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Inspection Summary


Overall summary & rating

Good

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkway Medical Group on 27 October 2015. 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 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, 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.

We saw some area of outstanding practice:

  • On the National GP Patient Survey, the practice consistently scored higher than the national and local averages across a number of areas, such as ease of access to the service, patient care and overall experience. For example, 96.6% of patients described their overall experience as good (compared to 86.3% locally and 84.8% nationally) and 96% of respondents would recommend this surgery to someone new to the area. This compared to the clinical commissioning group (CCG) average of 79% and the national average of 78%.

  • The practice supported staff to take a reflective approach to staff training, to ensure the value of training was realised and it had an impact on the way staff delivered the service. Throughout the year the staff completed a reflective learning log where they documented the training they had completed, what their key learning points were and how this might change the way they do their job. Managers discussed this with staff at appraisal sessions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 December 2015

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 there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and 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 people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • Good medicines management systems and processes were in place.
  • The premises were clean and hygienic and there were good infection control processes in place.
  • There were appropriate arrangements for recruiting and vetting staff.

Effective

Good

Updated 24 December 2015

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.
  • 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. The practice used a reflective learning approach for staff to ensure the value of training was realised and it had an impact on the way staff delivered the service.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 24 December 2015

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for almost all aspects of care.
  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 24 December 2015

The practice is rated as good for providing responsive services.

  • Staff had reviewed the needs of their patient population and were providing services to meet them. The practice engaged with the local clinical commissioning group (CCG) and worked with them to improve and develop patient care;
  • 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. Evidence provided during the inspection showed that the practice responded quickly to any issues raised.
  • Patients said they found it easy to make an appointment with a named GP which helped provide continuity of care. Urgent, same day appointments and telephone consultations were available.

Well-led

Good

Updated 24 December 2015

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 this.
  • 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 partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice supported the active patient participation group to inform how the practice could improve.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 24 December 2015

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

  • Effective systems were in place which helped ensure patients with long-term conditions received an appropriate service which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 84.9%. This was higher than the England average of 81.6%;
  • Longer appointments and home visits were available when needed.
  • Patients at risk of hospital admission were identified as a priority, and steps were taken to manage their needs.
  • Staff had completed the training they needed to provide patients with safe care.

Families, children and young people

Good

Updated 24 December 2015

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

  • Regular antenatal clinics and weekly baby clinics were held by midwifes attached to the practice. The GP partners provided support to the baby clinics. We saw good examples of joint working with midwives, health visitors and school nurses.
  • 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.
  • A full, child immunisation programme was provided. Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 98.7% to 100% and five year olds from 97.6% to 100.0%. This was the same as or higher than the local CCG averages.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • 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 produced a newsletter aimed at young people and there was also a section on the practice website aimed at the needs of young people.
  • Younger patients were able to access contraceptive and sexual health services, and appointments were available outside of school hours.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the Quality and Outcomes Framework (QOF) data for 2014/15 showed the practice’s uptake for the cervical screening programme was 95.7%, which was higher than the national average of 81.9%.

Older people

Good

Updated 24 December 2015

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

  • Staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met.
  • Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
  • The practice offered home visits and longer appointment times where these were needed by older patients.

  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the percentage of patients with atrial fibrillation, who were treated with anticoagulation drug therapy or antiplatelet therapy was 100%, which was better than the England average (of 98.3%).

  • 79.4% of patients aged 65 years or over received a seasonal influenza vaccination which was better than the national average (of 73.2%).

Working age people (including those recently retired and students)

Good

Updated 24 December 2015

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

  • The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided 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.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data for 2014/15 showed the practice had obtained 100% of the overall points available to them for providing services for patients with hypertension. This was 6.5% above the local CCG and 11.6% above the England average.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 December 2015

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

  • Nationally reported data showed the practice had performed well in providing recommended care and treatment to patients with mental health needs. For example, the QOF data for 2014/15 showed the practice had obtained 100% of the overall points available to them for providing care and treatment to patients with mental health needs. This was 7.6% above the local CCG average and 9.6% above the England average.
  • 89.4% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • They 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 December 2015

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 patients with learning disabilities.
  • Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data for 2014/15 showed the practice had obtained 100% of the overall points available to them for providing services for patients with learning disabilities. This was 9.5% above the local CCG average and 15.9% above the England average.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Staff provided vulnerable patients with information about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, the documentation of safeguarding concerns and contacting relevant agencies.