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Archived: Westcotes GP Surgery Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westcotes GP Surgery on 21 June 2016. Overall the practice is rated as requires improvement.

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.

  • 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.

  • 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 ensured all staff received regular appraisals. All members of staff received regular reviews of their performance which included a report and a rating.

  • Data showed patient outcomes were low compared to the national average. The practice had employed two practice nurses to improve the range of services offered to patients.

  • Patients said they did not always find it easy to make an appointment with a named GP or that there was continuity of care, with urgent appointments available the same day.

The areas where the provider must make improvements are:

  • Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including those in relation to appointment access and consultations with GPs and nurses.

  • Ensure there is an effective system in place to manage and monitor processes to improve outcomes for patients.

The areas where the provider should make improvement are:

  • Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 November 2016

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.

  • There was an infection control lead in place and quarterly infection control audits were carried out.

Effective

Requires improvement

Updated 23 November 2016

The practice is rated as requires improvement for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average in some outcomes compared to the national average in 2014-15. For example, the most recent published results in 2014-15 were 77.2% for Westcotes GP Surgery 1 and 79.7% for Westcotes GP Surgery 2 of the total number of points available. Data for 2015-16 had shown no significant improvement.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • A programme of clinical audits was in place which included medicine audits.

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

  • There was evidence of appraisals, performance monitoring reviews 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. The practice held monthly multi-disciplinary meetings to review the care and needs of patients.

Caring

Requires improvement

Updated 23 November 2016

The practice is rated as requires improvement for providing caring services.

  • The majority of patients said they were treated with compassion, dignity and respect. However, not all felt listened to or involved in decisions about their care.

  • Data from the national GP patient survey showed patients rated the practice lower than others for some aspects of care.

  • CQC comment cards received from patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice had a carer’s register in place which represented 1% of the combined patient lists. There was also a carer’s champion who ensured carer’s received information about local carer’s services available to them.

  • Information for patients about the services available was easy to understand and accessible and available in numerous different languages.

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

Responsive

Requires improvement

Updated 23 November 2016

The practice is rated as requires improvement for providing responsive services.

  • Data from the national GP patient survey showed patients rated the practice lower than others and reported that access to a named GP and continuity of care was not always available quickly. Patients reported that they could not always get through to the practice easily by telephone and were not always satisfied with the practice opening hours.

  • 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 and other stakeholders.

  • The practice held bi-monthly gold standard framework (GSF) meetings to discuss and review the needs of all palliative care patients.

  • The practice had carried out a disability access audit to assess disabled access for patients and to identify reasonable adjustment measures to be taken.

  • The practice allocated a ‘tracker’ who were non-clinical members of staff, to patients identified as vulnerable or who suffered a long-term health condition and were at risk of unplanned admission to hospital.  The role of the tracker was to contact patients on a monthly basis to ensure they had a point of contact in the practice and ensured patients’ needs were met and reduced their risk of unplanned admission to hospital. The tracker would also give patients advice on local support groups and organisations that may be helpful to them to ensure their social needs were met.   

Well-led

Requires improvement

Updated 23 November 2016

The practice is rated as requires improvement for being well-led.

  • 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. However, there was a lack of effective systems and processes in place in relation to the management, monitoring and improvement of patient outcomes and patient satisfaction.

  • The provider was aware of and complied with the requirements of the duty of candour. The lead GP 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 and met on a bi-monthly basis.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available when needed.

  • The practice participated in an admissions avoidance scheme and delivered personalised care plans and regular reviews for patients with a long term condition with a view to deliver more personalised care and to reduce emergency or unplanned hospital admissions.

  • The practice allocated a ‘tracker’ who were non-clinical members of staff, to patients identified as vulnerable and at risk of unplanned admission to hospital. Their role was to contact patients on a monthly basis to ensure they had a point of contact in the practice and ensured patients’ needs were met. The tracker would also give patients advice on local support groups and organisations that may be helpful to them to ensure their social needs were met.

  • All these patients had a named GP and 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.

  • The practice held bi-monthly Gold Standard Framework (GSF) meetings to review and discuss the needs of all palliative patients.

  • There was a GP lead for patients who were at end of life.

  • The practice held weekly meetings with district nursing teams.

  • Performance for diabetes related indicators was 52% which was lower than the CCG average of 85% and the national average of 89%. (This included an exception reporting rate of 11.7% which was comparable to the national average of 11%). (Westcotes GP Surgery 1).

  • Performance for diabetes related indicators was 76% which was lower than the CCG average of 85% and the national average of 89%. (Westcotes GP Surgery 2).

Families, children and young people

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • 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

  • 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.

  • 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, health visitors and school nurses.

  • The lead GP had attended Gillick Competence and Fraser Guidelines training.

  • The practice liaised with health visiting teams on a weekly basis.

  • Midwifery led clinics were held in the practice on a two weekly basis.

  • The practice reviewed children whose appointment had not been attended and where there had been no notification of cancellation. Any concerns relating to these children were discussed with health visiting teams on a weekly basis.

  • Immunisation rates for the standard childhood immunisations were mixed. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 82% to 88% and five year olds from 73% to 80% during 2014-15.  However, rates for some of the vaccinations given had improved with some higher than local and national averages.

  • The practice’s uptake for the cervical screening programme was 82%, which was better than the CCG average of 69% and the national average of 74%. (Westcotes GP Surgery 1).

  • The practice’s uptake for the cervical screening programme was 72%, which was better than the CCG average of 69% and the national average of 74%. (Westcotes GP Surgery 2).

Older people

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • 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 participated in a care navigation scheme which provided a wide range of support to older people through home visits from a care navigator to help them remain healthy and to help patients carry on living in their own homes.

  • Patients received personalised care plans from a named GP to support continuity of care.

  • The premises were accessible to patients with mobility difficulties.

Working age people (including those recently retired and students)

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • 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. For example, extended hours appointments were available and online services such as ordering repeat prescriptions and appointment booking for the convenience of patients who worked or had other commitments during the day.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • An automated arrival machine was available to give patients the opportunity to arrive themselves for their appointment rather than speak to a receptionist.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • 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.

  • 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.

  • All clinical staff had attended Mental Capacity Act (MCA) training.

  • Performance for mental health related indicators was 92% which was higher than the CCG average of 90% and the national average of 93%. (This included an exception reporting rate of 19% which was higher than the national average of 11%). (Westcotes GP Surgery 1).

  • Performance for mental health related indicators was 71% which was lower than the CCG average of 90% and the national average of 93%. (Westcotes GP Surgery 2).

People whose circumstances may make them vulnerable

Requires improvement

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and 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.