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Inspection Summary


Overall summary & rating

Good

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highview Medical Centre on 21 December 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. However the system for assessing and confirming the immunisation status of staff that had immediate contact with patients needed strengthening.

  • Staff assessed needs and delivered care in line with current evidence based guidance. However a summary of the care plan following such assessments was not given to patients with dementia, mental health needs or Learning disability.

  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • All staff had received an appraisal within the last 12 months.
  • 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 a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had systems to support carers.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a 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.

The areas where the provider should make improvement are:

  • Ensure continued oversight and completion of vaccinations for clinical staff.
  • Develop a system to document meetings with the health visitor.
  • Consider giving a copy of the care plan to patients with dementia, mental health needs and learning disabilities.

  • Continue to monitor and encourage attendance to the breast and bowel cancer screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 March 2017

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 support, 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 and well managed. However the system for assessing and confirming the immunisation status of staff that had immediate contact with patients needed strengthening.

Effective

Good

Updated 30 March 2017

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. For example,

    the percentage of patients with diabetes, on the register, in whom the last blood pressure reading in the preceding 12 months (01/04/2015 to 31/03/2016) showed good control was 83% compared to the CCG average of 77% and the national average of 78%.

  • Staff assessed needs and delivered care in line with current evidence based guidance. However a summary of the care plan following such assessments was not given to patients with dementia, mental health needs and learning disabilities.

  • 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 30 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients showed patients felt they were treated with compassion, dignity and respect. For example 93% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 93% and the national average of 92%.

  • Patients said 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.

Responsive

Good

Updated 30 March 2017

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with NHS England and NHS Herts Valleys Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice in conjunction with the CCG and neighbouring practices was working towards establishing a ‘Hub’ to provide on the day urgent appointments.

  • Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

  • Patient satisfaction for telephone access to appointments was lower than local CCG and national averages. For example

    69% of patients said they could get through easily to the practice by phone compared to CCG average of 78% and the national average of 73%.

  • 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 as appropriate.

Well-led

Good

Updated 30 March 2017

The practice is rated as good for being well-led.

  • The practice had aims and plans to deliver high quality care and promote good outcomes for patients. Staff were knowledgeable about the aims and plans and their responsibilities in relation to it.

  • There was a 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 a governance framework which supported the delivery of 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 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 30 March 2017

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

  • Nursing staff supported by GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • There was a system to identify patients at risk of hospital admission that had attended A&E or the out of hours service and these patients were regularly reviewed to help them manage their condition at home.
  • Performance for diabetes related indicators were above the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2015 to 31/03/2016), was 86%, compared to the CCG average of 77% and the national average of 78%.

  • 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 30 March 2017

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’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 82% and the national average of 81%. Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice provided a variety of health promotion information leaflets and resources for this population group.

  • The practice offered referrals to family planning and related screening such as chlamydia screening.

Older people

Good

Updated 30 March 2017

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.

  • All patients over 75 had a named accountable GP.

  • All these patients were offered an over 75s health check.

  • The practice had identified those patients at risk of an unplanned hospital admission and had put in place the necessary assessments care plans and services to help them avoid unnecessary hospital admission (with the involvement of multiple agencies such as the community services, Home First which helps people stay well and independent, the Community Navigator which aids patients living at home with additional social support and the multi specialist team which arranges specialist services such as physiotherapy, occupational therapy).

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included morning home visits with GP and the nurse prescriber offering minor illness, nursing and chronic disease management.

  • The practice supported three local care homes and had a programme of regular visits to provide care for the residents which ranged from twice weekly for the larger homes and weekly for the smaller home.

  • There was a domiciliary phlebotomy service for housebound patients.

Working age people (including those recently retired and students)

Good

Updated 30 March 2017

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.

  • This population were given priority appointments focused on early mornings and late afternoons, this supported patients who were unable to attend the practice during normal hours.

  • The practice was open every other Saturday from 8.30am until 11am.

  • The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 March 2017

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

  • 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

  • The practice offered annual reviews to all patients on the mental health register which included physical checks.

  • 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 support groups and voluntary organisations including the community drugs and alcohol team.

  • Patients could access the local Wellbeing Team provided by the local community mental health trust at the practice.

  • The practice had a system in place to follow up patients who had attended A&E 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 30 March 2017

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, 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 support groups and voluntary organisations.

  • The practice held regular health visitor liaison and multi-disciplinary team meetings to discuss the care needs of specific patients.

  • The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.

  • 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.

  • The practice identified patients who were also carers and signposted them to appropriate support. The practice had identified 151 patients as carers (approximately 2% of the practice list). The practice had identified a carer’s champion who provided information including a carer’s pack and directed carers to the various avenues of support available to them.

    The practice offered carers health checks and flu vaccinations.

  • The practice provided care to a local travelling community, taking account of their specific needs in a sensitive facilitative way that encouraged them to seek medical advice as much as was necessary.