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Rock Healthcare Limited Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rock Healthcare on 14 May 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be good for providing safe, effective and caring services. We found it to be outstanding for being responsive and well led. It was also outstanding for providing services for all the population groups that we assess.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they usually found it easy to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had very good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

The areas where the provider should make improvements are:

  • The practice should introduce a documented “cold chain” policy to ensure the safety of temperature sensitive medication.

We saw several areas of outstanding practice including:

  • The practice had increased the flexibility of access to appointments and use of co-located services and could demonstrate the impact of this by reduced use of the out of hours service and very positive patient survey results. The practice provided appointments between 8am and 8pm 365 days a year.
  • The practice had a very good skill mix which included advanced nurse practitioners (ANPs) and was able to see a broader range of patients than practice nurses.
  • The practice had continually reached out to the local community by approaching local bail hostels and centres for the treatment of addiction and ensured anyone attending the practice would be seen by a clinician even if they were not a registered patient.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 August 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough suitably trained staff to keep patients safe.

Effective

Good

Updated 20 August 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked effectively with multidisciplinary teams and other services.

Caring

Good

Updated 20 August 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for most 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 to help patients understand the services available was easy to understand. Information to support patients’ conditions was produced electronically on an individual basis. We also saw that staff treated patients with kindness and respect and maintained confidentiality.

Responsive

Outstanding

Updated 20 August 2015

The practice is rated as outstanding for providing responsive services. It 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. The practice was proactive in initiating and becoming part of local projects to improve outcomes for patients. Patients said they usually found it easy to make an appointment with a GP or nurse and that there was continuity of care, with urgent appointments available the same day. The practice had very 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 that the practice responded quickly to issues raised. There was evidence of learning from complaints with staff and other stakeholders.

Well-led

Outstanding

Updated 20 August 2015

The practice is rated as outstanding for providing well-led services. The practice had a clear vision with quality and safety and care as its top priorities. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. High standards were promoted and owned by all practice staff and teams worked together across all roles. Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. The practice carried out proactive succession planning and initiated new projects to improve patient outcomes. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice gathered feedback from patients using new technology, and it was working to re–establish its patient participation group (PPG).

Checks on specific services

People with long term conditions

Outstanding

Updated 20 August 2015

The practice is rated as outstanding for the care of people with long-term conditions. Clinical 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. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Self-empowerment was promoted so that patients could be more involved in their own health management and improvement.

Families, children and young people

Outstanding

Updated 20 August 2015

The practice is rated as outstanding 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. Immunisation rates were 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. Appointments were available outside of school hours and at weekends, with a location based midwife service being available. We saw good examples of joint working with health visitors and outreach clinics.

Older people

Outstanding

Updated 20 August 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice successfully gained additional finance to undertake multi-agency work to improve the quality of care for older people.

Working age people (including those recently retired and students)

Outstanding

Updated 20 August 2015

The practice is rated as outstanding 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 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.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 20 August 2015

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia and GP demonstrated sound knowledge around patients who lacked capacity to make their own decisions.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia and patients are referred to a memory assessment clinic when appropriate.

People whose circumstances may make them vulnerable

Outstanding

Updated 20 August 2015

The practice is rated as outstanding 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, asylum seekers and those with a learning disability. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.