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Archived: Willow Wood Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willow Wood Surgery on 9 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, caring and responsive services and outstanding for providing effective services. It was also good for providing services for the following population groups older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia).

  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

  • 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.
  • 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.

We saw several areas of outstanding practice including:

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example the practice was part of a CCG supported scheme to reduce the number of hospital attendance and admissions for patients living in residential and nursing homes. Data provided by the GP lead showed from that for year 2011/12 to year 2012/13 there had been a 76% reduction in patients being admitted to hospital from the accident and emergency unit of the local hospital.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice was instrumental in developing an initiative to improve care over the winter months (2014/15) and to reduce hospital admissions. This initiative provided an early intervention scheme to allow patients to be seen at home earlier in the morning and a paediatric centralised clinic to support parents to access GPs and nurses rather than attending accident and emergency departments. The initiative also increased access to GP services around high demand periods such as Easter.
  • The practice had introduced a new system whereby patients hospital discharge summaries were triaged daily by one of the practice nurses with anything that required action referred to the GPs. This system had recently been reviewed and showed that GPs were now reviewing and actioning approximately 40% of the total number of discharge summaries. This allowed them to provide more appointments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 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 patient safety was recorded, monitored, appropriately reviewed and addressed. There were enough staff to keep people safe.

Effective

Outstanding

Updated 13 August 2015

The practice is rated as outstanding for providing effective services. The practice monitored its performance and had systems in place to improve outcomes for patients. The practice carried out a range of clinical audits to evaluate the operation of the service. For example, the initial audit of those patients with atrial fibrillation led to changes in the prescribing practices of the GPs. The second cycle of this audit showed that the practice had improved outcomes for patients and had exceeded the standard set by NICE with regard to the appropriate use of anti-coagulation treatment for patients with atrial fibrillation.

The practice worked effectively with health and social care services to promote patient care. For example the practice was part of a CCG supported scheme to reduce the number of hospital attendance and admissions for patients living in residential and nursing homes. This scheme involved supporting patients and their carers with detailed care plans and the opportunity to meet with the named GP at regular intervals. The scheme also supported GPs to meet with and offer support and education to the nursing home staff to reduce hospital admissions and to support patients to remain at home. Data provided by the GP lead showed from that for year 2011/12 to year 2012/13 there had been a 76% reduction in patients being admitted to hospital from the accident and emergency unit of the local hospital. The scheme had been so successful other practices within the CCG were considering adopting it. A further example was the GP lead was also the Director of the Vale Royal GP Alliance and was instrumental in developing an initiative to improve care over the winter months (2014/15) and to reduce hospital admissions. This initiative provided an early intervention scheme to allow patients to be seen at home earlier in the morning and a paediatric centralised clinic to support parents to access GPs and nurses rather than attending accident and emergency departments. The initiative also increased access to GP services around high demand periods such as Easter. This initiative provided patients with an improved service and provided the local health economy of approximately £381000 of savings.

The practice worked effectively with health and social care services to promote patient care. Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. There was good communication between staff and staff felt appropriately supported. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.

Caring

Good

Updated 13 August 2015

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. There was plenty of supporting information to help patients understand and access the local services available. We also saw that staff treated patients with sensitivity, kindness and respect.

Responsive

Good

Updated 13 August 2015

The practice is rated as good 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. For example GPs attended neighbourhood meetings to ensure they were aware and involved with any issues and initiatives identified within their local area. A further example was the involvement of the practice in the winter initiatives to provide early intervention services during high demand periods and to reduce attendance at A&E departments and the number of hospital admissions.

Well-led

Good

Updated 13 August 2015

The practice is rated as good for providing well led services. There was a clear leadership structure in place. Quality and performance were monitored. Staff told us they could raise concerns, felt they were listened to, felt valued and well supported.

The practice had an active Patient Forum and Patient Participation Group and other systems to seek and act upon feedback from patients.

Checks on specific services

People with long term conditions

Good

Updated 13 August 2015

The practice is rated as good for the care of people with long-term conditions. There were systems in place for call and recall of patients for annual reviews. Patients with long term conditions had alerts placed on their records to ensure they were offered longer appointments with the GP. Patients with multiple problems were able to have all conditions reviewed in one appointment. There was a system in place to ensure that annual blood tests were arranged via the computer system to ensure those patients not attending were identified.

Long term conditions clinics worked to local and national guidelines, and used computerised templates. Queries or concerns from clinics were raised with the GP on the day, and there was an open door approach to sharing problems and learning. Weekly clinical meetings enabled shared problem solving, difficult case review and the discussion and adoption of updated guidelines. Recent examples of this included audits on improving heart failure management and changes to management of atrial fibrillation to reduce stroke risk.

The practice had achieved and implemented the Gold Standards Framework for end of life care. Gold Standards Framework meetings were held alongside multi-disciplinary meetings every month where the needs of patients with terminal illnesses and complex health needs were discussed. Clinical staff spoken with told us that frequent liaison occurred outside these meetings with health and social care professionals in accordance with the needs of patients.

Families, children and young people

Good

Updated 13 August 2015

The practice is rated as good for the care of families, children and young people. All new mothers were sent a letter advising them how to access services for mother and baby. The staff were responsive to parents’ concerns about their child’s health and prioritised appointments for children presenting with an acute illness. There was a system in place to follow up babies who had not been immunised and there was also an escalation procedure to GPs if this remained a concern. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. Regular liaison took place with the health visitor to discuss any children who were at risk of abuse and to review if an appropriate level of GP service had been provided.

Older people

Good

Updated 13 August 2015

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 and had a range of enhanced services. For example The practice was part of a scheme to improve care given to patients living in residential and nursing homes. Highlights of this scheme included once or twice weekly proactive ward rounds at the homes, an extensive care plan which included preferred priorities of care, assessment of capacity, usual health and plans for future care.

The practice had a designated named GP for patients who are 75 and over and care plans were in place for these patients.

The practice was involved in the development of local integrated care teams

Drop in clinics for vaccinations were advertised in the reception for all patients but at risk patients were sent specific letters to advise them of the need to have the vaccination. There was information available to patients about services offered within the local community including those patients who may be experiencing social isolation.

Working age people (including those recently retired and students)

Good

Updated 13 August 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice was open Monday 8am to 8pm and 8am to 6:30pm Tuesday to Friday. The practice offered on the day appointments and telephone consultations. The practice offered on line prescription requests. The practice offered health promotion and screening that reflected the needs for this age group such as smoking cessation, sexual health screening and contraceptive services.

Health checks were offered to patients who were over 45 years of age to promote patient well-being and prevent any health concerns.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 August 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients an annual appointment for a health check and a medication review. The practice referred patients to appropriate services such as psychiatry as needed. Telephone consultations and the triage service provided support to patients suffering from extreme anxiety and phobias.

The practice had information for patients in the waiting areas to inform them of other services available. For example, for patients who may experience depression or those who would benefit from counselling services for bereavement.

People whose circumstances may make them vulnerable

Good

Updated 13 August 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, register of carers was maintained to ensure support needs and appropriate referrals were made or offered. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance in order to ensure the length of the appointment was appropriate. Staff were knowledgeable about safeguarding vulnerable adults. They had access to the practice’s policy and procedures and had received training in this.