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Archived: The Practice Canberra Good

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Inspection Summary


Overall summary & rating

Good

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Practice Canberra on 8 October 2014. We rated the practice as ‘Good’ for the service being safe, effective, caring, responsive to people’s needs and well-led. We rated the practice as ‘Good’ for the care provided to older people and people with long term conditions and ‘Good’ for the care provided to, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

We gave the practice an overall rating of ‘Good.'

Our key findings were as follows:

  • Patients were positive about the practice and services provided. They were happy with the opening hours and flexible appointment system.
  • Patients said that staff were welcoming, caring and treated them with dignity and respect and the GPs involved them in decisions about their treatment and care.
  • Systems were in place to keep patients safe including incident reporting protocols, safeguarding and infection control procedures.
  • Staff were appropriately qualified to deliver effective care and treatment in line with NICE guidance.
  • The practice had a clear vision and strategy to address health inequalities in the local community and staff worked as a team to achieve this.
  • The practice proactively sought feedback from patients and used it to make improvements to the services provided.

We saw several areas of outstanding practice including:

  • The practice offered an innovative service for 120 homeless people working with a homeless charity.
  • Excellent access to the practice with 8:00am to 8:00pm opening hours on a weekday and Saturday morning appointments.
  • Ring fenced appointments for vulnerable patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 March 2015

The practice is rated as good for safe. Procedures were in place to ensure incidents were reported, analysed and learning shared. Safety alerts received from the NHS central alert system were distributed to the appropriate staff and acted upon. Medicines were managed safely and staff were trained to deal with medical emergencies. Safeguarding procedures were in place to protect children and vulnerable adults from harm. Staff were knowledgeable on safeguarding both children and vulnerable adults and knew who to report to with any concerns. We observed the premises to be clean and tidy. We saw there were cleaning schedules in place and cleaning records were kept. Patients we spoke with told us they always found the practice clean and had no concerns about cleanliness or infection control. Systems were in place to monitor risk. Where risks had been identified control measures were in place to minimise them. Equipment used by the practice had undergone regular safety checks. Appropriate pre-employment checks had been carried out on staff before they started working for the practice to ensure they were of suitable character.

Effective

Good

Updated 5 March 2015

The practice is rated as good for effective. The practice was carrying out effective needs assessment in line with professional guidance. Referral rates and prescribing data compared favourably with other practices in the CCG. The practice had scored 99% in their QOF performance in the previous year and used QOF to steer practice activity. The practice had carried out clinical audits in line with CCG recommendations. Staff were appropriately qualified to deliver effective care and treatment. The practice worked with other services/health care professionals to manage patients with multiple needs. The practice offered a wide range of services to promote good health.

Caring

Good

Updated 5 March 2015

The practice is rated as good for caring. Patients were overall satisfied with their GP practice. Patients said they were treated with dignity and respect and staff were welcoming and friendly. This was reflected in the national patient survey 2014. The results of the national patient survey 2014 showed that the practice scored below the CCG average for the percentage of patients who said the GPs were good at listening to them, explaining tests and treatments and involving them in decisions about their care.  However during our inspection patients said the clinical staff involved them in decisions about their care and treatment and this was reflected in the completed Care Quality Commission (CQC) comment cards we received. Patients were positive about the emotional support provided by staff at the practice and the practice worked closely with a local befriending service to support patients who were lonely or bereaved.

Responsive

Good

Updated 5 March 2015

The practice is rated as good for responsive. The practice had planned services to meet the needs of the local population. These included flexible access to appointments, diabetes clinics and a women’s only clinic on a Wednesday morning. The practice had recognised the needs of different groups in the planning of its services. For example, patients had access to a translation service to help them with their communication needs and there was access for patients with mobility needs. The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from the Patient Participation Group (PPG) and had a system in place for handling concerns and complaints. Patients’ complaints had been acknowledged and resolved in a timely manner.

Well-led

Good

Updated 5 March 2015

The practice is rated as good for well-led. The practice had a clear vision and strategy to address health inequalities in the local community by providing high quality health care. Staff were able to articulate the vision of the practice and worked as a close knit team to achieve this. Governance arrangements were in place including policies and procedures to govern activity and defined roles for staff and lines of accountability. Weekly staff meetings were held and staff received adequate training and support to carry out their job roles effectively, including annual appraisal. The practice had gathered feedback from patients through patient surveys, a suggestion box, NHS Choices feedback and complaints received. The practice had developed action plans as a result of patient satisfaction questionnaires and made improvements to the service.

Checks on specific services

People with long term conditions

Good

Updated 5 March 2015

The practice is rated as good for the population group of people with long-term conditions. The practice had effective recall systems and protocols in place for the care of patients with long-term conditions including input from the health care assistants, practice nurse and GPs. The GPs took lead roles in the management of long-term conditions including heart disease, asthma, chronic obstructive pulmonary disease and diabetes and were supported by the practice nurse to provide effective care. The practice monitored patients with long-term conditions using quality and outcomes framework (QOF) performance. The practice had achieved 98% in its performance against the various disease registers within the QOF framework in the previous year. The practice participated in an integrated care pilot (ICP) which provided an enhanced level of input from specialists to improve the health and wellbeing of patients with long-term conditions.

Families, children and young people

Good

Updated 5 March 2015

The practice is rated as good for the population group of families, children and young people. The practice provided a range of services for families, babies, children and young people including weekly women’s only sessions with a female GP who specialised in women’s health and family planning, a weekly baby clinic, baby immunisations, ante-natal and post-natal care and child development checks. The practice worked with innovative local services, such as the neighbourhood mums and dads project and the family nurse partnership providing specialist nurse support for new parents. The practice participated in a connecting care for children group pilot, a partnership across GP practices and paediatric services from Imperial college healthcare NHS trust to provide a multi-disciplinary level of care for children. The practice worked with the health visitor who attended practice meetings to discuss any concerns the practice or the health visiting team may have in relation to children. The lead GP attended child protection case conferences and a system was in place to alert staff if a child was on a child protection plan.

Older people

Good

Updated 5 March 2015

The practice is rated as good for the population group of older people. The practice had a range of services targeted at older people. For example the practice participated in an integrated care pilot (ICP) which provided an enhanced level of input from specialists to improve the health and wellbeing of older patients with complex needs. The pilot involved the practice working with a hospital consultant to run a virtual ward (A virtual ward uses the systems and staffing of a hospital ward to provide preventative care for people in their own homes). The practice worked with community independence services and health and social care coordinator services to support older patients to retain their independence in their own homes and reduce hospital admissions. The practice had a vulnerable register for patients over 75 years, a named GP and care plans in place. The practice provided a carer’s identification scheme to ensure carer’s were included in the care provided to elderly patients when visiting the GP. The practice worked with a local befriending service providing social contact and companionship to older patients.

Working age people (including those recently retired and students)

Good

Updated 5 March 2015

The practice is rated as good for the population group of working age people (including those recently retired and students). The practice provided easy access to this population group. For example appointments were available early mornings, late evenings and weekends for those who were working or in education. In addition the practice offered telephone consultations and online booking for this group.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 March 2015

The practice is rated as good for people experiencing poor mental health (including people with dementia). The practice participated in a shared care mental health Locally Enhanced Service (LES). Through this LES the practice communicated with the community mental health area teams to facilitate the discharge of stable patients to primary care. These patients were followed up by the practice with the support of a primary care mental health support worker who attended the practice weekly and conducted joint reviews. The lead GP for mental health met regularly with the mental health worker to discuss patients and referrals to Improving Access to Psychological Therapies (IAPT) services. If an acute assessment was needed patients would be referred to the local mental health assessment service. The practice participated in a dementia Directed Enhanced Service (DES) to profile patients who may be at risk of dementia.

People whose circumstances may make them vulnerable

Good

Updated 5 March 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice collaborated with a local homeless service and provided easy access for homeless patients. At the time of our inspection there were 120 homeless patients or those with no fixed abode registered at the practice. The practice provided a multi-lingual advocacy service to help those with English as a second language with job searches or benefit claims. The practice worked closely with the local community translating and interpreting service, a collaboration through which they provided health specific ESOL (English Speaking for Other Languages) courses and classes to help those with English as a second language better access healthcare. The practice had an extremely low incidence of patients with a learning disability, with only one patient on the register. However the practice had developed close links and communication with the local learning disability team. The practice was also a registered distributor of food-bank vouchers.