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Inspection Summary


Overall summary & rating

Good

Updated 15 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashville Medical centre on 20 January 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.
  • 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 that 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.
  • There was a clear leadership structure and staff felt supported by management. 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.

The areas where the provider should make improvement are:

  • Ensure regular staff meetings are held.

  • Review the practices opening hours in light of patient feedback in the GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 April 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • 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.

Effective

Good

Updated 15 April 2016

The practice is rated good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients. The practice computers had links to clinical guidelines and had developed protocols and templates for long term conditions.

  • Data showed that the practice performance was better than neighbouring practices in the Clinical Commissioning Group.

  • The practice met with other local providers to share best practice

    .

Caring

Good

Updated 15 April 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.

Responsive

Good

Updated 15 April 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 Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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.

  • 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.

Well-led

Good

Updated 15 April 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 this.

  • 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.

  • 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 knowing about 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 participation group was active.

Checks on specific services

People with long term conditions

Good

Updated 15 April 2016

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

  • The practice was pro-actively managing patients with long term conditions (LTC). The practice nurse was the lead on managing patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma. Annual reviews and spirometry for patients with COPD were carried out. Patients with COPD were all given self-management plans and had ‘rescue antibiotics’ and oral steroids at home. Patients had guidance on how and when to use them.

  • Services such as spirometry, phlebotomy, ABPM and anticoagulation management service were carried out at the practice.

  • The practice had scored 97.2% on the recent QOF report for diabetes which was above the CCG average.

  • 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 15 April 2016

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

  • Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. For example, they would refer families for additional support and had multidisciplinary meetings with health visitors where any safeguarding concerns would be discussed.

  • 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 triaged all requests for appointments on the day for all children when their parent requested the child be seen for urgent medical matters, thus were able to offer appointments at a mutually convenient times, for example after school, when appropriate

  • We saw positive examples of joint working with midwives, health visitors and school nurses. Monthly meetings were held, however

    health visitors were based relatively close to the practice which allowed them to discuss any concerns they had immediately.

Older people

Good

Updated 15 April 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.

    Patients over 75 years had a named GP to co-ordinate their care.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs

Working age people (including those recently retired and students)

Good

Updated 15 April 2016

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

  • The practice offered working age patients access to extended appointments three times a week

    .

    They also had GP telephone triage for all requests for same day appointments, which enabled telephone consultations where appropriate, without patients having to take time off work

    .

  • They offered

    on-line services which included appointment management, viewing patient records,

    repeat prescriptions

    and registration.

  • Patients had access to NHS health checks for people aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified

    .

People experiencing poor mental health (including people with dementia)

Good

Updated 15 April 2016

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

  • The practice had a register of patients experiencing poor mental health. These patients were invited to attend annual physical health checks and all 55 had been reviewed in the last 12 months.

  • There was a primary care mental health worker (PCMH) based at the practice one day a week, whose role included supporting patients with mental illness transfer from secondary care back to primary care. GPs could also refer new patients to them.

  • There were monthly reviews of all patients being seen by the PCMH worker with the lead GP

  • Reception staff we spoke with were aware of signs to recognise for patients in crisis and to have them urgently assessed by a GP if presented.

  • The practice had achieved 100% of the latest QOF points for patients with Dementia which was above both CCG and national averages.

  • The practice had annual reviews for patients with dementia, which included early consideration of advance care planning and discussing power of attorney issues. All dementia patients had a care plan which both they and carers had been involved in drafting.

  • Dementia friendly training had been arranged for all staff at the practice.

People whose circumstances may make them vulnerable

Good

Updated 15 April 2016

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

  • The GPs told us that patients whose circumstances may make them vulnerable such as people with learning disabilities and homeless patients, were coded on appropriate registers.

  • These patients had ‘pop ups’ on their computer notes to alert all members of staff of vulnerable patients. GPs told us this was to allow them to meet their specific additional needs such as double appointments, interpreter, visual/hearing impaired, carer details, and risk assessment stratification.
  • Patients with learning disabilities were invited annually for a specific review with their named GP. We saw all ten on the register had reviews carried out in the last 12 months.