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Dr Lindsay Mackenzie Good Also known as Wootton Vale Healthy Living Centre

Inspection Summary


Overall summary & rating

Good

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wootton Vale Healthy Living Centre; Dr Lindsay Mackenzie on 27 April 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 the skills, knowledge and experience to deliver effective care and treatment.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Feedback from patients about their care was consistently positive.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
  • The practice had good facilities and was well equipped to treat patients.
  • The practice actively reviewed complaints and assessed how they were managed. They responded to complaints, ensuring improvements and changes took place as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

The practice employed two healthcare coordinators. This role provided the link between clinicians and patients to offer support and advice in areas such as smoking cessation, support for patients diagnosed with cancer, referring patients to secondary care and identifying and supporting carers.

The practice‘s vision is to facilitate provision of care and services in a community setting. We saw numerous examples of how it has achieved this including the following:

  • The lead GP had undertaken a redesign of the clinical team to ensure a quality service was provided and had developed a Women’s Health Practitioner role to support women’s health and provide sexual health advice to men and women.
  • The practice managed an integrated gynaecology service, commissioned by Bedfordshire Clinical Commissioning Group (BCCG) for surrounding practices. This service allows women to receive treatment and tests in a primary care setting, reducing the need for hospital attendance with the exception of surgical procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 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 and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had robust processes for infection control.
  • 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.
  • Staff had received training appropriate to their role and relevant pre-employment checks had been completed.
  • Emergency medicines and oxygen were available.

Effective

Good

Updated 3 November 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.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had introduced a robust system of competencies for staff to complete that included patient feedback.
  • 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 provided clinical space to a number of community services and staff, such as dermatology and a Parkinson’s nurse.
  • There was a multi-agency special notes sharing process with the out of hours service and hospital to ensure patients’ needs were recognised.

Caring

Good

Updated 3 November 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.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice held a register of carers and was actively looking to identify patients who may have caring responsibilities, including young people, to offer support.
  • A condolence card was sent to carers who had suffered a bereavement, which contained useful information on bereavement support.

Responsive

Outstanding

Updated 3 November 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Bedfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice organised regular multi-disciplinary meetings to share information regarding vulnerable adults or children.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice offered evening appointments and telephone consultations for patients unable to attend the practice during normal hours.
  • 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.
  • Dementia screening was undertaken for patients at risk and annual reviews were performed on diagnosed patients.
  • The practice employed two health care coordinators to support the clinical team and to provide an interface between patient and clinician.

  • The practice managed an integrated gynaecology service, commissioned by Bedfordshire Clinical Commissioning Group (BCCG), for surrounding practices. This service enabled women to receive treatment and tests in a primary care setting, only needing to attend hospital for surgery.
  • The practice had developed a Women’s Health Practitioner role to support women’s health and provide sexual health advice to men and women.

Well-led

Good

Updated 3 November 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 lead GP had undertaken a redesign of the clinical team and developed a Women’s Health Practitioner role to support women’s health and provide sexual health advice to men and women.
  • 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. The partners 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 had an active patient participation group (PPG) who worked closely with the practice to improve the patient experience and practice systems.

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

  • The practice had employed an assistant practitioner, who was a student nurse and was supporting her in her studies with the clinical manager acting as mentor.
  • The practice worked closely with the Bedfordshire Clinical Commissioning Group and provided intelligence to help improve patient outcomes. 
Checks on specific services

People with long term conditions

Good

Updated 3 November 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 for example, diabetes, asthma and chronic obstructive pulmonary disease (COPD) and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was higher than local and national averages. For example, the percentage of patients with diabetes, on the practice register, in whom the last HbA1c was 64mmol/mol or less in the preceding 12 months was 87% compared to local CCG average of 76% and national average of 78%.
  • 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Asthma care audits were used to identify patients who would benefit from additional support and more frequent reviews.
  • The practice was keen to offer support for patients suffering from neurological conditions such as, multiple sclerosis and Parkinson’s disease. They liaised with specialist nurses and provided dedicated clinical space. This service was offered to patients from the practice as well as patients from the surrounding area.
  • There was a robust recall system in place to monitor patients in this group.
  • Patients benefitted from access to on-site specialist services. For example, access to a dedicated respiratory nurse, dermatology GP and a Women’s health nurse specialist.
  • NHS Health checks were used to identify patients at risk of developing long term conditions. These patients were then provided with further treatment and support as necessary.
  • Dementia assessments were performed at annual reviews for patients suffering from long term conditions.

Families, children and young people

Good

Updated 3 November 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 higher number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • 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 88%, which was higher than the CCG average of 83% and the national average of 82%.
  • 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, including clinics held on site and attending meetings.
  • The practice frequently undertook safeguarding audits, attended monthly meetings and worked with other agencies to support children and families at risk.

Older people

Good

Updated 3 November 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.

  • Monthly combined palliative care and unplanned hospital admission meetings were held with community services to provide a multidisciplinary package of care to these patients.
  • The practice worked closely with community matron to provide care for patients in this group.
  • An information sheet was available signposting older patients to services available both in the practice and externally.

  • The local pharmacist provided a same day medication delivery service for patients unable to collect their medicines from the pharmacy.
  • A hearing advisory service was available at the practice.

Working age people (including those recently retired and students)

Good

Updated 3 November 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.
  • The practice had developed a women’s health practitioner role to support women's health and provide sexual health advice to men and women.
  • 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.
  • Late appointments and telephone advice were available for patients unable to attend the practice in normal working hours.
  • In addition the practice offered the Electronic Prescription Service (EPS) and SMS text message reminders.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 November 2016

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

  • The practice held registers of patients suffering from poor mental health and those with dementia.
  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the 12 months preceding our inspection. This was above the CCG average of 84% and the national average of 84%.
  • Performance for mental health related indicators was also above local and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their patient record in the preceding 12 months was 100%;
  • 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, including MIND, SEND and local advocacy services.
  • The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health. The practice had developed a family orientated approach to mental health problems in children and parents. Safeguarding meetings were held every 6 weeks, attended by health visitors to ensure families were given support, especially in cases where women were showing signs of post-natal depression.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • Mental health reviews were completed and medication monitoring systems were in place and facilitated through corroborative working with local mental health services.
  • Patients could be referred to external support services for example, the lifestyle hub, cognitive behavioural therapy and addiction support services.
  • The practice offered space for mental health professionals to see patients who needed to be seen in a more local environment including CALS (alcohol workers) and Changing Faces (disfigurement camouflage).
  • A project was planned to screen patients for early signs of dementia and refer to services for diagnosis.

People whose circumstances may make them vulnerable

Good

Updated 3 November 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 homeless people, travellers and those with a learning disability. They adapted services where possible to facilitate the needs of these vulnerable groups. Where appropriate used the health care coordinators to support and sign post patients.
  • The practice offered longer appointments, annual reviews and personalised care plans 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.
  • Patients who required additional support with drug and alcohol addictions and were unable to travel to specialist clinics were seen in the practice by local support groups for example, the Pathway 2 Recovery service.
  • 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.
  • Priority appointments were available for patients registered as carers, who were also offered regular health assessments.
  • Electronic alerts on the clinical system ensured vulnerable patients were quickly identifiable.
  • Translation services and British Sign Language (BSL) interpretation was available through an external agency.
  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 127 patients as carers (2.4% of the practice list) whose ages ranged from 17 to 93 years of age.
  • The practice provided support to carers including offering flexible appointments and assistance with carers assessments, applying for benefits and advice on advanced care plans.