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Archived: Salford Health Matters Eccles Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 16 November 2014

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Salford Health Matters Eccles. The practice is registered with the Care Quality Commission to provide primary care services.

We carried out a comprehensive inspection on 3 October 2014. We spoke with patients, members of the patient participation group (PPG), and staff including the management team.

The practice is rated as Outstanding. An effective, responsive and well-led service is provided that meets the needs of the population it serves.

All regulated activities provided by Salford Health Matters Eccles were inspected.

Our key findings are as follows:

  • The service is safe.  Staff understand and fulfil their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents are maximised to support improvement.
  • The service is effective. The practice is using innovative and proactive methods to improve patient outcomes and it links with other local providers to share best practice. It is involved in a local scheme where a holistic approach to health and social care is being trialled.
  • The practice is caring. Feedback from patients about their care and treatment is consistently and strongly positive. There is a patient centred culture and strong evidence that staff are motivated and inspired to offer kind and compassionate care, working to overcome obstacles to achieve this. There are many positive examples to demonstrate how people’s choices and preferences are valued and acted on.
  • The practice is responsive to people’s needs. The practice implements suggestions for improvements and makes changes to the way it delivers services as a consequence of feedback directly from patients and from the patient participation group (PPG).
  • The practice is well-led.  They have clear vision which has quality and safety as its top priority. A business plan is in place that is monitored and regularly reviewed by the board, and discussed with all staff. The practice is a social enterprise and has a board of directors, including a non-clinical chief executive, responsible for making business decisions. High standards are promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • All patients who require an appointment with a GP are seen on the day their request is made. Requests can be made at any time of the day, and the practice has late night and weekend opening so patients not available during working hours can access appointments easily.
  • Appointment length is need-specific so GPs arrange longer appointments when they think this is necessary. Longer appointments are routinely offered to some patients, for example patients with a learning disability.
  • Patients have the facility to attend another practice within the group that has different late night or a different Saturday opening if this is more convenient for them.
  • As well as discussing significant events with staff, they are discussed with people outside the practice so that ideas for improvement can be shared. 
  • The practice has a very good skills mix which includes advanced nurse practitioners (ANPs). The ANPs are able to have more responsibility than practice nurses and see a broader range of patients. There is a preceptorship programme in place to support new ANPs to the practice. There is an excellent system for completing and learning from clinical audit cycles, and learning is shared within the practice and with external organisations.
  • The practice takes the care of vulnerable people seriously. A GP from the practice attends a drop-in centre three times a week and homeless patients have access to that GP without an appointment. All patients can access the practice for appointments if they prefer.
  • The practice takes the care of people with dementia seriously. All staff are 'dementia friends', so know more about how they can help people with the condition.
  • The practice proactively looks for feedback from patients and sends a text message to all patients following an appointment to ask one question about their satisfaction. They contact patients who are not satisfied to discuss areas for improvement.
  • The business plan is discussed and monitored by the board. At any given time detailed information about the performance of all areas of the practice is available.
  • Communication with staff is excellent. Weekly meetings away from the workplace take place and staff receive weekly email correspondence from the chief executive informing them of any relevant information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for safe. Safety within the practice was monitored and ways to improve were identified. 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 to support improvement. As well as discussing significant events with staff, they were discussed with people outside the practice so that ideas for improvement could be shared. Information about safety was highly valued and also used to promote learning and improvement. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. There were enough staff to keep people safe.

Effective

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for effective. Our findings at the inspection showed 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, and we also saw evidence that confirmed that these guidelines were influencing and improving practice and outcomes for their patients. The practice was using innovative and proactive methods to improve patient outcomes and it worked in partnership with other neighbourhood practices and community organisations to share best practice. There was an excellent system for completing and learning from clinical audit cycles, with learning being shared within the practice and with external organisations. The practice had a very good skills mix which included advanced nurse practitioners (ANPs). The ANPs were able to have more responsibility than practice nurses and see a broader range of patients. There was a preceptorship programme in place to support new ANPs to the practice. The practice was involved in a local scheme where a holistic approach to health and social care was being trialled.

Caring

Outstanding

Updated 16 November 2014

The practice is rated as outstanding for caring. Feedback from patients about their care and treatment was consistently and strongly positive. We observed a patient centred culture and found strong evidence that staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how people’s choices and preferences were valued and acted on.

Responsive

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for responsive. We found the practice had initiated positive service improvements for their patients that were over and above their contractual obligations. The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback directly from patients and from the patient participation group (PPG). The practice had reviewed the needs of their local population and engaged with other services in the area, including the Clinical Commissioning Group (CCG) to secure service improvements where these had been identified.

Patients reported excellent access to the practice, with telephone and face to face appointments always available on the day requested. There was an accessible complaints system with evidence demonstrating that the practice responded quickly to issues raised. There was evidence of shared learning from complaints with staff and other stakeholders.

Well-led

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for well-led.  The practice had a clear vision which had quality and safety as its top priority. A business plan was in place that was monitored and regularly reviewed by the board, and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles. Staff worked well with the other practices within the group to share expertise. We found there was a high level of constructive staff engagement and a high level of staff satisfaction, and this was monitored.  The practice sought feedback from patients, which included using new technology, and it had an active PPG.

Checks on specific services

People with long term conditions

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group of people with long term conditions. Patients had an annual review of their condition and their medication needs were checked at this time. When needed, longer appointments and home visits were available. Patients at risk of being admitted to hospital due to their condition had a care plan in place, and this was regularly reviewed by a GP.

Families, children and young people

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group of families, children and young people. Systems were in place for identifying and following-up children who were at risk. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives and health visitors. 

Older people

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group of older people. The practice had a register of all patients over the age of 75 and these patients had a named GP. Patients at risk of an unplanned hospital admission had a care plan in place. Housebound patients were routinely visited so they could be given information and advice to prevent hospital admissions. The practice had found their appointment system, where patients could speak with a clinician by telephone on the day they contacted the practice, worked particularly well for older people. They found older patients engaged with the practice at an earlier stage so more serious illnesses could be prevented.  The practice worked as part of a multi-disciplinary team to take a holistic approach to caring for the over 65 age group. This was a trial for their area.

Working age people (including those recently retired and students)

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group of working age people (including those recently retired and students). Appointments were routinely offered until 6.30pm, with appointments until 8pm one evening each week. The practice was also open one Saturday morning each month. Patients had the facility to attend another practice within the group who had different late night or Saturday opening times if this was more convenient. Telephone calls to patients who were at work were made at times convenient to them.

NHS Health Checks were offered to all patients between the ages of 40 and 74. This was an opportunity to discuss any concerns the patients had and identify early signs of medical conditions. Different ways of engaging patients to increase the attendance rate were being trialled and the practice had reported an increase in the take-up rate following invitations being issued by text message.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group of people experiencing poor mental health (including people with dementia). All staff at the practice were ‘dementia friends’ which gave them an understanding of dementia and the things that could make a difference to people living in their community. A primary care mental health worker regularly attended the practice and patients were able to see them in the setting they were familiar with. The practice had sign-posted patients experiencing poor mental health to various support groups, and they were proactive in helping patients address issues such as smoking to improve all aspects of their health. Arrangements had been made to see patients who displayed aggressive behaviour at one of the other practices within the group. Additional training had been provided for the staff at the other practice and the premises had been deemed more suitable.

People whose circumstances may make them vulnerable

Outstanding

Updated 16 November 2014

The practice was rated as outstanding for the population group 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 learning disabilities. They took the care of vulnerable people seriously. Homeless patients could access a GP from the practice without an appointment at a drop-in centre three times a week. They could also be seen at the practice if they preferred. The practice offered longer appointments for people with learning disabilities.

Staff knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.