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Inspection Summary


Overall summary & rating

Good

Updated 11 April 2019

Inspection areas

Safe

Good

Updated 11 April 2019

Effective

Good

Updated 16 July 2018

We rated the practice and all of the population groups as good for providing effective services.

Please note: Any Quality Outcomes (QOF) data relates to 2016/17. QOF is a system intended to improve the quality of general practice and reward good practice.

Effective needs assessment, care and treatment

The practice had systems to keep clinicians up to date with current evidence-based practice. We saw that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.

  • Patients’ immediate and ongoing needs were fully assessed. This included their clinical needs and their mental and physical wellbeing.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • Patients were encouraged to register for online access to book or cancel appointments and request repeat medicines. We saw that 33% of patients had registered for this service. Staff supported patients who were uncertain of how to register, and provided practical support to register and/or download the appropriate ‘app’ onto their smartphone.
  • Staff used appropriate tools to assess the level of pain in patients.
  • Staff were able to provide information and advice to patients to inform them of options available to them if their condition got worse and where to seek further help and support. Non-clinical staff made use of a comprehensive triage assessment tool which guided them in providing safe and relevant advice to patients.

Older people:

  • Older patients who were frail or may be vulnerable received a full assessment of their physical, mental and social needs. The practice used a frailty tool to identify patients aged 65 and over who were living with moderate or severe frailty. Those identified as being frail had a clinical review including a review of medication.
  • Patients aged over 75 were invited for a health check. If necessary they were referred to other services such as voluntary services and supported by an appropriate care plan.
  • The practice provided GP services to a number of nursing and residential homes for older people. Before the inspection we sought feedback from two of these homes. They told us the practice worked effectively with staff and residents to provide appropriate care, including advance care planning for patients approaching the end of life.
  • The practice followed up on older patients discharged from hospital. It ensured that their care plans and prescriptions were updated to reflect any additional or changed needs.
  • Staff had appropriate knowledge of treating older people including their psychological, mental and communication needs.

People with long-term conditions:

  • Patients with long-term conditions had a structured annual review to check their health and medicines needs were being met. The practice liaised as appropriate with relevant health and other professionals to meet the needs of this group of patients.
  • Staff who were responsible for reviews of patients with long term conditions had received specific training.
  • The practice provided a level two diabetic service. This meant it was able to support in-house patients whose diabetes was controlled with injectable therapies.
  • GPs followed up patients who had received treatment in hospital or through out of hours services for any acute exacerbations of their condition.
  • The practice had arrangements for adults with newly diagnosed cardiovascular disease including the offer of high‑intensity statins for secondary prevention, people with suspected hypertension were offered ambulatory blood pressure monitoring and patients with atrial fibrillation were assessed for stroke risk and treated as appropriate.
  • The practice was able to demonstrate how they identified patients with commonly undiagnosed conditions, for example diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation and hypertension).
  • The practice had a higher than average exception reporting rate for patients with asthma and hypertension. We explored this during the inspection. The practice told us they sent patients three appointment letters, after which the patients were deemed as not wishing to receive the intervention. However, they told us that in some cases the reviews were completed later, which meant that patient care was not being compromised. Following receipt of the draft inspection report, the practice informed us that they were carrying out discussions with the data quality team and with other practices, to identify the reason for higher than average exception reporting rates in some cases.
  • The practice had achieved higher than local and national average results in relation to patients with asthma receiving a review in the preceding 12 months.
  • The practice had achieved higher than local and national average results in relation to patients with diabetes who had an HbA1C result which was in normal ranges in the preceding 12 months. HbA1C monitors the amount of glucose in the haemoglobin in the blood and is an indication of how well diabetes is being controlled.

Families, children and young people:

  • Childhood immunisations were carried out by a local social enterprise organisation in line with the national childhood vaccination programme. Uptake rates for the vaccines given were in line with the target percentage of 90% or above.
  • The practice had arrangements to identify and review the treatment of newly pregnant women on long-term medicines. These patients were provided with advice and post-natal support in accordance with best practice guidance.
  • The practice had arrangements for following up failed attendance of children’s appointments following an appointment in secondary care or for immunisation.
  • The practice had regular meetings with the health visiting team to share information and plan care for children and families with additional medical or social needs. New baby (6-8 week) checks were carried out by the GP in the practice.
  • The practice hosted a weekly midwifery clinic.

Working age people (including those recently retired and students):

  • The practice’s uptake for cervical screening was 73%, which was the same as the local average, and comparable to the national average of 72%. The practice told us there were some challenges in relation to their uptake of cervical screening due to cultural issues and beliefs amongst some of their patient population. Staff who shared the same ethnicity encouraged uptake and endeavoured to explain the value of the screening test and reduce anxieties about undergoing the procedure.
  • The practices’ uptake for breast and bowel cancer screening was in line the national average.
  • The practice had systems to inform eligible patients to have the meningitis vaccine, for example before attending university for the first time.
  • Students who attended university or college out of the area were able to register at the practice temporarily for three months during the summer break when they returned home.
  • Patients had access to appropriate health assessments and checks including NHS checks for patients aged 40 to 74. There was appropriate follow-up on the outcome of health assessments and checks where abnormalities or risk factors were identified.

People whose circumstances make them vulnerable:

  • 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 held a register of patients living in vulnerable circumstances including those with a learning disability. The practice offered annual health checks to patients with a learning disability.
  • Residents at a nearby bail hostel accessed GP services from the practice. The practice worked closely with local support services including drug and alcohol services and local authority housing services, to help meet the additional needs experienced by this group of patients.
  • The practice had a system for vaccinating patients with an underlying medical condition according to the recommended schedule.

People experiencing poor mental health (including people with dementia):

  • The practice assessed and monitored the physical health of people with mental illness, severe mental illness, and personality disorder by providing access to health checks, interventions for physical activity, obesity, diabetes, heart disease, cancer and access to smoking cessation services. There was a system for following up patients who failed to attend for administration of long-term medication.
  • When patients were assessed to be at risk of suicide or self-harm the practice had arrangements in place to help them to remain safe.
  • The practice had access to ‘Admiral’ nurses who provided additional support to older patients with a mental health condition.
  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was higher than the local and national average of 84%.
  • 93% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the previous 12 months. This was in line with the local and national averages of 91% and 90% respectively.
  • The practice specifically considered the physical health needs of patients with poor mental health and those living with dementia. For example, 100% of patients experiencing poor mental health had received discussion and advice about alcohol consumption. This was above the local and national averages of 92% and 91% respectively.
  • Patients at risk of dementia were identified and offered an assessment to detect possible signs of dementia. When dementia was suspected there was an appropriate referral for diagnosis.

Monitoring care and treatment

The practice had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. For example, an audit into contraceptive implants had been carried out. The findings were that appropriate checks and advice had been given in all cases, and that removals had been carried out appropriately in line with patient wishes or clinical need.

Where appropriate, clinicians took part in local and national improvement initiatives. For example, the practice was part of a local GP federation. The federation had a number of initiatives planned or underway. These included an extended access scheme, review of childhood immunisation delivery arrangements and a more equitable allocation of nursing homes to practices in the locality.

  • The practice had a higher than average overall exception reporting rate. Exception reporting is the removal of patients from Quality and Outcomes Framework (QOF) calculations where, for example, patients are unable to attend a review meeting, or where certain medicines cannot be prescribed due to side effects or interactions with other medicines. We explored the reasons for this during the inspection. The practice told us a number of their patients were resident in nursing homes which meant that some treatments were not appropriate for this group of patients. They told us they offered three appointments for those patients for whom interventions and reviews were appropriate before exception reporting them. Following receipt of the draft inspection report, the practice informed us that they were carrying out discussions with the data quality team and with other practices, to identify the reason for higher than average exception reporting rates in some cases.
  • The practice used information about care and treatment to make improvements.
  • The practice was actively involved in quality improvement activity. Where appropriate, clinicians took part in local and national improvement initiatives.

Effective staffing

Staff had the skills, knowledge and experience to carry out their roles.

  • Staff had appropriate knowledge for their role, for example, to carry out reviews for people with long-term conditions, older people and people requiring contraceptive reviews.
  • Staff whose role included immunisation and taking samples for the cervical screening programme had received specific training and could demonstrate how they stayed up to date.
  • The practice understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff were given opportunities to maintain and develop their skills.
  • The practice provided staff with ongoing support. This included an induction process, appraisals and access to clinical mentoring and advice when required. The practice assured themselves of the competence of staff employed in advanced roles by informal audit of their clinical decision making, including non-medical prescribing.
  • The practice had appropriate systems in place to support and manage staff when performance issues arose.

Coordinating care and treatment

Staff worked together and with other health and social care professionals to deliver effective care and treatment.

  • From discussions with staff we learned that all appropriate staff, including those in different teams, services and organisations were involved in assessing, planning and delivering care and treatment.
  • The practice shared clear and accurate information with relevant professionals when deciding care delivery for people with long-term conditions and when coordinating healthcare for care home residents. They shared information with, and liaised, with community services, social services and carers for housebound patients; and with health visitors and community services for children who had relocated into the local area.
  • Patients received coordinated and person-centred care. This included when they moved between services, when they were referred, or after they were discharged from hospital. The practice worked with patients to develop personal care plans that were shared with relevant agencies.
  • The practice ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients, including those who may be vulnerable because of their circumstances.

Helping patients to live healthier lives

Staff were consistent and proactive in helping patients to live healthier lives.

  • The practice identified patients who may be in need of extra support and directed them to relevant services. This included patients in the last 12 months of their lives, patients at risk of developing a long-term condition and carers.
  • Staff encouraged and supported patients to be involved in monitoring and managing their own health. A local social prescribing scheme provided additional support to help counteract social isolation and encourage engagement with other services and agencies relevant to their circumstances.
  • One of the GPs was trained to provide additional support and guidance for patients dealing with alcohol related problems.
  • The practice supported national priorities and initiatives to improve the population’s health, for example, stop smoking campaigns, tackling obesity.

Consent to care and treatment

The practice obtained consent to care and treatment in line with legislation and guidance.

  • Clinicians understood the requirements of legislation and guidance when considering consent and decision making.
  • Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.
  • The practice monitored the process for seeking consent appropriately.

Please refer to the Evidence Tables for further information.

Caring

Good

Updated 16 July 2018

We rated the practice as good for caring.

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

  • Feedback from patients we received in person and from CQC comment cards was mostly positive about the care and treatment provided by staff.
  • Staff demonstrated their understanding of the impact of personal, cultural, social and religious needs on health choices made by patients.
  • The practice gave patients timely support and information.

Involvement in decisions about care and treatment

Staff helped patients to be involved in decisions about care and treatment. They were aware of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information that they are given).

  • Telephone or face to face interpreters were available for patients who did not have English as a first language. In addition, some staff spoke languages appropriate to the patient group.
  • Staff communicated with people in a way that they could understand, for example patient information could be provided in large font when required to aid patients with visual impairment.
  • The practice was able to access advice and information from a sensory services support team when required.
  • Staff signposted patients to additional community and advocacy services when necessary. As part of the CCG Quality Improvement Activity (QIA) scheme the practice were preparing to provide all newly identified carers with an information pack which provided detailed information about support and other guidance available locally.

Privacy and dignity

The practice respected patients’ privacy and dignity.

  • Staff recognised the importance of maintaining the dignity of patients and showing respect to their circumstances and needs.
  • Conversations at the reception area at the main site could not be overheard by patients in the waiting room. Seating in the waiting area at the branch site had been arranged to optimise confidentiality when patients approached the reception desk.
  • A private room could be provided if patients wanted to discuss sensitive issues or appeared distressed.

Please refer to the Evidence Tables for further information.

Responsive

Good

Updated 16 July 2018

We rated the practice, and all of the population groups, as good for providing responsive services.

Responding to and meeting people’s needs

The practice organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

  • The practice understood the needs of its population and tailored services in response to those needs.
  • Online access to book appointments or request repeat prescriptions was available. An on- call GP was available each day on a rota basis to cover both sites and deal with urgent and unexpected patient need. Telephone triage, on the day appointments or home visits were available according to need.
  • The facilities and premises were appropriate for the services delivered.
  • The practice made reasonable adjustments when patients found it hard to access services.
  • Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was coordinated with other services.

Older people:

  • All patients had a named GP who supported them in whatever setting they lived, whether it was at home or in a care home or supported living scheme.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • One of the GPs who had additional expertise in surgical procedures was able to carry out joint injections in patients’ homes when they were housebound and unable to attend surgery.
  • Before the inspection we sought feedback from two nursing homes for older people. They told us the practice responded appropriately when they requested advice, medicines support or home visits.
  • The practice provided examples when staff had delivered prescriptions or medicines to patients’ homes when they were unable to arrange collection themselves.

People with long-term conditions:

  • Patients with a long-term condition received an annual review to check their health and medicines needs were being appropriately met. Consultation times were flexible to meet patients’ needs.
  • The practice held regular meetings with the local district nursing team to discuss and manage the needs of patients with complex medical issues.

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.
  • The practice held monthly meetings with the health visitor to update patient records and plan future care.
  • Children under two years were given a same day appointment upon request.

Working age people (including those recently retired and students):

  • The needs of this population group 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 had two sites, and patients were able to access appointments at either to suit their needs. Telephone triage and online services were available.
  • Alcohol and depression questionnaires were available on line for patients to complete to assess their health before choosing whether or not to seek additional support from the practice.
  • Extended hours were offered on Tuesday morning at both sites from 7.30am to 8am; on Wednesday morning and evening at Albion Mount site from 7.30am to 8am and from 6.30pm to 7pm and on Thursday evening at Albion Mount site from 6.30pm to 7pm. In addition, the local federation was in the process of preparing to offer additional extended hours on weekdays and weekends from three hubs across the district.
  • A college was due to open close to the site of Albion Mount Medical Practice, and the practice had approached the college management to offer their services in supporting students in relation to their sexual health and contraceptive needs.

People whose circumstances make them vulnerable:

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • A bail hostel was situated adjacent to the practice. The practice worked with other appropriate support services to provide the additional support and monitoring required for this group of patients.
  • People in vulnerable circumstances were able to register with the practice, including those with no fixed abode

People experiencing poor mental health (including people with dementia):

  • Staff we spoke with had an understanding of how to support patients with mental health needs and those patients living with dementia.
  • Practice staff had accessed dementia friendly training.
  • GPs had access to appropriate pre-dementia assessment tools and were able to refer to a memory clinic when appropriate.
  • The practice had input from ‘Admiral’ nurses who worked to provide additional support to older patients with mental health needs.
  • The practice provided an example of when they had proactively followed up a patient with mental health needs when they failed to attend for reviews, resulting in appropriate urgent care and treatment being provided.

Timely access to care and treatment

Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.

  • Patients had timely access to initial assessment, test results, diagnosis and treatment.
  • Waiting times, delays and cancellations were minimal and managed appropriately.
  • Patients with the most urgent needs had their care and treatment prioritised.
  • Patients reported that the appointment system had improved with recent changes.

Listening and learning from concerns and complaints

The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

  • Information about how to make a complaint or raise concerns was available. At the time of our visit verbal complaints were not routinely collated. Following our feedback, the practice responded by preparing information for patients which enhanced the process of making verbal or written complaints.
  • The complaint policy and procedures were in line with recognised guidance. At the time of our visit we saw that Parliamentary and Health Services Ombudsman (PHSO) details were not included in response letters to patients. Following our feedback, the practice responded and the letter template was changed before the inspection was completed. The practice learned lessons from individual concerns and complaints and also from analysis of trends. It acted as a result to improve the quality of care. For example, following a complaint where a patient had been booked in for the wrong procedure; staff were reminded to document carefully as much information as possible relating to the reason for appointments.

Please refer to the Evidence Tables for further information.

Well-led

Good

Updated 16 July 2018

Checks on specific services

People with long term conditions

Good

Updated 16 July 2018

Families, children and young people

Good

Updated 16 July 2018

Older people

Good

Updated 16 July 2018

Working age people (including those recently retired and students)

Good

Updated 16 July 2018

People experiencing poor mental health (including people with dementia)

Good

Updated 16 July 2018

People whose circumstances may make them vulnerable

Good

Updated 16 July 2018