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Claypath and University Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Claypath & University Medical Group on Tuesday 6 September 2106. 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.
  • 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.
  • 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.
  • 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.
  • 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. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

There were areas of outstanding practice:

  • The practice had pioneered the frail/elderly nurse practitioner. Evidence from the two year Clinical Commissioning Group (CCG) funded pilot had influenced the practice to continue to fund these posts as both patient care had improved and it had freed up GP time to deal with urgent cases. This was not only proactive care but also appropriate reactive care to the frail/elderly and housebound patient groups.
  • The practice was particularly effective in managing patients with long term conditions such as: provision of Insulin initiation on site, for patients with Type 2 diabetes. Their patients did not have to attend secondary care (hospitals) for this treatment and this avoided outpatient appointments at the hospital; and their care was delivered closer to home.
  • Patients who had a dual diagnosis of Asthma and Chronic Obstructive Pulmonary Disease (COPD) were treated using the GOLD (Global initiative for chronic Obstructive Lung Disease) guidance. This up to date evidence based treatment assured that patients received the most appropriate care for these complex conditions.
  • The practice had organised services to meet the needs of its student population of over 14,000 patients (this equated to over half of the practice’s registered patients). This included liaising with the University to share information, having a dedicated student website and having an annual patient satisfaction survey for this group of patients.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice


Inspection areas

Safe

Good

Updated 16 December 2016

The practice is rated as good for providing safe services.

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

  • Risks to patients were assessed and well managed.

Effective

Outstanding

Updated 16 December 2016

The practice is rated as outstanding for providing effective services.

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

  • All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review and accreditation were actively pursued.

  • There was a truly holistic approach to assessing, planning and delivering care and treatment to patients who use their services. Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. All patients who were prescribed a certain anti-depressant now had a recall on their records to assure their blood pressure was taken, recorded and reviewed by a clinician every six months prior to their prescription being renewed.

  • The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice. There was evidence of appraisals and personal development plans for all staff.

  • Staff, teams and services were committed to work collaboratively. Patients who had complex needs were supported to receive coordinated care. There was evidence of innovative and efficient ways to deliver more joined up care to people who use services.

Staff were consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. Every contact with patients was used to do so.

Caring

Good

Updated 16 December 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.

  • 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 easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and tried to maintain patient and information confidentiality. We found the reception area lacked privacy because of the openness of the reception and waiting areas.

Responsive

Good

Updated 16 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. Such as: Pioneering the Frail elderly and pharmacy support schemes which had now been adopted across the North Durham CCG.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available every day with the duty doctor or Nurse Practitioner. Patient satisfaction scores in these areas were consistently higher than local and national averages.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had a large number of students registered with them and had tailored its services to meet the needs of these patients.
  • 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 16 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 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

Good

Updated 16 December 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 patients in its population.

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

  • The practice had introduced a number of initiatives to improve the care of older patients. They had identified an increasing number of older people and organised care to better meet their needs. This included early memory loss reviews and avoiding unplanned admissions.

The practice had pioneered the frail/elderly nurse practitioner. Evidence from the two year CCG funded pilot had influenced the practice to continue to fund these posts as both patient care had improved and it had freed up GP time to deal with urgent cases.  This was not only proactive care but also appropriate reactive care to the frail/elderly and housebound patient groups.

People with long term conditions

Good

Updated 16 December 2016

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

  • GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice provided Insulin initiation on site, for patients with Type 2 diabetes. Their patients did not have to attend secondary care (hospitals) for this treatment and this avoided outpatient appointments at the hospital; and their care was delivered closer to home.

  • The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was 84% compared to the CCG average of 81% and the national average of 77%.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 81% which was lower than the CCG average of 87% and the national average of 88%.

  • Longer appointments and home visits were available when needed.

  • Patients who had a dual diagnosis of Asthma and Chronic Obstructive Pulmonary Disease (COPD) were treated using the GOLD (Global initiative for chronic Obstructive Lung Disease) guidance.

  • All of 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 16 December 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 relatively high 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.

  • The percentage of women aged 25-64 whose notes record that cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 86% which was higher than the CCG average of 83% and the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. There was a breastfeeding room with facilities for nursing mothers and their children.

  • Same day access and re-assessments of care and treatment were available for babies and children, the on-call doctor provided the opportunity for poorly babies and children to be re-assessed when necessary later in the day.

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

Working age people (including those recently retired and students)

Good

Updated 16 December 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 as well as a full range of health promotion and screening that reflected the needs for this age group.

  • The practice provided GP services to in excess of 14,000 university students each year. Specific clinics were set up with funding from the CCG. They included a Sports Injury clinic (two year trial) which produced positive results: they included fewer inappropriate referrals to Orthopaedic clinics, fewer Accident &Emergency (A&E) attendances in 18-24 age group and faster access to acute sports injury treatment. The funding for Primary Care Outcomes Scheme (Helping people to recover from episodes of ill health or following injury , Domain 3) ceased in April 2016 and the clinic had to be withdrawn.

  • Students had a specific website address and the practice undertook an annual patient satisfaction survey to receive and act on feedback from students

  • The practice worked closely with the University to offer same day access to patients deemed to be of concern. They involved other organisations in the planning of how services were provided to students, for example the University Counselling Service.

  • The practice was working closely with the CCG and Tees Esk Wear Valley NHS Foundation Trust to improve the service provision for patients with eating disorders.

  • The practice had strong links with the University and had developed a ‘White Form’ to enable important information to be collected prior to registration, for example with regard to previous vaccinations.

  • Saturday surgery was provided for those patients unable to attend during the week.

People whose circumstances may make them vulnerable

Good

Updated 16 December 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.

  • There was a GP and Nurse identified to support patients with a learning disability. The practice offered longer appointments for these patients.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. This included patients of no fixed abode and temporary residents who were housed in local refuges for short periods of time.

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

  • The practice had been involved in registering and supporting the local authority with a recent humanitarian project. Ensuring interpreters were provided and that all newly registered patients had the appropriate screening and where necessary treatments.

  • 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 had pioneered the role of the Frail/Elderly Nurse Practitioner with a two year pilot which had now been adopted throughout the CCG and in house the service had continued.


People experiencing poor mental health (including people with dementia)

Outstanding

Updated 16 December 2016

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

  • 97%of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 91% which was slightly higher than the CCG and national averages of 90%.

  • 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. When appropriate direct referrals were made to the mental health team.

  • There was an in house counselling service.

  • The student QOF template prompted GPs to check for suicidal ideation. There was same day access provided for urgent mental health needs.

  • The practice had the lowest suicide rate within the CCG. We were shown figures from January 2010-December 2015 which showed the practice’s suicide rate was much lower than the expected norm.

  • The practice had systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

There were GPs with special interests in eating disorders and they were liaising with the CCG and Tees Esk Wear Valley NHS Foundation Trust provider to improve access to local services for their patients.