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Glenridding Health Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 8 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glenridding Health Centre on 20th October 2017. Overall the practice is rated as outstanding.

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.
  • 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.
  • Risks to patients were assessed and well managed.
  • 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 the management team.
  • The practice proactively sought feedback from staff and patients, which it acted on. Rigorous and constructive challenge from people who use services, the public and stakeholders was welcomed and seen as a vital way of holding the service to account
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear and proactive approach to seeking out and embedding new ways of providing care and treatment.

We saw some examples of outstanding practice:

  • Since the new provider had taken over the practice a number of new initiatives had been put in place, such as a video consultation pilot for some of their housebound and elderly patients living in more rural locations. This not only allowed patients to access timely consultations with a practice GP but also enabled more socially isolated patients to connect with other users of the system and access video games and puzzles.

  • The practice played an integral role in the local community and we saw numerous examples of joint working with other organisations to improve health outcomes, tackle care inequalities and obtain best value for money. The benefits of this reached beyond their own patient group, as they were able to help a nearby practice to improve their access to GP appointments.

There was one area where the provider should make improvements:

  • Continue to investigate ways for increasing uptake of health reviews and screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 December 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.

Effective

Good

Updated 8 December 2017

The practice is rated as good for providing effective services.

  • The practice had achieved 83.7% of the total number of points available from the Quality and Outcomes Framework, compared to the clinical commissioning group (CCG) average of 98.8%, and the national average of 95.3%. However, the practice could demonstrate that systems were in place to offer recalls to patients, and that low patient numbers had an impact on these results.

  • 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

Outstanding

Updated 8 December 2017

The practice is rated as outstanding for providing caring services.

  • Feedback from people who use the service, those who are close to them and stakeholders was continually positive about the way staff treated people. Data from the national GP Patient Survey, published in July 2017, showed patients rated the practice higher than others for all aspects of care. For example, 99% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 88% and the national average of 86%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • There were carers’ leads in the practice and on the patient participation group who offered support, and the practice had identified nine patients as carers (1.2% of the practice list).
  • 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.

  • There was a strong, visible person-centred culture, and staff were highly-motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who use the service, those close to them and staff were strong, caring and supportive, and these relationships were highly valued by all staff and promoted by leaders. Staff at the practice were actively involved in raising money for local and national charities, and they had received funding from the new provider’s Social Enterprise Fund to donate to local causes.

Responsive

Outstanding

Updated 8 December 2017

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.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The interior of the practice building had been fully refurbished in 2016.

  • The practice offered video consultations to patients in their own homes, due to the number of patients who lived in remote rural areas. At the time of inspection, this intervention was still being trialled among a small group of patients to measure feasibility, but patients we spoke to who used it were positive about its benefits.

  • The appointment system had been changed from a walk-in service to pre-bookable appointments to reduce busy periods and improve access. The practice offered 15-minute standard appointments with a GP and 20 minutes with a nurse. Although appointments were now pre-bookable, patients could still request urgent on the day appointments. An audit of GP consultations showed 100% of patients who requested these were seen the same day.

  • 100% of patients said they could get through easily to the practice by telephone compared to the national average of 71%, and 97% of patients described their experience of making an appointment as good compared to the national average of 73%.
  • The practice worked with a nearby surgery to offer appointments for them three afternoons a week, while still being able to offer appointments to Glenridding patients. This helped the neighbouring practice to meet demand. Talks were ongoing about further ways the practice could share skills and resources to benefit patients, such as offering Glenridding patients appointments with some of the specialist staff at the neighbouring practice (such as a women’s health nurse).

  • 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.

Well-led

Outstanding

Updated 8 December 2017

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

  • The leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care.

  • A systematic approach was taken to working with other organisations to improve care outcomes, tackle health inequalities, and obtain best value for money. This was evidenced by the work the practice was doing with a neighbouring practice and with an external company to offer patients video consultations from their own homes.

  • There was a clear leadership structure, and leaders in the practice and at the new provider had an inspiring shared purpose, strived to deliver and motivated staff to succeed. There was strong collaboration and support across all staff and a common focus on improving safety, quality of care, and people’s experiences.

  • Practice specific policies were implemented and were available to all staff. These had been developed with practice staff to align with the policies of the wider organisation while remaining relevant to the work of a GP practice.

  • A comprehensive understanding of the performance of the practice was maintained. The practice had commissioned an audit of their GP consultations to ensure that they were performing well and to look for improvements.

  • 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.

  • Rigorous and constructive challenge from people who use services, the public and stakeholders was welcomed and seen as a vital way of holding the service to account. The practice worked closely with an actively involved patient participation group, and the new provider had promoted the use of the website iwantgreatcare.org to gather patient feedback.

  • There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. There were consistently high levels of staff engagement. Staff at all levels were actively encouraged to raise concerns. They had opportunities to meet regularly and share learning.

  • The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear and proactive approach to seeking out and embedding new ways of providing care and treatment.

Checks on specific services

Older people

Outstanding

Updated 8 December 2017

The practice is rated as outstanding for the care of older people, as the practice is rated outstanding overall.

  • The practice offered proactive, personalised care to meet the needs of the older people in their population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • A toe nail cutting service had been made available from the practice every six weeks, and the practice manager had undertaken training to repair hearing aids, to save patients having to travel to receive this service.

  • The practice manager helped to raise funds each year for and organise a Christmas lunch at a local hotel for the over 60’s in the village, many of whom were practice patients.

  • Performance for conditions associated with older patients in line with national averages. For example, the practice achieved 97% of the total points available for chronic obstructive pulmonary disorder (national average, 96%) and 98% of the total points available for stroke and transient ischaemic attack (national average, 97%).

People with long term conditions

Outstanding

Updated 8 December 2017

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

  • One of the GPs had a lead role and specialist training in chronic disease management, and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was slightly below the national average. The practice achieved 84% of the total points available, compared to the national average of 91%.

  • 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

Outstanding

Updated 8 December 2017

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

  • 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 higher than national average 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 72%, which was below the national average of 77%.

  • Appointments were available outside of school hours, and some were embargoed specifically for patients who attended school during the day. The premises were suitable for children and babies.

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

  • The practice maintained close links with the local school, and pupils were invited to attend the surgery to learn about healthy living and healthcare. Pupils with an interest in a career in nursing had attended for work experience.

Working age people (including those recently retired and students)

Outstanding

Updated 8 December 2017

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

  • 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.

  • Appointments were embargoed in the late afternoon/evening for patients who worked during the day.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People whose circumstances may make them vulnerable

Outstanding

Updated 8 December 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable, as the practice is rated outstanding overall.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • The practice offered longer appointments for patients who needed them.

  • Due to the rural area where the practice was situated there were a number of isolated patients. As such, the practice was trialling a system of offering patients teleconferencing equipment to be installed in their own homes so that they could have video consultations with the practice when required. The system could also be used by patients to hold video calls with family.

  • 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 at the practice collected food to donate to the local food bank.

  • 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.

  • There was a carers’ lead at the practice and on the Patient Participation Group who offered support, and the practice had identified nine patients as carers (1.2% of the practice list).

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 8 December 2017

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

  • In 2016/17, 100% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was above the national average of 84% and an increase from 80% the previous year.

  • 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.

  • Performance for mental health related indicators was significantly lower than the national average. The practice achieved 55% of the total points available, compared to the national average of 94%. However, they had low numbers of patients who were eligible for these interventions, and had not reported any exceptions for these indicators which allow for patients who cannot attend for review to be discounted from the numbers. The national average for exception reporting in mental health was 13%.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • There was 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.