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Westwood Surgery Outstanding

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 6 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westwood Surgery on 21 September 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 a system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.

  • The provider used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they were proactive in developing templates and protocols to assist in implementing best practice guidelines and they shared these with other practices.

  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice.

  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Some patients said they did not always find it easy to make an appointment with a named GP but urgent appointments were available the same day. Systems had been put in place to improve consistency for patients and these were consistently reviewed. The practice guaranteed same day access for patients.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The provider 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 provider had implemented their vision and strategy at the practice since they had taken over and all staff we spoke with said there had been significant improvements in all areas.

  • The provider had strong and visible clinical and managerial leadership and governance arrangements. There was a clear leadership structure and staff felt supported by management.

  • The provider proactively sought feedback from patients, which it acted on.

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

  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice:

  • The provider had excellent systems to ensure learning from significant events was shared with the whole practice team and staff were involved in the analysis of significant events. These systems had been implemented at the practice since the provider takeover and were embedded. For example, staff had been fully appraised of their responsibilities in reporting and records showed a wide range of reporting including near miss incidents and reporting of positive practice. Significant events were discussed at meetings across the practice and this included a multidisciplinary meeting. A six monthly significant event newsletter was provided to all staff with a detailed list of the significant events and the action taken. An annual significant event meeting involving all staff was held. This involved staff taking part in mixed staff team workshops to analyse a number of significant events and review the actions taken to assess if any improvements in the process were required. Staff told us they found these meetings an excellent environment for learning and they felt involved in the improvements to the service.

  • To support learning and improvement the provider had a complaints committee which investigated and reviewed all complaints, a mortality committee to regularly review patient deaths that were referred to the coroner and specific lead clinical staff reviewed cancer diagnoses against national guidance.

  • There were excellent systems in place for sharing information about safeguarding concerns and identifying children at risk and these had been implemented at the practice and were embedded. These systems included early intervention multidisciplinary safeguarding meetings called “Think Family”. The provider had led on the pilot for these meetings and the format and principles had been rolled out to other practices in the Bassetlaw CCG area and shared with the wider community. The provider had also developed templates for assessing patients requesting contraception. These templates assisted staff to identify child sexual exploitation and to assess the patient’s competency to make decisions.

  • There were excellent systems to ensure health and safety in the practice. For example, although NHS property services had completed health and safety risk assessments and implemented maintenance plans on behalf of the landlord, the provider had monitored and reviewed these and completed their own risk assessments to assure themselves the building was safe. On take over of the practice patients told us the provider had not used the building until they could be assured it was safe and had chosen to transport patients to their other sites on the first day.

  • A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. The provider had a detailed programme of clinical audit which included auditing some areas annually to ensure continued improvement in areas such as prescribing practice and they had made significant savings in this area. They took account of and monitored good practice developments through their extensive audit systems, developing templates and protocols to support and improve practice. The practice shared this learning and their developments with local practices.

  • Care was provided by integrating the primary, secondary and social care workforces. Larwood and Bawtry were one of the fifteen test sites across England to have been chosen to develop and test a new enhanced primary care approach. The provider, Larwood Health Partnership, was part of the multidisciplinary team leading this project. The provider had implemented this multidisciplinary approach, (Primary Care Home Model), across all their sites.

The provider should make the following improvements:

  • Improve patient experience of making an appointment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 6 December 2017

The practice is rated as outstanding for providing safe services.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. For example, although NHS property services had completed health and safety risk assessments and implemented maintenance plans on behalf of the landlord, the provider had monitored and reviewed these and completed their own risk assessments to assure themselves the building was safe

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The practice used every opportunity to learn from internal and external incidents, to support improvement. The practice had excellent systems to ensure learning from significant events was shared with the whole practice team and staff were involved in the analysis of significant events. For example, a six monthly significant event newsletter was provided to all staff and an annual significant event meeting involving all staff was held.

  • There were excellent systems in place for sharing information about safeguarding concerns and identifying children at risk. These systems included early intervention multidisciplinary safeguarding meetings called “Think Family”.

Effective

Good

Updated 6 December 2017

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that excellent systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients. The practice had extensive auditing processes to monitor performance and was proactive in developing tools to promote consistent application of best practice.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). The practice manager closely monitored progress with the clinical team.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

  • Staff were proactively supported to acquire new skills and training was encouraged and supported.

Caring

Good

Updated 6 December 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for most aspects of care.

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Positive comments were received from patients during the inspection about the care and treatment they received.

  • Information for patients about the services available was accessible.

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

Responsive

Good

Updated 6 December 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Patients we spoke with said they did not always find it easy to make an appointment with a named GP but urgent appointments were available the same day. Systems had been put in place to improve consistency for patients and these were consistently reviewed.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and evidence from one example reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 6 December 2017

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

  • The provider had a clear vision with 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 provider had implemented their vision and strategy at the practice since they had taken over and all staff we spoke with said there had been significant improvements in all areas.

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

  • The practice gathered feedback from patients, and it had a very engaged patient participation group which influenced practice development.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • The partners encouraged a culture of openness and honesty. The provider had excellent systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken. These systems had been implemented at the practice on takeover and were embedded.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

Checks on specific services

People with long term conditions

Outstanding

Updated 6 December 2017

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

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

  • Performance for diabetes related indicators was 100% which was 10% above the CCG average and 9% above the national average.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for 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 6 December 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances. The provider had implemented early intervention multidisciplinary safeguarding meetings called “Think Family” at Westwood Surgery on takeover. As part of this initiative, monthly multidisciplinary meetings were held to discuss concerns about children and wider family issues.

  • Data relating to uptake rates for childhood vaccines and cervical screening were not available at the time of the inspection. Information provided by the practice showed they had improved uptake of child hood vaccinations from 70% in July 2016 to 90% in July 2017. Children who did not attend for their immunisations were discussed at the multidisciplinary “Think Family” meetings and reminders were sent.

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

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Outstanding

Updated 6 December 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. Patients were referred to social prescribing teams for additional assistance where necessary.

  • The practice had excellent systems to ensure continuity and safe care for patients in care homes. The practice had named GPs and dedicated administration teams for each home to aid continuity. Regular visits to homes were completed by the named GP and this had reduced The work undertaken by the practice with one home had been influential in the home winning a quality award.

  • The provider was in the process of implementing a new care model using paramedics to improve access to care for patients in the community.

Working age people (including those recently retired and students)

Outstanding

Updated 6 December 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice offered extended opening hours at the practice and urgent care walk in clinics atone of the providers other sites.

  • All GPs had a named secretary for patients to contact if they required test results or wanted to leave a message for a GP, cards with the secretary’s contact details were given to patients.

  • 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)

Outstanding

Updated 6 December 2017

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

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

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • Performance for mental health related indicators was 87% which was the same as the CCG average and slightly below the national average of 93%.

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

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and those living with dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 6 December 2017

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

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

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.