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The Grove Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 22 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grove Medical Centre on 23 May 2016. 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 report incidents and near misses. There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice was approached by other providers in the area to take over their practices following retirement.

  • Feedback from patients about their care was consistently positive. Several patients told us that the GPs would often call in on housebound patients and those with palliative care needs, without being asked. When the other practices were merged, staff took time and effort to engage with patients to provide a service tailored to the needs of each site.

  • Risks to patients were assessed and well managed.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, to maintain consistency with long term condition management across town boundaries, the Advanced Nurse Practitioners would undertake long term condition reviews for housebound patients where required.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw areas of outstanding practice including:

  • Several patients told us that the GPs would often call in on housebound patients and those with palliative care needs, without being asked.
  • The practice had developed its own easy to read leaflet which clearly explained to parents and carers how and when they should seek urgent medical help with an unwell child. There was a policy displayed and promoted, stating that all unwell children would be seen on the day.
  • We saw evidence of teamwork within the practice with adult safeguarding and a close working relationship with outside agencies such as the adult safeguarding team and the local authority. We saw examples of where GPs had gone out of their way and beyond usual duties to ensure patients were safe and protected. We observed evidence of this.

  • Staff told us there was a commitment to development and training in any areas that might benefit patients. All staff were learning British Sign Language (BSL) to be more welcoming and inclusive for a family of patients who used BSL to communicate.

  • Ability to listen to the Patient Participation Group (PPG) and act on patient feedback was excellent.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. These were discussed as a whole practice team, monthly and reviewed annually to ensure all actions had been completed. After acquiring the practices from other providers, staff reviewed all significant events going back to 2008 to look for trends and patterns and to ensure all possible action had been taken.  

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Information about safety was highly valued and was used to promote learning and improvement.

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation.

  • Lessons were shared with all staff 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.

  • Risks to patients were assessed, regularly reviewed and well managed.

Effective

Good

Updated 22 July 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 the CCG average and just below the national average.

  • 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 22 July 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, or comparable to others for several aspects of care. The practice had identified the scores that were below average and acknowledged that they were an evolving practice that had taken on other practices during the time this data was collected. They had since undertaken their own patient satisfaction surveys which showed high patient satisfaction.

  • Patients told us 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 saw staff treated patients with kindness and respect and maintained patient and information confidentiality.

  • Several patients told us that the GPs would often call in on housebound patients and those with palliative care needs, without being asked and offer support to family members and carers.

  • There was a named member of staff, called the First Point of Call, for carers, who could signpost or refer to other agencies where required and patients had this named individual as their contact.

Responsive

Outstanding

Updated 22 July 2016

The practice is rated as outstanding 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. Over the last two years the practice had taken over two other practices and developed these to enable better access and care for their patients.

  • The ability of the practice to listen to the PPG and act on patient feedback was excellent.

  • The practice showed innovative practice to respond flexibly to different groups of people.

  • They had recently taken over a third practice which they hoped to merge with The Grove Medical Practice to further improve access across the town.
  • Patients told us that they found it very easy to make an appointment with a named GP and 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.

  • 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 all staff and other stakeholders.

  • Following feedback from patients the waiting room had been redesigned to reduce the chance of any conversations being overheard and all telephone calls were taken in a central hub in a separate area to ensure conversations could not be overheard.

  • Following feedback from patients, an extra three telephone lines were added to improve access.

  • Staff were learning British Sign Language to be more inclusive and welcoming for their patients who used this form of communication.

Well-led

Good

Updated 22 July 2016

The practice is rated as good for being well led.

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced together with the staff and everyone understood their role in delivering care.

  • 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.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • 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.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners and practice manager 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. These were shared by email and discussed verbally.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was small and developing but active.

  • We saw evidence that all feedback from patients was discussed and where possible, acted upon, from the redesign of the waiting room to the addition of an extra telephone line. Answers to feedback were displayed so that patients knew their suggestions were acknowledged and acted upon.

  • All policies were available on the shared drive; staff could access these from any of the three sites.

  • There was a strong focus on continuous learning and improvement at all levels, support had been given for a nurse to train as an advanced nurse practitioner and staff were encouraged to develop new skills to benefit the patients, such as British Sign Language.

Checks on specific services

People with long term conditions

Good

Updated 22 July 2016

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

  • Practice nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.

  • Clinical meetings are held monthly to discuss performance in long term condition management.

  • All patients with a long term condition were reviewed following hospital admission to assess and advise how admission may be avoided in the future.

  • Performance for diabetes related indicators at 90% was higher than the CCG average of 85% and equal to the national average of 90%.

  • Until the practice merged in 2014, one of the branches had never had a recall system for patients with long term conditions. This has been put in place and patients requiring annual reviews have been invited to attend the surgery or reviewed opportunistically when attending for other reasons.

  • Longer appointments and home visits were available when needed.

  • Patients who were diagnosed with multiple long term conditions had their care reviewed in a single appointment at the site of their choice.

  • To improve consistency for patients living across boundaries in the Rotherham and Barnsley CCG areas, it was decided that one of the Advanced Nurse Practitioners would undertake long term condition reviews for housebound patients where required.

  • 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 multidisciplinary teams met monthly and all meetings were minuted.

  • Education sessions had been set up monthly to improve self care and empower patients to manage long term conditions along with support from the practice. These were advertised on the practice website and leaflets in the practice. Patients were being asked what they would like included in future sessions.

Families, children and young people

Good

Updated 22 July 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 high for all standard childhood immunisations, for example, immunisation rates for children under the age of two were 98% to 100% (The national average was 96% to 98%). Staff offered immunisation opportunistically and had a dedicated member of the administration team who dealt with all recall letters and child immunisation administration.

  • 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.

  • In the last 5 years 78% of women aged between 25 and 60 years have received a cervical screening test which is comparable to the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • Lunchtime appointments were made available after a patient survey suggested that parents and carers would find it easier to attend the practice when their children were at nursery or school.

  • We saw positive examples of joint working with midwives, health visitors, school nurses and social services.

  • The practice had developed its own leaflet which clearly explained to parents and carers how and when they should seek urgent medical help with an unwell child.

  • There was a policy, displayed and promoted, that all unwell children would be seen on the day.

Older people

Good

Updated 22 July 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.

  • There was a housebound patient protocol and the practice was part of a locality nursing home patient review scheme.

Working age people (including those recently retired and students)

Good

Updated 22 July 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.

  • Lunchtime appointments were offered following an in house patient survey.

  • Telephone consultations with a GP were available.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 July 2016

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

  • 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is below the CCG average of 81% and the national average national average of 84%.

  • Performance in mental health indicators at 88% was above the CCG average of 83% and below the national average of 93%.

  • The practice had a close working relationship with a consultant psychiatrist who would offer support to the GPs.

  • The practice regularly worked with multi disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations.

  • The practice hosted Improving Access to Psychological Therapies Programme (IAPT) to support patients’ needs.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 22 July 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 for patients with a learning disability.

  • 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.

  • We saw evidence of teamwork within the practice with adult safeguarding and a close working relationship with outside agencies such as the adult safeguarding team and the local authority.

  • Several patients told us that the GPs would often call in on housebound patients and those with palliative care needs, without being asked.