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University Medical Group Outstanding Also known as University of Reading Medical Practice

Inspection Summary


Overall summary & rating

Outstanding

Updated 8 May 2015

We undertook a comprehensive inspection of the University Medical Centre on 28 January 2015. We have rated the practice overall as outstanding.

Specifically, we found the practice to be outstanding for providing responsive service and for being well led. It was also outstanding for providing services for the people with long-term conditions, for working age people (including those recently retired and students), for people whose circumstances may make them vulnerable and for people experiencing poor mental health (including people with dementia). It was good for providing caring, effective and safe services.

Our key findings were as follows:

  • The practice was responsive to the needs of the local population and engaged effectively with other services.
  • There was a culture of openness, transparency, continual learning and improvement within the practice.
  • The practice was committed to providing high quality patient care and provided good support and training to staff to facilitate this.
  • 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.

  • Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • 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 (PPG).
  • 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
  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • The practice had a clear vision, a strong learning culture and was committed to continued quality improvement. This culture was embodied by all of the staff. Staff responded to change and were encouraged to bring suggestions for improvement. All staff were united to deliver the practice vision, of providing high quality care to patients.

  • The practice promoted work with young people and schools as part of “You’re welcome initiative”. This included engaging students by offering work experience opportunities at the practice. The practice nurse had written a book on immunisations and used this to educate young children. The practice had engaged with students on a work experience basis, and had asked them to review the services they offered to teenagers and young patients.
  • Innovative approaches were evident to enable patients in vulnerable groups to access care services. For example, the practice held weekly diabetes clinics using the ‘House of Care’ model, in line with best practice. The practice hosted a Diabetic Eye screening clinic specifically for the residential care home patients with diabetes. The practice had arranged for a psychiatrist to hold regular clinics onsite to enable easy access to students, and audits showed this had positive impact on patients.
Inspection areas

Safe

Good

Updated 8 May 2015

The practice is rated as good for providing safe services. Staff

understood and fulfilled their responsibilities to raise concerns, and to 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 patients safe.

Effective

Good

Updated 8 May 2015

 The practice is rated as good for providing

effective services. Data showed patient outcomes were at or above average for

the locality. Staff referred to guidance from National Institute for Health and

Care Excellence and used it routinely. Patient’s needs were assessed and care

was planned and delivered in line with current legislation. This included

assessing capacity and promoting good health. Staff had received training

appropriate to their roles and any further training needs had been identified

and appropriate training planned to meet these needs. There was evidence of

appraisals and personal development plans for all staff. Staff worked with

multidisciplinary teams.

Caring

Good

Updated 8 May 2015

 The practice is rated as

good for providing caring services. Patients said they were treated with

compassion, dignity and respect and they were involved in decisions about their

care and treatment. Information to help patients understand the services

available was easy to understand. We also saw that staff treated patients with

kindness and respect, and maintained confidentiality.

Responsive

Outstanding

Updated 8 May 2015

 The practice is rated as

outstanding for providing responsive services. The practice had initiated

positive service improvements for its patients that were over and above its

contractual obligations. It acted on suggestions for improvements and changed

the way it delivered services in response to feedback from the patient participation

group (PPG). The practice reviewed the needs of its local population and

engaged with the NHS England Area Team and Clinical Commissioning Group (CCG)

to secure service improvements where the need for these had been identified.

Patients told us it was easy to get an appointment with a named GP or a

GP of choice, with continuity of care and 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 the practice responded quickly when issues were

raised. Learning from complaints was shared with all practice staff. 

Well-led

Outstanding

Updated 8 May 2015

The practice is rated as

outstanding 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. There was a high level of constructive engagement with staff and a

high level of staff satisfaction. The practice gathered feedback from patients

using new technology, and it had an active patient participation group (PPG).

Checks on specific services

Older people

Good

Updated 8 May 2015

The practice provided good care to older patients. The practice had a very low proportion of elderly patients.

The practice offered proactive, personalised care to meet the needs of the

older patients in its population. All patients had a named GP. All patients in this population group were offered flu vaccinations, and 85% of these patients had received their flu vaccination.

Staff were able to recognise signs of abuse in older people and knew how to escalate or refer these concerns. The premises and services had been adapted to meet the needs of people with mobility problems.

We saw that the waiting area and treatment rooms were able to accommodate patients with wheelchairs. Disabled Access toilet facilities

were available.

The practice held regular multi-disciplinary team meetings to ensure systems were in place to try to reduce the number of hospital admissions.

People with long term conditions

Outstanding

Updated 8 May 2015

The practice is rated as outstanding for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that 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.

The practice

provides a weekly diabetes clinic run by two diabetes nurses using the ‘House of Care’ model, in line with best practice. The practice achieved the Premium Payment from the Clinical Commissioning Group in 2014 for achieving over 70% on each of the nine diabetes care processes.

The practice hosted a Diabetic Eye screening clinic specifically for the residential care home patients with diabetes.

The practice had information about long term conditions on the practice website and leaflets were also available at the practice. 

The practice had a robust recall system which ensured

patients with one or more long term condition were able to have their bloods checked at the same time as their review appointment, for example diabetes and thyroid.

Families, children and young people

Good

Updated 8 May 2015

The practice is rated as good for

quality of care to families, children and young children. A pregnancy planner was available with information from inception to birth and beyond.

GPs

carried out

a home-visit to provide new baby checks for babies born at home. All new mothers had access to midwives, who held weekly clinics onsite. 

Childhood immunisations were carried out at the practice. The immunisation rate was monitored and take up was good.

Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals.

The practice had set up a social media page and actively promoted this to maximise interaction with young patients about their health

and medicines. Staff had completed

training in domestic violence and Identification and Referral to Improve Safety (IRIS), to ensure staff were able to take appropriate action. The GPs reviewed and discussed all patients on the safeguarding register every fortnight.

Working age people (including those recently retired and students)

Outstanding

Updated 8 May 2015

The practice is rated as outstanding 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 provided medical services to students of University of Reading. The practice offered a range of clinics to support this patient group. For example, family planning, contraception and gynaecology. The practice offered weekly walk-in  sexual health and contraception clinic. 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. The practice provided a range of scheduled appointments between 8am and 6pm Monday to Friday. The practice offered early morning and evening appointments.

The practice was also open one Saturday morning each month. Telephone calls to patients who were at work were made at times convenient to them. Smoking cessation clinics were offered to patients. There was health promotion material available in the waiting area and on the website. This included sexual health and family planning advice and information on healthy lifestyle was also available.

The practice has a duty team, consisting of a GP and nurse who will see emergencies and minor illnesses on the day. 

People whose circumstances may make them vulnerable

Outstanding

Updated 8 May 2015

The practice is rated as outstanding 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, travellers and those with a learning disability. All registers were reviewed and discussed regularly.  All homeless patients were placed on the practice cause for concern list, and the

practice used their own address if the patient did not have a fixed abode. Patients who lived in hostels, the practice

offered weekly telephone consultations. If patients were unable to attend the practice they were sign-posted to a local service for homeless people. This service was nurse lead clinic where patients could also access food, clothes, mental health support and advice.

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

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 8 May 2015

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

Special registrations were arranged for new students who had declared a mental health condition on their university application. This included a 20 minutes appointment with GP followed by an appointment with the Mental Health worker

. The patient was then offered appointments with the same GP throughout their studies. Through research the practice had identified the need for a psychiatrist onsite, for students and a request was made to the University of Reading. The University now funds a psychiatrist,

who runs a clinic once a week during term time .An annual audit of this service was performed last year and it showed that of the 33 students seen by the psychiatrist, 80% of patients were able to continue with their studies.

 

The GP mental health lead meets with the Head of Student supports services (who also covers Disability and Counselling services) at the University of Reading on a weekly basis to discuss complex patients with information sharing consent form in place.

The practice hosts a

weekly Eating Disorders clinic to which students could self- refer. The duty doctors saw patients, on the day, with suicidal tendencies or who had been referred by the student counselling service.

The practice provided weekly GP follow up appointments to patients who were especially vulnerable and at risk due to their mental health. These patients were routinely offered a monthly review.