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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alverthorpe Surgery on 28 June 2016. 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 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 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.
  • The practice held a safeguarding register which was reviewed on a monthly basis.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 14 December 2016

The practice is rated as good 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 in the majority of areas.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience 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.

Caring

Good

Updated 14 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.
  • The practice had a carers’ information board displayed in the waiting area which displayed information and promoted health checks for carers.
  • Information for patients about the services available was easy to understand and accessible.
  • Staff had received sensory impairment training and as a result had changed signage throughout the practice. The wording on the patient call screen had been slowed down to ensure it was visible for longer.
  • There was a portable hearing loop to support patients who were hard of hearing, this could be used at the reception area and also taken into consultations.
  • Interpretation services were available for non-English speaking patients.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • A room was available for patients wishing to speak to a member of staff in private.

Responsive

Good

Updated 14 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 to secure improvements to services where these were identified. For example; the practice were involved in the avoiding unplanned admissions scheme which aimed at reducing avoidable unplanned admissions for vulnerable patients and those with complex physical or mental health needs, who are at high risk of hospital admission.
  • Patients said they found it easy to make an appointment, with urgent appointments available the same day. The practice were part of a hub of practices, which offered patient appointments from 6.30pm until 8pm each weekday and from 9am until 3pm on Saturdays.
  • The practice also provided extended hours from 6.30pm until 7.15pm on Tuesday evenings when patient could access an appointment with the GP or practice nurse.

  • The practice offered dedicated appointments for children/young people and these could be accessed in person or via a telephone clinic. The practice nurse was also available during these sessions for any patient preferring to speak to a female member of staff.

  • The practice offered a range of online services including booking appointments and repeat prescription requests.
  • The practice continually monitored the appointment system to ensure an adequate number of appointments were available. This resulted in many patients having access to same day appointments
  • The practice took a holistic approach to patient reviews and all reviews were carried out during one appointment.
  • 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 evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice actively monitored accident and emergency (A&E) attendances and engaged with patients to educate and discuss the most appropriate service to access. As a result the practice had the lowest A&E attendance rates across the district in 2014.
  • Offered services led by pharmacists and physiotherapists. These staff were able to either directly support clinical staff or deliver services to patients which reduced the need to access these services at other locations and demand on primary and secondary care services.

Well-led

Good

Updated 14 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 lead GP 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

People with long term conditions

Good

Updated 14 December 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.
  • Outcomes for diabetes related indicators were comparable or better than other practices. For example the percentage of patients on the register who had a flu immunisation in the preceding 12 months was 100% compared to the CCG average of 97% and national average of 94%.
  • 91% of patients with diabetes, on the register, had a record of a foot examination and risk classification, compared to the CCG average of 89% and national averages of 88%
  • Longer appointments and home visits were available when needed.
  • 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.
  • The practice used a risk stratification tool to aid management of diabetes and coronary heart disease. This aimed to improve consistency, quality and effectiveness of patient care at the point of care.

Families, children and young people

Good

Updated 14 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 practice offered dedicated appointments for children/young people and these could be accessed in person or via a telephone clinic. The practice nurse was also available during these sessions for any patient preferring to speak to a female member of staff.
  • The practice worked closely with the local youth project and involved them in reviewing the practice website and producing a survey aimed at younger patients.
  • The percentage of eligible women, who had undergone a cervical screening test in the preceding five years, was 91% which was better than the CCG average of 84% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 14 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 people 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 worked alongside Age UK and the local Health and Wellbeing Team to promote groups and services available.

Working age people (including those recently retired and students)

Good

Updated 14 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 reflects the needs for this age group.
  • The practice were part of a local hub of practices who offered patient appointments from 6.30pm until 8pm each weekday and from 9am until 3pm on Saturdays.
  • The practice offered a range of online services including booking appointments and repeat prescription requests.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2016

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

  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 83% and national average of 84%.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record, in the preceding 12 months. This was better than the CCG average of 90% and national average of 88%.
  • 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.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice used a risk stratification tool to aid identification and management of dementia. This aimed to improve consistency, quality and effectiveness of patient care at the point of care.

People whose circumstances may make them vulnerable

Good

Updated 14 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments or multiple appointments for patients with a learning disability.
  • The practice had a system in place to follow up patients who did not attend their appointment.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed 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.