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Greenhead Family Doctors Good

Inspection Summary


Overall summary & rating

Good

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenhead Family Doctors on 10 February 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 an effective system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • 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.
  • 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. However, some patients told us that it was sometimes more difficult to book a routine appointment in advance.
  • The practice had good facilities and was well equipped, despite the limitations of the Victorian building, to treat patients and meet their needs. We saw that patients with mobility issues who found accessing the surgery difficult were visited at home or had their consultations arranged on the ground floor.
  • There was a clear and visible 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.

The areas where the provider should make improvement are:

  • Undertake a review of the approach to complaints resolution to assure themselves that patients are advised in writing that the practice has concluded their response and that further representations can be made to the Parliamentary and Health Service Ombudsman.

  • Arrange appropriate awareness training on the Mental Capacity Act for relevant staff across the team who have yet to receive it.

  • Continue to review the most appropriate arrangements for the secure storage of cleaning products.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 March 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found 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. 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 to minimise risks to patient safety. However, we have asked the provider to review the current storage arrangements of their cleaning products.

  • 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 adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 21 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or below average compared to the national average. Staff were aware of current evidence based guidance.

  • 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 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 21 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 all 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.

  • 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 21 March 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 had a higher than average older population and oversaw care in 11 nursing homes. The provider had developed a referral protocol to support home visits for these locations.

  • 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 found it easy to make an urgent appointment with a named GP and there was continuity of care. However, a small number of patients said that it was sometines difficult to book a routine appointment in advance.

  • 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 examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. However, we saw that letters did not consistently include reference to the Parliamentary and Health Service Ombudsman or formally confirm that the review of the complaint had been concluded by the provider.

  • The practice maintained a register of patients known to be carers and the provider had appointed a carers champion.

Well-led

Good

Updated 21 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 policies and procedures to govern activity and held regular governance meetings.

  • 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.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour. We saw that a comprehensive policy had been drafted and we were sent evidence that a training update had been provided for staff in the week following our inspection.
  • The partners 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.

  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas by the newly appointed practice manager who had undertaken a review of training needs across the practice.

  • 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

Good

Updated 21 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.

  • 66% of diabetic patients on the register had achieved a blood sugar result of 59 mmol or less in the preceding 12 months. This demonstrated that their diabetes was being well controlled. This was 5% lower than the local average and 4% lower than the national average. In addition, 73% of diabetic patients had received a foot examination to check for nerve or skin damage associated with their condition. This was 13% lower than both the local and national average. The provider had recently recruited a practice nurse with specialised skills in diabetes and was engaged in a programme of review to improve care for this patient group.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and were offered 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 21 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 accident and emergency (A&E) attendances. Immunisation rates were in line with or higher than local and 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 85%, which was the same as the CCG average of 85% and higher than the national average of 81%.

  • A full range of contraceptive services including implants and coils was provided by a female GP at the practice.

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

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

Older people

Good

Updated 21 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.

  • A nursing home visit protocol had been developed to assist in identifying appropriate support to these patients.
  • The practice maintained good links with local care homes and the multi-disciplinary care home support team.

Working age people (including those recently retired and students)

Good

Updated 21 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. Telephone appointments and evening appointments were available.

  • The practice was proactive in offering online services such as appointment booking and medication requests 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 21 March 2017

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

  • 84% of eligible patients diagnosed with dementia  had had their care reviewed in a face to face meeting in the last 12 months, which was  1% higher than the national average
  • 86% of patients experiencing a serious mental illness had an up to date care plan. This was 8% higher than the national average.

  • 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.

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

  • Patients with mental health issues were actively supported with same day appointments for patients in need.

  • 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 21 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 those with a learning disability.

  • 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 informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.