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Inspection Summary


Overall summary & rating

Good

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Michael Coggan (Otherwise known as Harewood Surgery) on 30 August 2016. We returned on 05 September 2016 to review information unavailable to us during the visit on 30 August 2016. Overall the practice is rated as good.

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

  • Staff members knew how to raise concerns, and report safety incidents. Safety information was recorded and issues identified were shared with staff members.
  • Risks to patients were assessed and documented including those associated with; premises, equipment, medicines, and infection control.
  • Patient care was planned and provided to reflect best practice using recommended current clinical guidance.
  • Patient comments were positive about the practice during the inspection and members of the practice patient participation group told us they were involved with practice development.
  • Information regarding how to complain was available in an easy to read format.
  • Patients told us there were urgent appointments available on the day they were requested.
  • The practice had suitable facilities and equipment to treat patients and meet their health requirement needs.
  • Staff members told us they were supported in their working roles by the practice management and the GPs.
  • The dispensary processes and procedures were found to be appropriate and designed to keep people safe. However the dispensing staff members had limited understanding of the practice’s agreed process for changing medicines after hospital discharge.
  • The practice had identified 18 patients as carer’s and this equated to 0.6% of their patient population.

The areas where the provider should make improvements:

  • Improve and maximise the system used to identify carer’s at the practice.
  • Record verbal complaints and the action taken to resolve them and cascade the learning to staff working at the practice to prevent reoccurrence.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 December 2016

  • The practice is rated as good for providing safe services.
  • There was a system in place to raise concerns, and report safety incidents. Incidents and lessons learned whilst handling them were shared with staff members during practice meetings.
  • When things went wrong patients received an explanation or apology when appropriate.
  • The practice had developed processes to keep people safe and safeguarded from abuse.
  • Risks to patients were assessed and managed, these included premises, equipment, medicines, and infection control.

Dispensary procedures kept people safe. However we found the dispensary staff had limited understanding of the practice process to add/change medication after hospital discharge. The practice immediately implemented a new condition to their process for adding/changing medication after hospital discharge. This change was agreed and documented as understood by all staff members.    

Effective

Good

Updated 23 December 2016

  • The practice is rated as good for providing effective services.
  • Data showed patient outcomes were above average compared with local and national practices.
  • Patient care was planned and provided in a way that reflected best practice and followed recommended current clinical guidance.
  • Staff had the skills, local community knowledge, and experience to deliver effective care and treatment in a primary care environment.
  • Clinical audits undertaken at the practice showed that GPs used the information to improve the service quality and patient outcomes.
  • Arrangements were in place for staff to receive supervision and appraisals.

Contact with multidisciplinary teams supported staff members to understand and meet the varied complexities of people’s needs.

Caring

Good

Updated 23 December 2016

The practice is rated as good for providing caring services.

  • Data from the ‘National GP Patient Survey’ published July 2016 showed patients rated the practice higher than other local and national averages for numerous aspects of care.
  • Patients talked about being treated with compassion, dignity, and respect. Patients also told us they were involved in decisions about their care and treatment.
  • We saw staff members behave to patients with kindness and respect, and maintained patient and information confidentiality.
  • Information for patients about the services available at the practice was easy to understand and accessible.

The practice recognised patients who were carers.,  The number identified was 18, this equated to 0.6% of the practice population. This percentage was  low for a practice of this size.

Responsive

Good

Updated 23 December 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 the Clinical Commissioning Group (CCG) 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. We were also told urgent appointments were available on the same day requested.
  • The practice had good facilities and was well equipped to treat patients and meet their various health needs.
  • Information about how to complain was available in an easy to understand format and evidence showed the practice responded quickly to issues raised.

Well-led

Good

Updated 23 December 2016

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

  • The practice had a clear vision and strategy conveyed in their statement of purpose to deliver high quality care, and promote good outcomes for patients. Staff members knew about the practice vision and their role in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular meetings where changes to governance were discussed.
  • The GPs promoted a culture of openness and honesty, and the practice system regarding notifiable safety incidents, ensured this information was shared with staff members to keep them well informed.
  • The practice sought feedback from staff and patients, which it used to inform development and improvement work. The patient participation group (PPG) actively supported the practice by offering their opinions and advice.
  • There was a strong focus on continuous learning, development of services, and improvement at all levels; this was evidenced in staff records, patient satisfaction and the quality of work.
Checks on specific services

People with long term conditions

Good

Updated 23 December 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 and patients at risk of hospital admission were identified as a priority.

Diabetic quality data from 2014 to 2015 showed:

  • The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c (this is a test that monitors diabetics blood/glucose levels over a period of time) is 64 mmol/mol or less in the preceding 12 months, was 75% (local practices 72% and nationally 78%).
  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 96% (local practices 77% and nationally 78%).

Other services provided by the practice for this population group were:

  • Longer appointments and home visits when needed.
  • A named GP and a structured annual review to check their health and medicine needs were being maintained and met.
  • The named GP of patients with complex needs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice nurses had received specialist training in diabetes, asthma, and chronic obstructive pulmonary disease, to support the GPs manage long term condition patients.
  • There was a practice based blood taking service to support patients in this population group that would struggle to access local hospital blood taking clinics.

Regular drug monitoring searches were undertaken for patients taking high risk medicine and medicines that require extra monitoring. These ensured patients’ conditions could be kept stable when taking these medicines.

Families, children and young people

Good

Updated 23 December 2016

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

  • There were systems in place to follow up children living in disadvantaged circumstances or were at risk, for example, children and young people who had experienced a high number of A&E attendances.
  • Immunisation rates were high for all standard childhood immunisations in comparison with practices locally and nationally.
  • Parents of children we spoke with told us they were treated in an age-appropriate manner; questions were encouraged, and easy to understand language was used during consultations to explain treatment.
  • Patients aged 25-64, attending cervical screening within the target period of 3.5 or 5.5 years coverage was 89% (compared locally 83% and nationally 82%).
  • Appointments were accessible outside school hours.
  • We were told by the practice nurses there was positive joint working with community professionals for patients in this population group.
  • On-line appointments were available for both advanced and on the day appointments.

The practice told us they ensured all babies, children and young people were seen on the day, this included a number of urgent appointments available each afternoon.

Older people

Good

Updated 23 December 2016

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

  • The practice was responsive to the needs of older people, and offered them home visits and urgent appointments when needed.
  • The practice had a long established named list approach and patients had a named GP assigned and knew who they were.
  • A standing agenda item during palliative care meetings was to discuss patients from this population group that staff members felt may be deteriorating. These discussions ensured patients in the final year of their life had patient agreed and documented treatment plans.
  • Senior health checks were booked and offered to patients on an ad hoc basis to maximise the uptake.
  • The premises were wheelchair accessible with a slope to the front door, and two clinical rooms on the ground floor.

There was not a hearing loop system available however one of the reception staff members could use sign language if needed.

Working age people (including those recently retired and students)

Good

Updated 23 December 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 at the practice and they had adjusted the services offered to ensure they were accessible, flexible and provided continuity of care.
  • The practice offered on-line services to support working patients.
  • There was a full range of health promotion and patient screening that reflected the needs of this population group.
  • Although the practice did not offer extended hours, they did offer GP telephone consultations to support working age people; this ensured that anyone who needed a consultation was provided one on the day.
  • Private employment medicals and insurance reports were available, to support patients that required them for work.

The ability to book on-line appointments and request repeat prescription services gave patients access when needed so they could arrange their time around their health requirements.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 December 2016

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

Mental health quality data from 2014 to 2015 showed, the practice performance was higher than the national and local practice averages for example:

  • 93% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (compared with 88% locally and 88% nationally).
  • 95% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months at the practice, (compared with 84% locally and 84% nationally).

Other services provided by the practice for this population group were:

  • Working with multi-disciplinary teams in the case management of patients experiencing poor mental health, and included those with dementia.
  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations such as ‘Health in Mind’ and ‘IAPT’ services.
  • The practice followed up patients who had attended accident and emergency that may have been experiencing poor mental health.
  • Staff had an understanding of how to support patients with mental health needs and dementia.
  • Patients with mental health issues had an appropriate alert placed on their records; this allowed staff members to recognise any extra needs these patients needed.
  • The practice told us they offered patients in this population group on the day appointments to ensure patients in mental health crisis could access a clinician and receive the support they needed.
  • The practice had an area in reception to enable private conversations with patients if they appeared to be distressed.

People whose circumstances may make them vulnerable

Good

Updated 23 December 2016

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

  • The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients. They worked closely with local care homes to provide, treatment planning, and home visits when needed.
  • The practice identified patients living in vulnerable circumstances this included those with a learning disability, homeless people or travellers.
  • There were 11 patients identified by the practice as living with a learning disability and they had all been offered an annual assessment and health check. The practice also offered longer appointments for patients with a learning disability.
  • The practice provided information to vulnerable patients about how to access various support groups and voluntary organisations.

Staff knew how to recognise the signs of abuse in vulnerable adults and children. They were aware of their responsibilities concerning the sharing of information and the documentation of safeguarding concerns. The practice safe guarding policy set out the details about how to contact the relevant local agencies during normal working hours and out of hours for staff members.