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Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willington Surgery on 3 November 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents. Information about safety was recorded, monitored, and appropriately reviewed. Learning was applied from events to enhance future service delivery but this was not always cascaded widely.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. This was kept under review by the practice which used audit as a mechanism to ensure patients received safe and effective care.
  • Risks to patients were assessed and well managed. Regular liaison meetings were held with the wider multi-disciplinary team to co-ordinate the provision of effective and responsive care and this included a care coordinator. The CCG pharmacist attached to the practice provided regular and effective support on medication issues and provided support for the nurse prescriber.

  • Most of the practice team had received an annual appraisal and had undertaken training appropriate to their roles, with any further training needs identified and supported by the practice. Those who had not completed an appraisal had one planned within the practice’s agreed timescale
  • Results from the national GP survey, and responses to our conversations with patients showed that patients were treated with compassion, dignity and respect, and that they were involved in their care and decisions about their treatment.

  • Urgent appointments were available on the day they were requested. However, patients said that they sometimes had to wait a long time for non-urgent appointments.
  • There was a clear leadership structure and staff felt supported by management and motivated to deliver high quality care. However, there had been a delay in reviewing some policies as they were uploaded onto the new IT and data management system, but there were plans to rectify this within 6 months.

  • The practice proactively sought feedback from patients, which it acted upon. For example, the practice undertook patient surveys and encouraged ongoing feedback via the use of a suggestion box. The practice implemented changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG) who were proactive and met regularly.

  • Information about services and how to complain was available and easy to understand. Complaints were followed up but learning was not always cascaded widely.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The provider was aware of and complied with the requirements of the Duty of Candour

However, the practice should

Implement systems to ensure appraisals are completed within agreed timescales and recorded as such.

Review the arrangements for cascading learning from significant events to try and prevent recurrence.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents. Incidents were reviewed and any lessons learnt were discussed at monthly clinical meetings to make sure action was taken to improve safety in the practice. However, learning was not always disseminated widely and did not always include the attached team

The practice had systems, processes and practices in place to keep people safe and safeguarded from abuse. Staff were trained and knew how to act on a safeguarding concern and the practice reviewed their protection plans to ensure vulnerable children and adults were kept safe

Procedures for dealing with medical emergencies were robust and staff knew where to find emergency equipment

Administrative systems were in place that ensured that incoming correspondence and test results were seen by a GP on the day and dealt with quickly

The appointment of new staff was supported by appropriate recruitment checks, all of the practice staff had received clearance from the Disclosure and Barring Service (DBS) and there were enough staff to keep patients safe. They were actively recruiting two additional GPs to replace a partner who had just retired and to enable more GP appointments to be available for patients

Effective

Good

Updated 4 February 2016

The practice is rated as good for providing effective services. Systems were in place to ensure that all clinicians were up to date with best practice in delivering care and used the National Institute for Health and Care Excellence (NICE) guidelines to inform their work. Patients’ needs were assessed and care was planned and delivered following best practice guidance and regular audits were undertaken and improvements were made as a result of these to enhance patient care

There was very good evidence of collaborative working with the multi-disciplinary team, particularly for people who were vulnerable or had complex needs. The CCG pharmacist attached to the practice provided regular and effective support on medication issues, contributed to audit activity and provided support and guidance to the nurse prescriber

The practice was proactive in promoting good health to its users, including self-management and a range of information leaflets and self help groups were offered to patients. Nationally produced data showed patient outcomes were above average overall for the locality, and the practice achieved 94% of the available points within the 2014-15 Quality and Outcomes Framework

Staff had received training appropriate to their roles and any further training needs had been identified and planned through their annual appraisal system. 80% of staff had completed their annual appraisal at the time of our visit

Caring

Good

Updated 4 February 2016

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care and told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. In particular, the practice excelled in care provided for people whose situation made them vulnerable and those with a mental health problem including dementia

Urgent appointments were available on the day they were requested for patients with an urgent need and for older people and those with complex needs. However, patients said that they sometimes had to wait a long time for routine appointments

Staff we spoke to said that they felt valued and respected and that they enjoyed working there. Attached staff told us that they felt part of the team and were able to approach any member of the team to discuss any concerns at any time and that they felt listened to and acted upon. During our inspection we saw that staff were treated with respect and that there was an open, friendly atmosphere

Information about services for patients and carers was available and easy to understand and displayed in the reception area. This included information for carers of people with a learning disability. We found that patients were treated with compassion, dignity and respect, and that they were involved in their care and decisions about their treatment

Responsive

Good

Updated 4 February 2016

The practice is rated as good for providing responsive services. It took into account the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to make improvements to services where these were identified.. The practice worked closely with their pharmacist to coordinate changes in medication, provide blister packs where required and arrange delivery of medication

Patients were able to make a routine appointment with a GP for up to three weeks in advance but not always with their preferred GP.There were always urgent appointments available the same day and older people or those with complex needs were also given a priority appointment on the same day

The practice was a new purpose build premises with good facilities and was well equipped

to treat patients and meet their needs.

Information about how to complain was available and was displayed in the reception area. Learning from complaints was shared with staff at monthly meetings but the learning was not always followed through which was demonstrated by  some complaints and significant events being repeated

Well-led

Good

Updated 4 February 2016

The practice is rated as good for being well-led. Staff were clear about the values of the practice being patient centred and were motivated to deliver high quality care and promote good outcomes for patients.The practice were implementing a new computer system and were in the process of reviewing their policies and so there were some policies overdue a review. However there were plans to rectify this

Clinical meetings were held for clinical staff and opportunities were available for staff to learn and develop. Attached staff held their own meetings which were attended by some members of the practice team. Information relating to complaints and significant events was discussed and shared routinely with relevant staff. During September 2015, the practice had reviewed the previous year’s complaints at a meeting where all the practice staff were invited to contribute

The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty and staff told us that they felt able to report any concerns. The practice had systems in place for knowing about notifiable safety incidents which were cascaded to all relevant staff by the practice manager

The practice proactively sought feedback from patients, which it acted upon. For example, the practice undertook patient surveys and encouraged ongoing feedback via the use of a suggestion box. The practice implemented changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG). For example; barriers were introduced at the reception desk to enable better confidentiality

Checks on specific services

People with long term conditions

Good

Updated 4 February 2016

The practice is rated as good 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 by a care coordinator who worked closely with community matron and nurse practitioner who had a lead role in managing long term conditions. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. A robust process was in place to follow up on non-attenders.  Longer appointments and home visits were also available when needed

The practice made good use of specialist services to assist people with diabetes and those with lung disease and referred them to the self-help groups ‘Diabetes and You’ and ‘Breathe-easy ‘ and proactively referred patients to these groups when identified with pre-diabetes

Specific care plans were written for all patients who were newly diagnosed with diabetes and chronic obstructive airways disease (COPD). Practice data showed that 71% of patients with a chronic disease had been offered smoking cessation advice

The practice worked well with the community matron and care coordinator to identify high risk patients and patients who had been admitted to hospital within the last five days with an acute attack of asthma. They  proactively reviewed those patients on discharge from hospital

The practice provided 24 hour blood pressure monitoring and cardiac event monitoring that enabled patients to receive these tests closer to home and they also loaned blood pressure monitors to patients where required

Families, children and young people

Good

Updated 4 February 2016

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

There was a system in place to provide childhood immunisation and the rates were relatively high for all standard childhood immunisations with current figures averaging at 98% compared to the CCG average which was 95%

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

Appointments were available outside of school hours and the practice reserved some late afternoon appointment slots for children. The premises were suitable for children and babies. This included childrens toys, a breast feeding room and baby changing facilities

We saw good examples of joint working with midwives and health visitors who attended daily and were able to access the practice doctors easily for discussion and advice. The practice also hosted a monthly meeting where at least one GP met with the attached team, consisting of midwives, health visitors and the community matron to discuss child concerns, care plans and safeguarding concerns

The practice offered a full range of contraceptive services including coils and implants and provided information on the C- card scheme whereby young people aged 13-19 could access confidential free sexual advice and condoms

The practice offered cytology and well woman clinics and had achieved 83% cervical cytology screening in 2014/2015 for people who were eligible for this which is comparable with the CCG average which is 84%  and the  national average which is 82%

Older people

Good

Updated 4 February 2016

The practice is rated as good for the care of older people and offered proactive, personalised care to meet the needs of the older people in its population and provided care plans for those at risk of unplanned admissions and for people with dementia.

The practice held a monthly meeting with members of the attached team (Community Support Team meetings) and the care coordinator specifically to discuss the care and management of older people who were in need of support. The meeting included the community matron, a psychiatric nurse, social care team, occupational therapist and voluntary sector where required

The practice offered home visits and urgent appointments so that older people with complex needs were prioritised to ensure they received care promptly. It also offered annual health checks with a nurse who specialised in long term conditions, and at the time of our visit 84% of people aged over 75 years had received a health check

They provided some services at the patients own home for older people who were house bound. For example; conducting blood tests, medication reviews, immunisations and vaccinations

The practice had close links with a local care home and undertook monthly reviews of all the residents there. They also made visits in between these arranged times when requested and provided a direct line access for the care home and other external stakeholders

Working age people (including those recently retired and students)

Good

Updated 4 February 2016

The practice is rated as good for the care of working age people (including those recently retired and students) and had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, telephone consultations with a GP was offered to people who were unable to access an appointment outside of their usual working hours. These were bookable in advance. Urgent appointments were available on the same day for those who needed them

The practice was mindful of working times of their patients and made time to contact them, where required at the end of their working day (up to 6.30pm)

NHS checks were offered for eligible people and performance data for 2014/2015 showed that 74% of eligible people had attended for a health check

There were health promotion leaflets and information available within the reception area which included; Chlamydia and sexual health information, flu vaccination information, counting the kicks for expectant mothers, smoking cessation, and information on self-help courses for new patients with a diagnosis of diabetes and those diagnosed with pre-diabetes

The practice offered travel vaccinations, flu clinics on Saturdays and were signed up to the ‘Choose and Book’ service which enabled patients some flexibility in where they accessed secondary care

People experiencing poor mental health (including people with dementia)

Good

Updated 4 February 2016

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

The practice provided annual health reviews for people diagnosed with dementia. Practice data showed that 97% of people with dementia had had their care reviewed in a face to face meeting in the last 12 months which was higher than the CCG average which was 84%

The practice also carried out opportunistic screening for dementia for at-risk groups and for those people concerned about their memory. Where screening identified a potential problem, this was followed up by the practice

It carried out annual health reviews for people with severe mental health issues and had a system in place for monitoring attendance and implementation of care plans. Practice data showed that 77% of patients experiencing severe mental illn health had attended for a health check in 2014/2015 and had been given the opportunity to attend a health promotion event hosted by the practice and PPG

Staff had a good understanding of how to support people with mental health needs and dementia and had received appropriate training including attending an event run by Southern Derbyshire Mental Health Champion who came to speak about ‘mindfulness’

The practice held a monthly meeting with the community psychiatric nurse and the care coordinator which enabled care to be planned for people with dementia

Staff had received ‘Dementia Friendly’ training and we observed staff treating older people with respect. The practice told us that they were taking part in the Derbyshire Dementia Friendly pilot

People whose circumstances may make them vulnerable

Good

Updated 4 February 2016

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

They held a register of patients living in vulnerable circumstances including people with a learning disability; people with a serious mental health condition including dementia; those who were at risk of abuse and those receiving palliative care

The practiced offered an annual health check for people with a learning disability. Practice data showed that 50% of patients with a learning disability who were on the practice register had attended for an annual health check and the remainder were planned for November to March 2016. They also provided primary care medical services for pupils in a local boarding school which was a specialist school for children with a learning disability.

The practice offered flexibility in accommodating vulnerable patients for appointments and offered some secondary care appointments at the practice where necessary, for example where patients needed to see a specialist but who were unable to travel to the local hospital.

Patient feedback showed staff were caring, compassionate and took time to listen

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and referred people for emergency access to community services where required, through the Voluntary Single Point of Access system

The practice had a safeguarding lead and staff had received appropriate training and knew how to recognise signs of abuse in vulnerable adults and children and 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