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Tudor Practice Stockland Green Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 27 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tudor Practice Stockland Green Limited on the 2 and 17 November 2016. The overall rating for the practice was good; however, the practice was rated as requires improvement for providing caring services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Tudor Practice Stockland Green Limited on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 February 2018 to confirm that the practice had carried out their plan to make improvements in relation to measures taken to improve patients’ satisfaction rates in areas such as patient involvement and access; as well as, improving measures to gain patient feedback and the uptake of national screening programmes. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • Members of the management team were aware of the issues regarding phone access and we saw evidence of actively communication with the Clinical Commissioning Group (CCG) to explore options regarding commissioning a more effective phone system. Staff explained that there was online appointment booking facilities and patients were also able to place repeat prescription requests using the online facilities. Staff continued to promote their website and social media pages to raise awareness regarding these options. Data provided by the practice showed 26% of patients were registered for online services; this was above the contract requirements’.

  • There were variations in patient satisfaction rates in relation to access. For example, satisfaction with opening hours had improved by 1% since the 2016 survey; however, access to appointments showed a 15% decline. In response to the national GP patient satisfaction scores in relation to access staff explained the practice were no longer closed on a Thursday afternoon.

  • Following the increased opening hours, in order to monitor patient satisfaction the practice had carried out a practice led survey between August and December 2017. Forty patients completed and returned a survey form. Data showed patients were satisfied with the practice opening times, getting through by phone and GP consultations.

  • Staff explained that since our November 2016 inspection, they had continued efforts to set up a Patient Participation Group (PPG). For example, posters were located in the reception area; non-clinical staff actively spoke with patients discussing the benefits of joining the PPG. As a result, the practice recruited five active members and were holding regular meetings to discuss areas of improvement.

  • The practice continued to encourage patients to engage with the cervical screening programme. For example, we saw posters in the reception area in a variety of languages. The practice sent out screening text reminders, appointment letters to women who missed three appointments and the clinical system identified patients which allowed GPs to proactively discuss the benefits of cervical screening during consultations’. The practice provided data taken from their clinical system which showed that uptake rates were 68% at the time of our inspection. We also saw evidence demonstrating all identified patients had been sent an appointment reminder letter.

However, there were also areas of practice where the provider needs to make further improvements.

In addition the provider should:

  • Continue monitoring appointment and phone access to increase patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 February 2017

The practice is rated as good for providing safe services.

  • 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. Learning was based on a thorough analysis and investigation.
  • The practice used clinical audit to improve patient outcomes.
  • When things went wrong patients received truthful information, and a written apology. They were told about any actions to improve processes to help prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse. The practice held monthly safeguarding meetings with health visitors.

  • Risks to patients were well managed and recognised as the responsibility of all staff.

Effective

Good

Updated 16 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that the practice was performing similarly to practices locally and nationally.

  • The practice was pro-active in identifying patients at risk of an unplanned hospital admission and regularly reviewed their health needs resulting in lower than average Accident &Emergency (A&E) attendances.

  • The practice had a structured system to ensure that all clinicians were up to date with both national and other locally agreed guidelines.

  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff members throughout the practice had lead roles across a range of areas and were committed to working collaboratively.
  • There was evidence of staff appraisals, personal development plans and succession planning.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The practice had reduced antibiotic prescribing by 32%. They utilized the ‘treating your infection’ forms, these were also printed in different languages.

Caring

Good

Updated 27 February 2018

Responsive

Good

Updated 16 February 2017

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 Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Clinical staff carried out home visits for patients that would benefit from these.

  • The practice had been unable to recruit a salaried GP and used long term locum GPs, this affected the continuity of patient care and involvement in decisions about their treatment. However, the practice had recently recruited a salaried GP who will commence at the practice in January 2017.
  • There were longer appointments available for vulnerable patients and for patients that did not speak English. Non English speaking patients were given 20 minute appointments and an interpreter was available. 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 offered a range of clinical services which included care for long term conditions.

Well-led

Good

Updated 16 February 2017

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.

  • 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.

  • Throughout our inspection we received positive feedback from staff. Staff spoke highly of the culture of the practice and were proud to be part of the practice team.

  • The provider was aware of and complied with the requirements of the duty of candour. The management 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.
Checks on specific services

People with long term conditions

Good

Updated 16 February 2017

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.

  • Performance for diabetes related indicators was 88%, compared to the CCG average of 86% and a national average of 87%. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87% compared to the CCG average of 89% and the national average of 88%.

  • Longer appointments and home visits were available when needed. All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs and advanced nurse practitioner worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 27 February 2018

Older people

Good

Updated 16 February 2017

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.

  • The practice maintained a palliative care register and held monthly palliative care meetings that included reviews of patients with conditions such as , dementia and heart failure.

  • Unplanned admissions were discussed with clinical staff at the practice as well as community staff.

Working age people (including those recently retired and students)

Good

Updated 16 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

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

  • 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 and flexible.

  • Appointments could be booked over the phone, face to face and online. The practice offered extended hours on Mondays, and Wednesdays if a bank holiday.

  • National cancer intelligence data 2014/15 indicated that the breast cancer screening rates for 50 to 70 year olds was 64% compared to the CCG average of 69% and a national average of 72%. Bowel cancer screening rates for 60 to 69 year olds was 38% compared to the CCG average of 50% and a national average of 58%. The practice had initiated a number of initiatives to increase uptake.

  • The practice had developed a Facebook page and information was available in different languages.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 February 2017

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

  • Performance for dementia indicators was 100%, compared to the CCG average of 96% and a national average of 97%, with exception rates of 14% compared to the CCG average of 18% and a national average of 20%. The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 73% compared to the CCG average of 84% and a national average of 83%, with exception rates of 8% compared to the CCG and national average of 7%.

  • Performance for mental health related indicators was 90% compared to the CCG and national average of 92%

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice arranged additional mental health services to be provided at the practice, for example, through Birmingham Mind Wellbeing.

  • 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 A&E 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.

People whose circumstances may make them vulnerable

Good

Updated 16 February 2017

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

  • There were longer appointments available for patients with a learning disability. The practice provided a ‘Hospital Passport’, that contained information on things the hospital needed to know about the patient that were important to them t such as their likes and dislikes.
  • The practice maintained a register of patients with learning disabilities, there were 29 patients registered (approximately 0.79% of the practice list).
  • 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.