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Archived: Dr Iain Glencross Good

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Inspection Summary


Overall summary & rating

Good

Updated 8 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Iain Glencross on 7 July 2016. 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.
  • 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.
  • Patient satisfaction at the practice was high. For example, 95% of patients said they found it easy to get through to the surgery by telephone.
  • The practice did not offer extended opening hours. However, 99% of patients said that they were able to access a GP the last time they had tried.
  • Patients said they found it easy to make an appointment with a named GP and there was good continuity of care, with urgent appointments available the same day. Patient satisfaction scores were consistently high: between January and September 2015, 96% of patients described their experience at the surgery as good or very good.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had an active patient participation group called the Patient Viewpoint Group (PVG). Following feedback from the PVG changes were made as to how the practice was run. For example, additional nursing appointments were offered in the afternoon and provision was made for patients to book phlebotomy appointments on line.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was liaising with Greater Huddersfield Clinical Commissioning Group (CCG) and had submitted plans to move to a modern building to improve access for patients and to enable them to offer additional services.
  • The practice was part of the Prime Health Huddersfield Federation and staff at the surgery were active within the CCG.
  • The practice was proactive in the management of mental health issues including dementia and staff had completed Dementia Friends training and Dignity in Care training to support patient needs. The practice had undertaken training to become a safe haven for vulnerable people.
  • There was a clear leadership structure and staff felt supported by the lead GP and the practice manager. 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.

We saw areas of outstanding practice:

The practice had bespoke computer mouse mats for all staff which included contact numbers for safeguarding queries, other relevant telephone numbers and information about which codes to use to identify carers.

Young people were contacted on their fifteenth birthday and offered the opportunity to update practice records with their own mobile number and take more control over their personal health. The practice had been recognised for offering a high standard of health services and materials aimed at young people.

For patients with a learning disability or for those patients who did not use English as their first language there was easy to read information available and a picture board to assist people in explaining what they needed and who they wanted to see. The practice had shared this communication board with the local pharmacy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 August 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; we saw evidence that significant events, complaints and actions required were discussed at the practice governance meetings.
  • 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 and these were also discussed with the PVG.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. The team had undertaken training on female genital mutilation (FGM) and contact numbers for the local safeguarding teams were available on bespoke practice mouse mats for all staff.
  • Risks to patients were assessed and well managed. 

Effective

Good

Updated 8 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Systems were in place to ensure that clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidance and other locally agreed guidelines. The practice liaised closely with the CCG.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment and had attended mandatory and additional training courses.
  • 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.
  • The practice used information in numerous languages to encourage the uptake of cervical screening. Patients with a learning disability also benefitted from easy read leaflets and a DVD which explained the process of having a smear test.
  • The health care assistant would visit vulnerable and older people in their own homes to offer health assessmnents and administer flu vaccinations. We saw evidence that this was supported by an up to date patient specific directive, appropriate training and assessment of competencies, knowledge of anaphylaxis and how to respond and adherence to policies and procedures.

Caring

Good

Updated 8 August 2016

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 several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. The waiting area was calm and staff were polite and friendly when greeting patients.
  • Information for patients about the services available was easy to understand and accessible. A “welcome to the practice” leaflet had been translated into numerous languages including Arabic, Bengali and Ukrainian.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Parking at the practice could be difficult, however, the clinicians ensured that all appointments ran to time, so that patients could make use of one hour parking restrictions without worrying they would be issued a ticket. We saw evidence that patients were seen promptly.
  • The practice encouraged the use of and made regular referrals for patients to voluntary organisations, to improve their social wellbeing. This included arranging buddies for patients with learning disabilities to attend the surgery and referrals to creative outlets such as singing, walking and creative arts.
  • The practice had supported vulnerable patients to access other services such as legal advocacy and other local support services.
  • The practice had trained to be a “Safe Place” under the Mencap safer places scheme. The practice had been able to use these skills to provide a safe haven for vulnerable people when required.

Responsive

Good

Updated 8 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Greater Huddersfield CCG to secure improvements to services where these were identified. The practice had submitted a bid alongside three other practices to secure funding for new purpose built premises. It was hoped this would improve access and parking for patients and allow the practice to increase the services it could provide.
  • Patients said they found it very easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. We were told that appointments ran to time and we saw evidence to confirm this. Patients told us they never waited more than 48hours for an appointment
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Due to the restrictions of the building the staff would individually assess the needs of the patient prior to their consultation and ensure that a suitable room was available.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised both verbally and in writing. Learning from complaints was shared with staff and other stakeholders including the PVG.

Well-led

Good

Updated 8 August 2016

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 a number of policies and procedures to govern activity and held regular governance meetings.
  • The staff discussed positively the benefits of training and had attended numerous learning and development events including a study day on spirituality and dementia friends training.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour. A culture of openness and honesty was encouraged. 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 viewpoint group was active.
  • There was a strong focus on continuous learning and improvement at all levels. The practice had provided additional training for its staff and supported learning and development. The team had developed a chaperone training resource that had been shared with other practices within the CCG.
Checks on specific services

People with long term conditions

Good

Updated 8 August 2016

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 using the computer systems.
  • Outcomes for patients with diabetes were higher than CCG and national averages. For example the percentage of patients with a recorded normal blood pressure reading was 89%.
  • Longer appointments and home visits were available when needed.
  • 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.

Families, children and young people

Good

Updated 8 August 2016

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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Children were offered same day, priority appointments.
  • The practice’s uptake for the cervical screening programme was 83%, which was better than the national average of 82% and comparable to the CCG average of 85%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw evidence of positive examples of joint working with midwives, health visitors and school nurses. New mums were sent a card from the practice congratulating them on the birth of their baby and inviting them to attend for a co-ordinated eight week baby check.
  • Appointments could be booked via a smartphone app and the practice also had a twitter account for people to keep up to date with news from the surgery.
  • Young people were contacted on their fifteenth birthday and offered the opportunity to update practice records with their own mobile number and take more control over their personal health. The practice had been awarded the Kirklees Young People Friendly kite mark. This award is in recognition of a service that provides the highest possible standard of health services and materials aimed at young people

Older people

Good

Updated 8 August 2016

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. When patients moved into local care homes they were supported to retain the services of their usual GP.
  • The practice was part of a pilot scheme to facilitate timely and appropriate discharges for older people from hospital. The scheme aimed to co-ordinate care and reduce the length of inpatient stays.

Working age people (including those recently retired and students)

Good

Updated 8 August 2016

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 consultations were available for those who requested them.
  • 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. This included the ability to access test results on line.
  • Appointments could also be booked via a smartphone app.
  • We were told and saw evidence that patients could access appointments at a time which suited their needs. Appointments were prompt and people were seen at their allocated time.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 August 2016

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

  • The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 100%, which is better than both the CCG and national average.
  • The percentage of patients with mental health issues who had an agreed comprehensive care plan was 97% compared to the CCG average of 89% and the national average of 88%.
  • The practice regularly worked with multidisciplinary 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. Dementia screening was offered opportunistically at new patient health checks and during long term conditions reviews.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and had a good knowledge of what was available in the local area.
  • 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. Same day appointments were offered to patients who were experiencing an acute mental health issue and proactive home visits would be undertaken by the health care assistant.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and had undertaken Dementia Friends training and Dignity in Care training.

People whose circumstances may make them vulnerable

Good

Updated 8 August 2016

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, dementia and those with drug or alcohol dependency.
  • The practice had identified 51 patients with a learning disability and offered longer appointments and annual health checks to this patient group. The practice had achieved a Learning Disability Friendly award which had been promoted by an NHS initiative. They had some easy read information available and a picture board to assist people to explain what they needed and who they wanted to see. The practice had shared this communication board with the local pharmacy.
  • 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 including walking groups, creative arts groups and a singing group.
  • The practice had a trained carer’s champion.
  • 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.
  • When patients required a translator a double length appointment was booked and we saw that practice information was translated into several different languages relevant to the patient group.
  • The practice was a designated “Safe Place” for vulnerable people had undertaken training through MENCAP for this.
  • The practice was situated in an area where the prevalence of HIV was high and offered testing for this at new patient health checks.