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Inspection Summary


Overall summary & rating

Good

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willow Tree Family Doctors on 24 November 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.
  • Outcomes for patients were comparable to local and national averages with the exception of the uptake of childhood vaccinations, which were comparable to local averages but significantly below national averages for some vaccinations.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however, members of the Patient Participation Group had said that it could be difficult to read the information displayed on the television display screen in the waiting room, and there were no information posters displayed in the area.
  • 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 one area of outstanding practice:

The practice had been working closely with staff from the supported living home situated next door in order to improve outcomes for residents with long-term conditions. They met regularly with staff from the home to discuss patients’ conditions and provide training on managing long-term conditions. We saw data which showed a positive impact for patients of this joint approach. For the five month period prior to the practice starting this joint working (November 2014-April 2015) there had been 80 ambulance call-outs and 23 unplanned admissions to hospital for these patients. Work with the home started in April 2015 and data showed that for the five month period following the work commencing (May to September 2015) there were 17 ambulance call-outs for these patients (a 78% reduction) and eight unplanned admissions to hospital (a 65% reduction).

The areas where the provider should make improvement are:

  • They should review the way that information is displayed in the waiting area to ensure that it is accessible to all patients.
  • They should consider what further action they can take to improve their uptake of childhood vaccinations.
  • They should ensure that waste bins are labelled to indicate the type of waste they are for.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 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 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 29 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 some childhood vaccinations there was a low uptake amongst the practice’s patients; uptake was comparable to the local average but significantly below 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 29 March 2017

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

Good

Updated 29 March 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. For example, they had been working closely with a nearby supported living home to improve outcomes for residents with long-term conditions.
  • 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.
  • 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.

Well-led

Good

Updated 29 March 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 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 29 March 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.
  • Performance for diabetes related indicators were better than local and national averages. Overall the practice achieved 100% of the total QOF points available for diabetes indicators, compared with an average of 89% locally and 90% nationally.
  • Longer appointments and home visits were available when needed.
  • The practice offered care plans to patients with long-term conditions, and had completed 188 during the 2015/16 reporting year.
  • 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 29 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 comparable to local averages, for all standard childhood immunisations, but in some areas were significantly below national averages.
  • 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 77% and the national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with health visitors.

Older people

Good

Updated 29 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified patients who were at high risk of unplanned admission to hospital and worked closely with these patients to ensure that these patients had priority access to a GP.
  • All patients aged 75 years and over had a named GP.

  • The practice’s performance in relation to conditions commonly found in older people was comparable to local and national averages. For example, The percentage of patients with hypertension who had well controlled blood pressure was 91% compared to a CCG and national average of 83%.

Working age people (including those recently retired and students)

Good

Updated 29 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 and text message reminders, 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)

Good

Updated 29 March 2017

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

  • Performance for mental health related indicators was comparable to local and national averages. The practice had 67 patients diagnosed with dementia and 89% of these patients had had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 86% and national average of 84%. The practice’s exception reporting rate for this indicator was 10% compared to the CCG and national average of 7%.
  • The practice had 116 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses and 95% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 91% and national average of 89%. The practice’s exception reporting rate for this indicator was 3% compared to the CCG average of 7% and national average of 13%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice hosted counsellors on site as part of the Improving Access to Psychological Therapies (IAPT) initiative. Patients could be referred to this service by a GP or could self-refer.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 29 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 had 85 patients on their learning disability register and on the day of the inspection, they had completed annual reviews for 47 of these patients since 1 April 2016.
  • 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.
  • The practice was situated next door to an assisted living home, and had been meeting regularly with staff from the home to discuss patients’ conditions and provide training on managing long-term conditions. We saw data which showed that since starting this joint-working pilot there had been a reduction in the number of unplanned admissions to hospital for these patients.
  • 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.