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Archived: Weelsby View Health Centre - Drs Chalmers and Meier Good

Inspection Summary


Overall summary & rating

Good

Updated 11 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Weelsby View Health Centre, Drs Chalmers and Meier on 19 May 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 generally assessed and managed, with the exception of those relating to employment checks undertaken on clinical staff.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 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 had policies and procedures to govern activity.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvement is:

  • To ensure that all necessary employment checks, or in the absence of an employment check a risk assessment to support the decision, should be undertaken on all clinical staff.

The areas where the provider should make improvement are:

  • To ensure that information for patients, in practice leaflets and on the website, on how they can access services is accurate, consistent and comprehensive. For example including details of the times that late appointments were available on a Monday evening.

  • To ensure that a Patient Participation Group is established.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 11 August 2016

The practice is rated as requires improvement 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, truthful information and a 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.

Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe in the area relating to employment checks. Not all clinical staff had received a Disclosure and Barring Service check and no risk assessment. to support the decision, had been undertaken so the practice could not provide complete assurance that all the clinical staff they employed did not pose any potential risk to patients.  

Effective

Good

Updated 11 August 2016

The practice is rated as good for providing effective services. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly in line with national averages. The practice had lower achievement rates for patients with diabetes who needed to have their cholesterol measured or needed a foot examination. However, the practice told us that there was a problem with the QOF data, following a change to their computer systems, with their exception rates showing as higher than they actually were.

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. There was evidence of appraisals and personal development plans for staff. Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 11 August 2016

The practice is rated as good for providing caring services. Data from the national GP patient survey showed patients rated the practice in line with other practices for some aspects of care including patients having confidence and trust in the last GP they saw and that the last nurse they spoke to was good at treating them with care and concern and involving them in decision about their care. In some areas the practice was rated as slightly lower than other practices, this included patients having enough time with the GP. However, overall 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 11 August 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. For example screening patients for high blood pressure.

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. However, it would be difficult for patients to obtain accurate details of appointment times as the information contained in the practice’s guide to services, the website and NHS Choices was either incomplete or contradictory.

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. 

Well-led

Good

Updated 11 August 2016

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

was to treat all patients, promptly, courteously and in complete confidence. S

taff knew and understood what the practices approach was 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.

However the practice needed to improve the governance arrangements to ensure that all employment checks were undertaken on all clinical staff.

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 sought feedback from staff and patients and had tried to set up a patient participation group but none of their patients volunteered.

Checks on specific services

People with long term conditions

Good

Updated 11 August 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.

Nationally reported data for 2014/2015 showed that the practices performance across a range of diabetes related indicators was similar to the national average for some of the indicators. For example 90% of their patients with diabetes had received an influenza injection compared to the national average of 94%. However, performance was worse than the national averages for the measurement of cholesterol and recording of foot examinations. 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 11 August 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 high number of A&E attendances. 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. Nationally reported data for 2014/2015 showed that the practice was in line with national averages for rates of cervical screening. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 11 August 2016

The practice is rated as good for the care of older people. The GPs in the practice had personal lists and would whenever possible ensure continuity of care with patients seeing the same GP. 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.

Working age people (including those recently retired and students)

Good

Updated 11 August 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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average. Overall the practice performance across a range of mental health related indicators was comparable to the national averages. The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 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 11 August 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 those with a learning disability. It offered longer appointments for patients with a learning disability and regularly worked with other health care professionals in the case management of vulnerable patients. It 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.