with mental health needs and dementia. For example dementia awareness training had been provided for all reception and administration staff.

  • Patients were able to access

    psychological therapies on referral from the practice.

  • Clinicians were able to inform patients how to access various support groups and voluntary organisations. This included signposting young patients to online counselling support.