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Archived: Colwall Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 30 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Colwall Surgery on 10 January 2017. The overall rating for this service is good.

Our key findings across all the areas we inspected were as follows:

  • The practice was aware of and provided services according to the needs of their patient population.
  • There were processes and procedures to keep patients safe. This included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
  • The practice was aware of the requirements of the duty of candour and systems were ensured compliance with this.
  • Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.
  • Advanced care planning and annual health checks were carried out for patients with dementia and poor mental health with significantly higher than national average results.
  • Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure that patients received the best care and treatment in a coordinated way.
  • The practice had an active Patient Liaison Group (PLG). The PLG was proactive in representing patients and assisting the practice in making improvements to the services provided.
  • Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
  • Information about services and how to complain was available and easy to understand. Patients told us that they knew how to complain if they needed to.
  • There was a clear leadership structure and staff told us they felt supported by management.
  • There was a culture of openness and accountability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting and recording significant events.
  • Lessons learned were shared at meetings so that improvements made were monitored.
  • When there were unintended or unexpected safety incidents, patients were given an explanation and were told about any actions taken to improve processes to prevent the same thing happening again. The practice was aware of the requirements of the duty of candour and systems ensured they complied with this.
  • The practice had systems, processes and practices to keep patients safe and safeguarded from abuse. Staff had received training relevant to their role.
  • The practice assessed risks to patients and had systems for managing specific risks such as health and safety, infection control and medical emergencies.
  • Appropriate recruitment procedures were followed to ensure that only suitably qualified staff were employed to work at the practice.

Effective

Good

Updated 30 March 2017

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff received appraisals and had personal development plans in place.
  • The practice had improved the quality of care and treatment it provided through clinical audit and ongoing monitoring.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to or above average for the local and the national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Staff worked with other health care teams and there were systems to ensure appropriate information was shared.
  • A pre-dementia register kept patients under regular review and facilitated early diagnosis and treatment for this disease.

Caring

Good

Updated 30 March 2017

The practice is rated as good for providing caring services.

  • Results from the National GP Patient Survey published on 7 July 2016 showed that the practice achieved above average for results in relation to patients’ experience and satisfaction scores on consultations with the GP and the nurse.
  • Patients were very complimentary about the practice and commented that staff were very friendly, that they received excellent care from the GPs and the nurses, and could always get an appointment when they needed one.
  • Patients rated the practice above local and national averages for the care and support provided.
  • Staff were courteous and very helpful to patients both attending at the reception desk and on the telephone. We saw that patients were treated with dignity and respect.
  • Information to help patients understand and access the local services was available.

Responsive

Good

Updated 30 March 2017

The practice is rated as good for providing responsive services.

  • Colwall Surgery reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to make improvements to the services they provided. For example, the practice provided an enhanced service for those patients at the end of their life.
  • Patients said they were able to make an appointment with the GPs and that there was continuity of care, with urgent appointments available the same day.
  • Information about how to complain was available and easy to understand and evidence showed that the practice had responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders accordingly.
  • 77% of patients found it easy to get through to this practice by telephone compared to the Clinical Commissioning Group (CCG) average of 80% and the national average of 73%. A new telephone system with more available lines was installed last year in response to patient feedback about the difficulties of telephone access.
  • 92% of patients described the overall experience of this GP practice as good compared to the CCG average of 91% and the national average of 85%.
  • 92% of patients said they would recommend this GP practice to someone who has just moved to the local area compared to the CCG average of 84% and the national average of 78%.

Well-led

Good

Updated 30 March 2017

The practice is rated as good for being well-led.

  • There was a clear leadership structure and staff understood their roles and responsibilities. Governance systems ensured that services were monitored and reviewed to drive improvement within the practice.
  • The practice had a clear vision to deliver high quality care to patients. They promoted healthy lifestyles and worked with other agencies to support patients. Staff were clear about the vision and their role to achieve this.
  • The practice had systems for responding to notifiable safety incidents and shared this information with staff to ensure appropriate action was taken.
  • Formal clinical meetings and full team meetings were held to share best practice or lessons learnt.
  • Staff felt supported by management and were comfortable raising any concerns as everyone at the practice was approachable and easy to talk to.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients and from the Patient Liaison Group (PLG). A PLG is a group of patients registered with a practice who worked with the practice team to improve services and the quality of care. A new telephone system was installed in response to patient feedback about telephone access to the surgery.
  • The practice was aware of and complied with the requirements of the duty of candour. A culture of openness and honesty was encouraged.
Checks on specific services

People with long term conditions

Good

Updated 30 March 2017

The practice is rated as good for the care of patients with long-term conditions.

  • GPs had a specialist interests in dementia, asthma and heart disease. These specialisms meant that Colwall Surgery had consistently been one of the lowest referring practices to secondary care in Herefordshire.
  • The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
  • The practice had taken part in a pilot for a diabetes prevention programme in Herefordshire. Patients between the ages of 35 and 95 were invited for a health review to assess for pre-diabetes so that early intervention could be applied. Patients were invited to attend focus group meetings. The initial meeting had been held on 16 January 2017 and was attended by 11 patients, with a further focus group session scheduled for 31 January 2017.
  • Longer appointments and home visits were available when needed.
  • All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
  • Clinical staff had close working relationships with external health professionals to ensure patients received up-to-date care.
  • NHS health checks were offered for early identification of chronic disease and there was proactive monitoring.
  • The practice patient leaflet and website provided information about other organisations and websites patients could access.
  • Telephone consultations were provided which was particularly helpful for those patients with poor mobility.

Families, children and young people

Good

Updated 30 March 2017

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

  • Same day appointments were offered to all children under the age of five.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Staff had been trained to recognise signs of abuse in vulnerable children and the action they should take if they had concerns. There was a lead GP for safeguarding children and GPs were trained to an appropriate level in safeguarding. All safeguarding concerns were discussed at the weekly GP meetings.
  • There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency attendances.
  • The practice worked with health visitors to coordinate care.
  • Performance for cervical screening indicators was in line with Clinical Commissioning Group (CCG) and national averages. The percentage of women aged 25-64 who attended for a cervical screening test in the last five years was 80% compared with CCG and national averages of 80% and 81%.
  • The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
  • Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
  • The practice offered a number of online services including requesting repeat medicines and booking appointments.

Older people

Good

Updated 30 March 2017

The practice is rated as good for the care of older patients.

  • The practice offered personalised care to meet the needs of the older people in its population and was responsive to their needs.
  • The practice offered a range of enhanced services, for example, in dementia and end of life care.
  • Home visits and rapid access appointments were offered for those patients with enhanced needs.
  • Nationally reported data showed that outcomes for patients were above local and national standards for conditions commonly found in older patients.
  • The practice were proactive with their older patients particularly in referring patients for full assessment and treating osteoporosis (bone disease) when it was diagnosed. The practice told us they were organising hip protectors for nursing home patients to lessen the risk of hip fractures for patients in this population group.
  • Telephone consultations were provided which was particularly helpful for those patients with poor mobility.
  • GPs or the district nurses visited those patients who were housebound or living in nursing homes to ensure that patients received their flu injection.

Working age people (including those recently retired and students)

Good

Updated 30 March 2017

The practice is rated as good for the care of working-age patients (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.
  • The practice was proactive in offering a full range of health promotion and screening services that reflected the needs of this age group.
  • Health promotion advice was offered such as smoking cessation and nutrition.
  • The practice offered online appointment booking and the facility to request repeat prescriptions online.
  • Telephone consultations were provided which was particularly helpful for those patients who worked during appointment times.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 March 2017

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

  • The practice had a high proportion of elderly (approximately 7% above the local average and 18% above the national average) and a high number of patients with dementia on their patient list. A pre-dementia register enabled GPs to keep patients under regular review and facilitate early diagnosis and treatment for this disease. A community dementia worker provided additional support through regular monthly memory clinics held at the surgery.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • Advanced care planning and annual health checks were carried out for patients in this population group. Nationally reported data showed that outcomes for patients were significantly higher than the national average for conditions commonly found for patients with poor mental health.
  • A shared care arrangement was in place with the Drugs and Alcohol Service for patients with substance misuse concerns.
  • Referrals to the Improving Access to Psychological Therapies (IAPT) team were made for patients who needed psychological support or counselling services.
  • Patients experiencing poor mental health were advised how to access various support groups and voluntary organisations. There was a system to follow up patients who had attended accident and emergency departments where they may have been experiencing poor mental health.
  • Clinical staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.

People whose circumstances may make them vulnerable

Good

Updated 30 March 2017

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

  • Staff had been trained to recognise signs of abuse in vulnerable adults and the action they should take if they had concerns. There was a lead GP and all clinical staff were trained to an appropriate level for safeguarding adults. All safeguarding concerns were discussed at weekly GP meetings.
  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
  • Longer appointments were available for patients with a learning disability. The practice had carried out annual health checks for 11 of the 12 patients on their register for 2015/2016.
  • Health screening was available for vulnerable patients including travellers and those who were homeless.
  • Vulnerable patients were informed how to access various support groups and voluntary organisations.
  • Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for increased staff awareness so that longer appointments could be allocated if appropriate.