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Inspection Summary


Overall summary & rating

Good

Updated 16 May 2017

Letter from the Chief Inspector of General

Practice

We carried out an announced comprehensive inspection at Saxonbrook Medical on 15 March 2016. The practice was rated as requires improvement for safe, effective, responsive and well-led services and overall. They were rated as good in caring. On 8 November 2016 we undertook a further comprehensive inspection. 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 a system in place for reporting and recording significant events. Improvements had been made to the reporting and recording of significant events and there was evidence of discussion and learning with staff.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Improvements had been made with the development of a range of risk assessments and the way in which risks were managed was evident. Health and safety, legionella, electrical testing and equipment calibration had been addressed through this process.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although results for patients feeling involved in their care and decisions about their treatment were lower than the national average.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. The process for managing complaints had improved with evidence of patient apologies and the identification of trends.
  • Patients and staff we spoke with said improvements had been made in accessing appointments with the newly developed call and triage system. National survey results demonstration that satisfaction was below average in this area, however on the day of inspection patients told us there had been recent significant improvements with this.
  • 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. Staff told us that communication had improved and they felt involved in the development of the practice.
  • The provider was aware of the requirements of the duty of candour.
  • Clinical audits were undertaken and we saw evidence that some of these were full cycle. The practice had made improvements in this area and had held audit meetings with the multi-disciplinary team to develop a programme and involve a range of clinical staff.
  • Patient outcomes were mixed, with some areas of performance below average, such as in relation to asthma and chronic obstructive pulmonary disease. Exception reporting was higher than average in some areas. However, these issues were adversely affected by changes within the practice including relocation, an influx of patients registering with the practice from a local walk in centre and a high proportion of patients from hard to reach groups. The practice were working to make improvements and there were demonstrable improvements in diabetes performance since the previous inspection. Unpublished data showed an increase of sixteen percentage points in the number of patients receiving a foot examination.

  • Mental health performance was below average; however the practice had developed a dedicated mental health and wellbeing service which had recently won national awards.
  • The practice had made improvements in mandatory training attendance for staff with the development of a range of training available including online and some in-house sessions to ensure that training was timely. However, records relating to induction were not always evident or complete.

We saw one area of outstanding practice:

  • A mental health wellbeing service had been developed within the practice. This provided patients with support with a number of issues including anxiety, depression, eating and mood disorders. The service also provided support around the long term management of chronic conditions such as schizophrenia. Data showed that the service had reduced the number of referrals into secondary care mental health services. The service had been the recent recipient of the Nursing Times ‘Nursing in Mental Health’ category and the clinical lead for the practice had been awarded the Nurse of the Year for the development of the service.

The areas where the provide should make improvements are:

  • Ensure that induction records are complete for new staff.

  • Ensure that improvements are made to the way in which the practice identifies carers.

  • Ensure that all aspects of underperformance in the national GP patient survey are addressed, including areas such as patients not feeling involved in the planning of their care.

  • Continue to work to improve patient outcomes (QOF) within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 May 2017

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 were informed as soon as practicable, 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 minimise risks to patient safety and had made recent improvements to risk management processes.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 16 May 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were below average compared to the national average in a number of aspects of chronic disease management. However, factors influencing this included the relocation of the practice, an influx of patients from a local walk in clinic and a high proportion of those being from hard to reach groups such as those with mental ill health.

  • Clinical audits were being undertaken and we saw that the practice had begun the process of developing an audit programme with involvement from a range of clinical staff.
  • Staff told us that when they commenced in post they had an induction period, however records relating to this were not always completed.
  • Staff were aware of current evidence based guidance.
  • Staff had the skills and knowledge 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.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 16 May 2017

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.
  • Survey information we reviewed showed that 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 accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 16 May 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, through the development of the wellbeing service within the practice.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • 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 evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 16 May 2017

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 policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

Older people

Good

Updated 16 May 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services. In addition, monthly multi-disciplinary meetings were held at the practice with the involvement of a range of other professional as needed.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible Add examples.

People with long term conditions

Good

Updated 16 May 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification was 53% which was lower than the CCG (81%) and national (82%) averages. However, unpublished data from the practice showed an improvement of 16 percentage points at the time of our inspection.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for 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 16 May 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • The practice wellbeing clinic was known to a range of local services and referrals had been received by teachers, school nurses, midwives and health visitors.

Working age people (including those recently retired and students)

Good

Updated 16 May 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations 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 through extended opening hours.
  • 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 16 May 2017

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 homeless people and those with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 16 May 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 45% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is significantly worse than the national average of 78%. However, the practice was taking action to improve services for people in this population group and the data pre-dates some of these improvements.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the preceding 12 months was 39% which was worse than the national average of 77%. However, the practice was taking action to improve services for people in this population group and the data pre-dates some of these improvements.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice wellbeing service had been running for several months and had seen improvements in patients accessing support around their mental health needs.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.