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Inspection Summary


Overall summary & rating

Good

Updated 20 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mollison Way Surgery on 14 September 2017. 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 a system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had the skills and knowledge to deliver effective care and treatment and liaised with other health and social services professionals to coordinate care.

  • Staff were proactively supported to maintain their professional development and acquire new skills. They had access to appropriate and bespoke training to meet their learning needs and to cover the scope of their work.
  • Patient feedback was mixed when compared against other practices. The patient feedback we received was positive. Patients said they were treated with compassion 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.
  • 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 practice used innovative and proactive methods to improve patient outcomes and worked with other local and national healthcare providers to share best practice.

We saw areas of outstanding practice:

  • The electronic dashboard used across the provider group was a powerful tool for understanding the practice's comparative performance across a range of clinical indicators and had helped drive local improvement, for example in managing diabetes.
  • Staff had access to a learning and development portfolio featuring training programs tailored for each staff role. For example, fortnightly web-based training for healthcare assistants; development support for practice nurses; a development programme for practice managers and a fortnightly consultant led learning program for clinicians.

The areas where the provider should make improvement are:

  • The practice should continue with its focus to improve patient experience as measured by the national GP patient survey.
  • The practice should ensure it documents its response to recommendations arising from its Legionella risk assessment so it can demonstrate that all identified risks have effectively mitigated.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 November 2017

The practice is rated as good for providing safe services.

  • There was an effective system 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 were informed as soon as practicable, received reasonable support, truthful information, and a written apology.
  • The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 20 November 2017

The practice is rated as good for providing effective services.

  • Quality and Outcome Framework (QOF) data 2016/17 showed that the practice had achieved good outcomes for patients despite taking over the practice contract part way through the financial year.
  • There were effective systems to ensure that clinicians were up to date with national and locally agreed guidelines.
  • Clinical audits demonstrated quality improvement.
  • Staff were proactively supported to develop their skills and had access to appropriate and bespoke training to meet their learning needs and to cover the scope of their work.
  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local and national healthcare providers to share best practice.
  • 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.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 20 November 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice somewhat below others for several aspects of care. The survey might not present an accurate picture of the current service following the change of provider.
  • Patients who participated in the inspection said they were treated with compassion and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect, and maintained patient confidentiality
  • Information for patients about the services available was accessible. The practice made information available in a number of locally spoken languages. 

Responsive

Good

Updated 20 November 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. For example, the practice was focusing on providing more integrated management of diabetes.

  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions as part of their care planning.
  • Patients we spoke with 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 evidence from four examples reviewed showed the practice responded quickly to issues raised. Learning was shared with staff and other stakeholders.

Well-led

Good

Updated 20 November 2017

The practice is rated as good for providing well-led services.

  • 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.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • There was a clear leadership structure and staff felt supported by management.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The practice had policies and procedures to govern activity and held regular governance meetings.
  • The practice leaders encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • There was a high level of constructive engagement with staff. The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on.
  • The practice was developing a patient participation group.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 20 November 2017

The practice is rated as good for people with long term conditions.

  • The clinical pharmacist and nursing staff had lead roles in long term disease management. Patients at increased risk of hospital admission were identified as a priority.
  • The practice monitored its performance in managing long term conditions with an electronic 'dashboard' which displayed up to date information on the practice's progress compared against other practices in the provider group.
  • 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.
  • 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

Good

Updated 20 November 2017

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

  • 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.
  • For newly registering families with a child under five, the practice offered a face to face consultation for the child. This enabled the practice to identify any special needs and offer early intervention to support the family. 
  • In 2016/17, the practice achieved the 90% immunisation targets for standard childhood immunisations.
  • Appointments were available outside of school hours. The premises were suitable for children and babies and the practice had baby changing facilities and could provide a private area for breast feeding. These facilities were signposted within the waiting room area.

  • The practice worked with midwives, health visitors and school nurses as appropriate to support this population group, for example providing shared antenatal and postnatal care for practice patients with the local community midwifery team.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 20 November 2017

The practice is rated as good 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 priority appointments for those with enhanced needs.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Older patients were provided with advice and coordinated support to help them to maintain their health and independence for as long as possible.
  • In 2016/17 the practice achieved influenza vaccination uptake for the over 65 year group of 75%.

Working age people (including those recently retired and students)

Good

Updated 20 November 2017

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

  • The needs of working age people 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, opening on Saturday morning.
  • The practice offered pre-bookable face to face consultations, telephone consultations and the facility for patients to securely email their doctor with any non urgent questions or queries. The practice was proactive in offering online services, which included online appointment booking; an electronic prescription service and online registration.
  • The practice promoted self management for minor ailments through an online symptom checker and patient information on common conditions.
  • The practice provided a full range of health promotion and screening services reflecting the needs for this age group, for example cervical screening, sexual health and contraceptive services; and the meningitis ACWY vaccination for older teenagers and students.
  • The practice uptake rate for cervical screening was 80% in 2016/17 which was close to the clinical commissioning group (CCG) average of 77% and the national average of 81%. The practice exception rate for this indicator was 12% which was in line with the CCG-wide exception rate of 11%.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 November 2017

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

  • 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%. The practice did not report any exceptions for this indicator.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 93% of patients diagnosed with a psychosis had a comprehensive care plan in their records compared to the national average of 90%. The practice did not report any exceptions for this indicator.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 20 November 2017

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

  • The practice identified and regularly reviewed patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and an annual health check.
  • Staff were trained to consider the wider circumstances of vulnerable patients and the impact on other family members and carers.
  • 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.
  • It was practice policy to encourage travellers and homeless patients to register with the practice, using the practice address if necessary.