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The Doc's Surgery Outstanding Also known as The Docs

Inspection Summary


Overall summary & rating

Outstanding

Updated 25 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Doc's Surgery on 21 June 2016. Overall the practice is rated as outstanding.

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

  • 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.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice developed a Caldicott Guardian role responsible for all patient information requests, to ensure all summary care record and HIV (HIV means Human Immunodeficiency Virus, which attacks the body's immune system) positive patients were dealt with in a timely and effective manner.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met local patients’ needs. For example the practice treated a small number of older Chinese patients and forged close working with a local organisation to help with translation services and support network.
  • 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 stakeholders and was regularly reviewed and discussed with staff. This included clinical discussions daily every lunch time and formal clinical meetings.
  • The practice had an established partnership with multiple healthcare professionals and research projects to facilitate and improve patient outcomes. For example the practice had been involved in the research into primary care missed diagnostic opportunities.

  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • Feedback from patients about their care was consistently positive.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw areas of outstanding practice including:

  • The practice offered a full in-house sexual health clinic to registered and non-registered patients. This included same day results for HIV testing and a full screening and treatment service, something which is normally offered in sexual health clinic. The practice had the highest number of patients with HIV in the UK. It had established close links with one of the HIV consultant at North Manchester Hospital and a joint clinic was held once a month. The practice had developed a “Man fact sheet” on raising the awareness of Human Papilloma Virus (HPV is the name for a group of viruses that affect your skin and the moist membranes lining your body).This was already showing to be a positive tool in raising awareness. One example, saw a high risk patient receiving the full course of vaccines so far. There was also an expressed interest in being involved in a pilot project at primary care level.
  • The GP partner had started an emotional wellbeing initially called “yoga on prescription” scheme to help support the high number of patients who suffered from acute illness such as stress, anxiety, low mood and generalised pain. . Between February and June 2016 there had been 27 patients issued a yoga prescription. The lead GPs presented the scheme to the House of Lords on 27th June 2016.
  • The GP partners had been using supervision meetings every 6-8 weeks for many years, which are held as counselling sessions. This had been an invaluable tool to help shape and develop strong clinical support and manage the successful business side of the practice. Any new partners must agree to attend these meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 August 2016

The practice is rated as good for providing safe services.

  • The practice had a Caldicott Guardian who was responsible for all data extraction requests, to ensure all summary care record were dealt with in a timely and effective manner.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse, which was regularly audited and with a clinical IT template designed.
  • There was an effective system in place for reporting and recording significant events, with long term logs of all actions and improvements made.
  • 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 prided itself on having a low complaint rate.
  • Risks to patients were assessed and well managed. We saw multiple examples of the business continuity plan being used effectively to support the practice in an emergency.

Effective

Outstanding

Updated 25 August 2016

The practice is rated as outstanding for providing effective services.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. For example, a monthly consultant led HIV clinic was established in the practice, resulting in expert care moving carefully into the local community.
  • The practice was awarded the gold “Pride in Practice” award which is a quality assurance service that strengthens and develops relationship with lesbian, gay, bisexual and transgender patients within your local community.
  • The practice had developed an in house process to ensure all referrals were actioned on the same day by the requesting clinician and had a system to monitor all two week referrals to avoid lost referrals or delays that may have occurred.
  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients. For example, templates were designed to help the clinical staff reduce time in consultation typing on the computer and to provide more hands on care using both local and national guidelines.
  • Data showed that the practice was performing highly when compared to practices nationally.
  • 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to CCG average of 84% and national average of 88%.
  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

Caring

Outstanding

Updated 25 August 2016

The practice is rated as outstanding for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. For example, 95% of patients said they had confidence and trust in the last GP they saw in the practice compared to CCG average of 93% and national average of 95%
  • Feedback from patients about their care and treatment was consistently positive.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the reception staff knew the majority of patients by their first name.
  • We found many positive examples to demonstrate how patients’ choices and preferences were valued and acted on.
  • Views of external stakeholders about the practice were very positive and aligned with our findings.
  • 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.

Responsive

Outstanding

Updated 25 August 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs, for example, a close working partnership had been forged with North Manchester hospital, which led to a Consultant led clinic being set up in the practice.
  • The practice offered a sexual health clinic to all their patients, with on the day HIV testing available to all patients.
  • There were innovative approaches to providing integrated patient-centred care. This was shown in many areas of the practice such as the development of the “Man fact sheet” on raising the awareness of Human Papilloma Virus (HPV - a common virus spread by skin to skin contact) in men.
  • Patients could access appointments and services in a way and at a time that suited them. For example, online texting service for test results and appointment reminder and cancellation service.
  • 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 staff and other stakeholders.

Well-led

Outstanding

Updated 25 August 2016

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

  • The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
  • 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. Governance and performance management arrangements were proactively reviewed and reflected 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 partners in the practice prioritised safe, high quality and compassionate care.
  • The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

Older people

Outstanding

Updated 25 August 2016

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

  • The practice believed in continuity of care with all older people having a named GP.
  • Support to the elderly Chinese population was witnessed, with the reception staff attending language classes at the Wai Yin local centre, to help patients feel more included. One family member commented on the excellent care provided to their mother.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. This resulted in 100% over 75 year old patients having a care plan in place which was reviewed annually.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

People with long term conditions

Outstanding

Updated 25 August 2016

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

  • The practice tailored care to suit the population and had a locally commissioned service, treating 259 HIV positive patients – the highest number in one practice in the UK.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Prevalence was lower for many diseases monitored due to the population.
  • 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.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Outstanding

Updated 25 August 2016

The practice is rated as outstanding 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.
  • Cervical screening was 80.6%, which was higher than local and national average.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Working age people (including those recently retired and students)

Outstanding

Updated 25 August 2016

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

  • The practice had a range of services offered to patients to help treat social phobias and stress.
  • 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. For example a full sexual health clinic and treatment service was available.
  • 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.

People whose circumstances may make them vulnerable

Outstanding

Updated 25 August 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

  • There was raised awareness for same sex relationships domestic violence training to help support patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, with Broken Rainbow and Survivors for sexual abuse organisations.
  • There was access to sexual health testing for registered and non-registered patients.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and had formed close link with one of the HIV consultants in the area.
  • 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 held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 25 August 2016

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

  • The practice had a system and checks in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Emotional wellbeing initially called the “yoga on prescription” scheme was available to all patients.
  • The practice had initiated in house sessions with local a Manchester based charity called Moodswings, helping people recover from mood problems and the severe emotional distress.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, the practice website had a range of signposting services for mental health services and local help groups.
  • Staff demonstrated clearly awareness of individual patient needs.