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Inspection Summary


Overall summary & rating

Good

Updated 22 October 2018

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 September 2017

The practice is rated as good for providing safe services.

  • Staff were encouraged to report significant events within a supportive environment. Significant events were regularly reviewed and analysed to ensure themes or trends were identified. Learning was shared within the practice and across all locations owned by the provider to promote wider learning and improvement to patient care.

  • Effective arrangements were in place to monitor patient safety alerts and improvements had been made to the management of medicines.

  • Systems were in place to safeguard children and vulnerable adults including multi-disciplinary working with other health and social care professionals.

  • Staffing levels and skill mix were regularly reviewed and improvements had been over the last 12 months. Efforts to improve continuity of care (specifically GPs) had also been made in response to patient feedback.

  • Risks to patients were assessed and well managed.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 27 September 2017

The practice is rated as good for providing effective services.

  • Staff were aware of current evidence based guidance including National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health.

  • Published data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the local and national average. This data reflected the practice performance under the management of the previous provider.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. End of life care was coordinated with other services involved.

Caring

Good

Updated 27 September 2017

The practice is rated as good for providing caring services.

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

  • Feedback from patients showed they were treated with compassion, dignity, and respect and they were involved in decisions about their care and treatment.

  • The national GP patient survey results showed patients rated the practice lower than others for several aspects of care. For example, 72% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 85% and national average of 86%.

  • However, results from a patient survey undertaken by the practice, compliments received and the NHS friends and family test results demonstrated that the majority of patients felt well cared for by GPs, nurses and reception staff. Satisfaction levels had improved over the last 12 months.

  • Patients had access to information about the available services and support groups.

  • The practice had identified 3.6% of its patients as carers and provided them with information and services such as flu vaccinations.

Responsive

Good

Updated 22 October 2018

At our previous inspection on 14 June 2017, we rated the practice as ‘Requires improvement’ for providing responsive services as the 2017 national GP patient survey results showed satisfaction scores were below the local and national averages in relation to access to the service. In addition, benchmarking data for accident and emergency services were above CCG averages and this may have been linked to the ease of accessing the service.

These areas had improved when we undertook a desk-based follow up review on 12 September 2018. The practice is now rated as ‘Good’ for providing responsive services.

Access to the service

Following our announced desk-based follow up review on 12 September 2018, the practice provided evidence they had continued to review and improve access to appointments. They told us that they had maintained extremely good access with the next advanced appointment currently being available within 48 hours. They also told us that they have an on-call system for on the day acute emergencies where a clinician telephone triages the list and brings patients back in when necessary.

The national GP patient survey results published in August 2018 showed patient satisfaction with how they could access care and treatment was now above local and national averages. These results reflected the views of respondents for the period January to March 2018.

  • 78.9% of patients responded positively to how easy it was to get through to someone at their GP practice on the phone. This compared to the clinical commissioning group (CCG) average of 60.5% and the national average of 70.3%.
  • 73.2% of patients responded positively to the overall experience of making an appointment. This compared to the CCG average of 66.8% and the national average of 68.6%.
  • 67.6% of patients were very satisfied or fairly satisfied with their GP practice appointment times. This compared to the CCG average of 59.5% and the national average of 65.9%.
  • 78.9% of patients were satisfied with the type of appointment (or appointments) they were offered. This compared to the CCG average of 72.3% and the national average of 74.4%.

The practice provided evidence of a patient survey carried out by the practice in August 2018. The results, in relation to access were positive:

  • 94% of patients thought it was easy to get through to the surgery by phone.
  • 94% of patients described their experience of making an appointment as good.
  • 94% of patients were happy with GP surgery opening times.

The practice provided evidence of communication with parents where they had encouraged them to use the practice, where appropriate, rather than attending accident and emergency services.

The practice also told us that they had reviewed patients who had attended an out of hours service up to February 2018. As a result of the review, they had contacted any patients who they considered may have been able to attend the practice instead to discuss their reasons for not doing so.

Well-led

Good

Updated 27 September 2017

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

  • The practice had a strong commitment to delivering high quality care and promoting good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • The arrangements for governance were effective and regularly monitored at a practice and strategic level. This ensured a comprehensive understanding of the practice performance was maintained.

  • The practice had a wide range of relevant policies and procedures to govern activity and these were regularly reviewed and updated.

  • There was a clear leadership structure with senior staff having key areas of responsibility.

  • The leadership and management team encouraged a culture of openness and honesty.

  • The practice proactively sought feedback from staff, patients and the patient participation group. We saw examples where feedback had been acted on to improve service delivery.

  • There was a focus on continuous learning and improvement at all levels with staff being encouraged to undertake training and develop their roles.

Checks on specific services

People with long term conditions

Good

Updated 27 September 2017

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

  • Clinical staff had lead roles in chronic disease management.

  • The practice had a system in place to recall patients for a structured annual review to check their health and medicines needs were being met. Patients with multiple conditions were usually reviewed in one appointment to ensure a holistic view of their care and treatment.

  • The GPs worked with a wide range of health and social care professionals to deliver a multi-disciplinary package of care for patients with complex health needs.

  • Joint working took place with a diabetic specialist nurse to facilitate the management of complex patients.

  • Patients at risk of hospital admission were identified as a priority and systems were in place to follow-up patients discharged from hospital. Care plans were updated to reflect any additional needs.

  • Published data showed the practice’s performance for long-term conditions was above or in line with local and national averages. For example, the practice achieved 98.5% for diabetes related indicators. This was above the local average of 95.5% and the national average of 89.9%.

  • Longer appointment times and home visits were provided for patients unable to attend the surgery.

Families, children and young people

Good

Updated 27 September 2017

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

  • Staff we spoke with demonstrated they were committed to safeguarding children and young people.

  • The lead GP held regular meetings with the health visitors and school nurses to review patients at risk of abuse and / or deteriorating health.

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

  • Staff told us children aged five years and under were prioritised and seen on the same day. Appointments were also available outside of school hours.

  • Reception staff sent a congratulatory card to parents on the birth of new babies.

  • The practice provided eight-week baby checks and postnatal reviews.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • The practice had baby changing facilities and offered a designated private area for mothers who wished to breastfeed on site.

Older people

Good

Updated 27 September 2017

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

  • Patients aged 75 years and over had a named accountable GP to ensure they received co-ordinated care.

  • The health needs and care plans of frail patients and those at risk of hospital admission were regularly reviewed at the monthly multi-disciplinary meetings.

  • Records reviewed and patient feedback showed older people were involved in planning and making decisions about their care, including their end of life care.

  • Nationally reported data showed patient outcomes for conditions commonly found in older people were in line with local and national averages.

  • Influenza, pneumococcal and shingles vaccinations were offered in accordance with national guidance.

  • The practice offered home visits and urgent appointments for patients with enhanced needs. Feedback from one of the care homes showed the practice was responsive to the health needs of patients.

Working age people (including those recently retired and students)

Good

Updated 27 September 2017

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

  • A range of services were offered at the practice to facilitate the delivery of care closer to home. This included phlebotomy, minor surgery and joint injections.

  • The practice was proactive in offering online services including appointment booking, requests for repeat prescriptions and access to some patient records.

  • Working age people had access to telephone consultations and advice.

  • A range of health promotion and screening services that were relevant to the needs of this age group were promoted. This included NHS health checks, access to a smoking cessation clinic and family planning.

  • The uptake rates for cervical cancer screening, bowel and breast cancer screening were generally in line with local and national averages.

  • The practice provided extended hours consultations with the nursing assistant and practice nurse on Tuesdays from 6.30pm to 8pm and on Friday from 7am to 8pm.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 September 2017

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

  • Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia. This included advance care planning for patients living with dementia and assessing a patient’s mental capacity for specific decisions.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients within this population group.

  • The physical health needs of patients with poor mental health and dementia were reviewed to ensure a holistic assessment of their needs.

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

  • The practice had systems in place for monitoring repeat prescribing for patients receiving medicines for mental health needs and to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Published data showed:

  • 91.2% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was above the local average of 86.5% and the national average of 83.8%.

  • All patients with a mental health condition had a documented care plan in the last 12 months, which was above the CCG average of 89.4% and the national average of 88.8%.

To note is the above data relates to the practice’s performance in 2015/16 prior to changes in the provider. The 2016/17 data was yet to be published at the time of our inspection.

People whose circumstances may make them vulnerable

Good

Updated 27 September 2017

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

  • Staff we spoke with knew how to recognise signs of abuse in vulnerable adults. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies. Safeguarding concerns were regularly discussed at the multi-disciplinary meetings.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed patients how to access various support groups and voluntary organisations.

  • End of life care was delivered in a coordinated way. Patients with end-of-life care needs were reviewed at regular multi-disciplinary team meetings attended by the lead GP, district nurses and a palliative community nurse specialist for example.

  • The practice had identified 3.6% of their patient list as carers and offered support including annual flu vaccinations.

  • The practice offered longer appointments for patients with a learning disability. Ten out of 16 patients with a learning disability had received an annual health review in the last 12 months.

  • Clinical staff undertook home visits for patients who were housebound.

  • Translation services were provided where required.