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Inspection Summary


Overall summary & rating

Good

Updated 6 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chipping Norton Health Centre on 4 May 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.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. 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 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.
  • 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 several areas of outstanding practice, including:

  • The practice ran clinics and group sessions for patients with addictions which was open to patients from a number of local practices. The sessions were run by the practice alongside support workers from a local drug and alcohol agency, and the GPs had access to an expert substance misuse clinician who could be contacted when required. The practice was in discussion with the CCG to expand this service and allow patients from practices in the wider area to attend.
  • Patients in the Chipping Norton area received enhanced support for their end of life care needs. This was provided by a charity which the partners of the practice had created and continued to support. Since April 2015, 30 patients had been supported by the charity, for a total of 1,425 nursing hours.

The areas where the provider should improve are:

  • Review the long term conditions recall systems and procedures to ensure that patients who are not attending health review appointments to manage their long term conditions are given wider opportunities to engage with health care provision.

  • Ensure all staff appraisals are completed by October 2016 and annual appraisals take place thereafter.

  • Ensure that employee records are updated to reflect training and DBS checks undertaken at the two previous practices prior to the merger in April 2015.

  • Ensure repeat prescription reviews are undertaken within the defined timescales to ensure medicines for patients are still appropriate for their care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 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

  • Lessons were shared 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 and well managed.

Effective

Good

Updated 6 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 average compared to the national average.

  • The latest published QOF data for the practice relates to one of the previous practice's results for 2014/15. However, the practice was able to provide the inspection team with its collated data for 2015/16, and this was used as an indicator of the quality outcomes for patients at this inspection.

  • 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.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • There was evidence of personal development plans for all staff. However, non-clinical staff had not received appraisals since the practice merger in April 2015. A new structure of staff management has been implemented with a schedule of appraisals due in April/May 2017.

Caring

Good

Updated 6 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 others for several aspects of care.

  • 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 6 July 2016

The practice is rated as outstanding for providing responsive services.

  • 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. This included piloting a CCG project to integrate community nursing care for patients with long-term conditions. The practice ran addictions clinics and groups which were attended by patients from other local practices. It also supported a local charity which provided free end of life care in the Chipping Norton area.

  • There were innovative approaches to providing integrated patient-centred care. This included running a daily walk-in clinic for patients requiring urgent GP consultations or to see a nurse prescriber for minor illnesses.

  • 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. This included part-funding a volunteer shuttle bus scheme to improve access from the town centre to the health centre.
  • The practice had also launched a diabetes community outreach programme, and had involved an expert patient in steering this project.
  • Patients could access appointments and services in a way and at a time that suits them. The practice offered protected GP consultation slots for patients with long-term conditions so that they could see their usual GP about acute issues within 24 or 48 hours rather than the duty GP in the walk-in clinic.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 6 July 2016

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 it.

  • 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 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 6 July 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Diabetes management indicators were comparable to national averages, with 96% of patients newly diagnosed with diabetes in the last 12 months being referred to a structured education programme within nine months of diagnosis, compared to a CCG average of 95% and a national average of 90%.

  • The practice had launched a diabetes community outreach programme, and recently held its first education event, with a view to getting more patients with diabetes involved in clinical research and improving their management of the condition.

  • The practice offered protected GP consultation slots for patients with long-term conditions so that they could see their usual GP about acute issues within 24 or 48 hours rather than the duty GP in the walk-in clinic.

  • The practice was piloting a CCG project to integrate community nursing care for patients with long-term conditions by co-ordinating the work of the practice team with district nurses.

  • 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 the most 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 6 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 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.

  • Eighty five per cent of female patients aged between 25 and 65 had a cervical screening test in the past five years, compared to a CCG average of 83% and a national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Children attending the walk-in clinic for urgent appointments were prioritised.

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

Older people

Good

Updated 6 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, including blood tests and reviews of long-term conditions, and urgent appointments for those with enhanced needs.

  • The practice provided support to a number of local care and nursing homes, with an allocated GP who visited for weekly ward rounds.

  • Patients in the Chipping Norton area received enhanced support for their end of life care needs. This was provided by a charity which the partners of the practice had help to create and continued to support. Since April 2015, 30 patients had been supported by the charity, for a total of 1,425 nursing hours. The practice had 50% funded a community volunteer bus service to help less mobile patients access the health centre and adjacent community hospital.

The practice had identified 4% of its patients as carers for other family members, and had links with the local carers’ association, as well as with the Citizens’ Advice Bureau which held sessions on site.

Working age people (including those recently retired and students)

Good

Updated 6 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.

  • The practice offered a total of seven hours of evening consultations midweek, with the hours varying on a rotating basis to offer more patient choice. Telephone consultations were available for those who could not easily attend in person.

  • The practice was proactive in offering online services including appointment booking and repeat prescription ordering, as well as a full range of health promotion and screening that reflects the needs for this age group.

  • It ran a number of clinics including for smoking cessation, counselling, addictions and well person health.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 July 2016

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

  • Ninety one per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

  • 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 various support groups and voluntary organisations.

  • 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.

The practice was in the process of working with a local green gym conservation group to support the physical and mental health of participants.

People whose circumstances may make them vulnerable

Good

Updated 6 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.

  • The practice ran addictions clinics and group sessions which were attended by patients from a number of local practices. The practice was in discussion with the CCG to expand this service.