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Inspection Summary


Overall summary & rating

Good

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Nelson Medical Practice on 12 October 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 with the exception of mandatory training for some members of staff.
  • 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.

There were areas of practice where the provider should make improvements:

  • Review practice procedures to ensure all staff have child protection training, annual basic life support training, infection control training and information governance training relevant to their role.
  • Review practice procedures to ensure medical oxygen cylinders are checked and replaced when needed.
  • Review practice procedures to ensure confidentiality agreements are signed by all locum staff.
  • Review practice procedures to ensure that patients are made aware of how to make a complaint and that all information is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 January 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 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, although not all staff had completed mandatory training.

Effective

Good

Updated 11 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 11 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP Patient Survey showed patients rated the practice at or below average for many 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

Good

Updated 11 January 2017

The practice is rated as good 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.
  • 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.
  • The practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders: however the practice had no complaints leaflet for patients.
  • The practice was part of a health centre where patients had access to services including diagnostics, phlebotomy, community service, endoscopy, assessment and rapid investigation services as well as outpatient services provided by the local hospital.
  • The practice provided minor surgical procedures including cryocautery (a procedure that uses very cold temperatures to treat abnormalities of the skin), fitted coils and implants and provided joint injections which reduced the need for referrals to hospital.

Well-led

Good

Updated 11 January 2017

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 GPs encouraged a culture of openness and honesty. The practice had systems in place for knowing about 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 11 January 2017

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. The practice ran nurse led clinics for patients with asthma, chronic obstructive pulmonary disease, diabetes and chronic heart disease.
  • The national Quality and Outcomes Framework (QOF) data showed that 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 94% which was above the CCG average of 92% and in line with the national average of 89%.
  • The national QOF data showed that 74% of patients with asthma in the register had an annual review, compared to the CCG average of 73% and the national average of 73%.
  • Longer appointments and home visits were available for people with complex long term conditions when needed.
  • All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice ran in-house respiratory and anticoagulation services which improved the monitoring of these patients.

Families, children and young people

Good

Updated 11 January 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 urgent care and Accident and Emergency (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 83%, which was in line with the Clinical Commissioning Group (CCG) average of 81% and the national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice patients had access to antenatal care through midwife led clinics and postnatal care through GP clinics.
  • The practice held weekly baby clinics with appointments with both GPs (for checks) and nurses (for immunisations) to allow ease of access. A patient care-co-ordinator contacted the patients shortly after baby’s birth to organise these appointments, to help make the process easier for families.

Older people

Good

Updated 11 January 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Longer appointments and home visits were available for older people with long term conditions when needed.
  • The practice had a frailty team (GP, nurse practitioner, physician associate and care coordinator) which ensured continuity and access for frail elderly patients. This team provided care for three local nursing/residential homes supporting the needs of 88 residents. The care coordinators acted as a link to patients in need of extra support and signposting; they also acted as a link to other services and support for patient and clinicians.
  • The practice also provided medical support for intermediate care beds provided by their local community services provider. (Intermediate care beds are in nursing or residential care homes and are specifically for patients leaving hospital but assessed as not ready to return to their own home.)

Working age people (including those recently retired and students)

Good

Updated 11 January 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. About 44% (12,000 patients) of patients in the surgery had registered for online access. Patients could also book double appointments online.
  • The practice offered extended hours appointments with GPs, physician associate, nurses and healthcare assistant which were suitable for working people.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 January 2017

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

  • 97% of 192 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 90% and national average of 89%.
  • The number of patients with dementia who had received annual reviews was 87% which was in line with the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • One of the practice GPs was named as the mental health clinician of the year 2015 by an organisation representing mental health access for ethnic minority patients.
  • The practice patients had access to the weekly memory clinics run by the local mental health team in the health centre where the practice is based.

People whose circumstances may make them vulnerable

Good

Updated 11 January 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, carers, travellers and those with a learning disability.
  • The practice offered longer appointments and extended annual reviews for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.