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Killamarsh Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JA Sutherland’s practice (Killamarsh Medical Practice) on 14 December 2015. 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, and we saw evidence that learning was applied from events.
  • 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, and clinicians had lead areas of responsibility.
  • Feedback from patients about their care was consistently and strongly positive.
  • 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 GP, and usually this was with a GP of their choice. Routine appointments could often be booked on the day and if not, they were available within two days. Urgent appointments were available the same day, and the practice offered additional appointments on a sit and wait at the end of each morning surgery.
  • The practice offered a minor injuries service and data demonstrated that 28 of 30 patients who had accessed this service since April 2015, had been treated without the need for referral to another unit such as the Accident & Emergency (A&E) department.
  • The practice used clinical audits to review patient care and took action to improve services as a result.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. This was to be enhanced by an extension, including seven new consulting rooms, which was under construction at the time of our inspection.
  • The practice worked well with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice reviewed feedback from patients acted upon it. For example, further to comments made on the NHS Choices website, the practice ensured that a member of the reception team was always placed at the front of the reception desk during opening hours.
  • 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. For example, as part of the extension to the building, the access road would be widened with a footpath to aid patient access from the car park.

We saw two areas of outstanding practice:

  • A community pharmacist visited weekly and worked with the practice and the CCG medicine management technician on a variety of prescribing matters. The pharmacist reviewed spirometry results (spirometry is a test used to help diagnose and monitor some lung conditions by measuring how much air can be expelled in one forced breath) and reviewed patients with diagnosed lung disease for advice and medication reviews. The pharmacist had also audited patients with atrial fibrillation to determine if anti-coagulation therapy was required in line with recognised guidance.Approximately 20-25 patients were seen by the pharmacist each month.

  • The practice employed their own community matron and care co-ordinator who managed patients by developing individualised care plans involving the wider health and social care team. This helped to keep patients safe in their own home (and in care homes), and also facilitated earlier hospital discharges. Alongside the practice’s proactive approach in providing good access to GP appointments, a measurable impact was seen in the lower attendance at out of hours and A&E services, and the lower rates of unplanned hospital admissions for this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 February 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 actions were taken to improve safety in the practice. For example, following the identification of a discrepancy on a prescription, it was noted that medicines had not been updated in accordance with advice from the hospital. This led to a more thorough review of hospital letters to ensure all actions were completed.

  • When there were unintended or unexpected safety incidents, people received support, truthful information, an apology and 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 people safe and safeguarded from abuse.

  • The practice had effective recruitment procedures in place to ensure all staff had the necessary skills and qualifications to perform their roles, and had received the appropriate pre-employment checks.

  • Risks to patients and the public were assessed and well-managed including procedures for infection control and other site-related health and safety matters. Risks to vulnerable patients with complex needs were monitored by multi-disciplinary team meetings to provide holistic care and regular review.

  • Medicines, including vaccines and emergency drugs, were stored safely and appropriately with good systems to monitor and control stock levels.

  • The practice had effective systems in place to deal with medical emergencies.

  • The practice ensured staffing levels were sufficient at all times to respond effectively to patient need.

Effective

Good

Updated 11 February 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality. The practice had achieved an overall figure of 100% for the Quality and Outcomes Framework 2014-15. This was 1.9% above the CCG and 6.5% above the national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance. We saw that the clinical team had just reviewed new NICE guidance on menopause.

  • Clinical audits demonstrated quality improvement, and we saw an example of a full cycle audit that had led to improvements in prescribing and documentation of clinical features for patients with acne.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. GPs had specific areas of interest including diabetes and dermatology, and acted as a resource for their colleagues.

  • A community pharmacist provided weekly input to the practice including the provision of medicine reviews and advice for patients with chronic lung disease.

  • Annual appraisals and personal development plans were in place for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs, in order to deliver care more effectively. For example, the community matron met weekly with the wider health and social care team to plan and oversee care for vulnerable patients. This helped manage the number of unplanned hospital admissions at 77 per 1,000 population compared to a national average of 90.

  • The practice had lower usage of Accident & Emergency (A&E) and out of hours services as a result of good GP access including a minor injuries service.

    Figures for 2014 showed A&E attendance at 219 per 1,000 patients compared to national average of 329. Out of hours attendances for 2014-15 recorded 112 contacts per 1,000 population which was almost 50% lower than the CCG average figure of 214.

Caring

Good

Updated 11 February 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice in line with CCG and national averages in respect of care. For example, 90% said the GP was good at listening to them compared to the CCG average of 92% and the national average of 89%.

  • Patients we spoke with during the inspection and feedback on our comments cards indicated they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.

  • The practice adopted a ‘kid gloves’ approach in dealing with vulnerable patients. This ensured their individual needs were accounted for in circumstances such as late arrival for an appointment.

  • Information for patients about the services available was easy to understand and accessible.

  • We observed that staff treated patients with kindness and respect, and maintained confidentiality.

  • GPs regularly visited end of life patients and were happy to be contacted outside of normal hours by carers and nursing staff to ensure the patient was cared for effectively.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 11 February 2016

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 to secure improvements to services where these were identified. For example, the practice had submitted a successful bid to expand its premises to support its vision for the future, which was in accordance with the CCG’s 21st century model of care to provide services closer to patients.

  • 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. For example, the practice had installed new and improved signage at the entrance of the practice further to comments received from the patient participation group (PPG).
  • People could access appointments and services in a way and at a time that suited them. Urgent and routine appointments were available on the day. All GP appointments were available to book on-line.

  • Comment cards and patients we spoke to during the inspection were very positive about their experience in obtaining a routine appointment. This was reinforced by the national GP survey in July 2015 which found 84% patients described their experience of making an appointment as good. This was in comparison to a CCG average of 76% and a national average of 73%.

  • The practice had good facilities and was well equipped to treat patients and meet their needs, and this would be enhanced further by the extension under construction.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff to improve the quality of service. An example of this included ensuring a receptionist was always available at the front of the reception desk throughout opening hours, in response to comments made on the NHS Choices website.
  • All patients had been allocated an accountable GP to oversee their care.

Well-led

Good

Updated 11 February 2016

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

  • It 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 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 practice sought feedback from staff and patients, which it acted on.

  • The PPG was active and influential in informing practice developments, for example the installation of automatic entrance doors.

  • There was a strong focus on continuous learning and improvement at all levels.

  • All staff had received inductions and had received regular performance reviews, and attended staff meetings. There was a high level of staff satisfaction, and this was supported by low staff turnover.

  • Effective succession planning ensured continuity of service and practice development.

Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

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

  • All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

  • Indicators to measure the impact of the management of diabetes were higher than local and national averages. For example, the percentage of patients on the practice register for diabetes with a record of a foot assessment in the preceding 12 months at 94% was approximately 5% above both local and national averages.

  • A practice nurse provided initiation of insulin for patients with diabetes.

  • Patients with diabetes are referred into the ‘Diabetes and You Programme’ to provide patients with advice and education to help manage their condition.

  • QOF indicators for asthma were higher than CCG and national averages. For example, 86.7%of patients with asthma received a review in the preceding 12 months, compared to the CCG and national averages of 74.2% and 75.3% respectively.

  • 58% patients on the practice long term condition registers had received a structured annual review during 2014-15 to check that their health and medicines needs were being met.

Families, children and young people

Good

Updated 11 February 2016

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

  • Urgent appointments and a walk in service was available every day to accommodate children.

  • 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, or did not attend for planned hospital appointments on more than two occasions. We were informed of examples when practice staff had referred children where safeguarding concerns had been identified. Effective liaison was in place between the practice and the health visiting team.

  • Immunisation rates were relatively high for all standard childhood immunisations. For example, vaccination rates  for children under two years old was 100% compared against a CCG average ranging from 97.8 to 98%.

  • 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’s uptake for the cervical screening programme was 86.1% which was above the CCG average of 83.9% and the national average of 81.8%.

  • A midwife provided services from the surgery. Appointments with the practice nursing team were available outside of school hours, and the premises were suitable for children and babies. A designated children’s play area was sited in the reception.

  • The female GPs provided a service to fit coils and contraceptive implants. This service was provided at short notice and often within the initial consultation.

  • A teenage youth clinic provided access to support with contraception, and chlamydia screening was offered.

Older people

Good

Updated 11 February 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. Care plans were in place for older patients with complex needs.

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

  • The practice provided primary medical services to residents at two local care homes. Managers at these homes were very happy with the level of care provided by the GPs, and described the relationship with the practice as extremely positive. They told us the practice were very responsive and caring, that they accommodated the individual needs of their patients, and that the practice achieved good outcomes for their residents.

  • 80% of over 75s had received an annual health check in the last 12 months.

  • Flu vaccination rates for the over 65s were 85.9% which was higher than the national figure of 73.2%.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages

Working age people (including those recently retired and students)

Good

Updated 11 February 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. This included good access to appointments including telephone consultations.

  • The practice was proactive in offering online services and all GP appointments were offered through the online booking system

  • Health promotion and screening was provided that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

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

  • 89.9% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a CCG average of 83.6% and a national average of 84%

  • The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages, although the rate of exception reporting was generally higher.

  • 100% of patients on the practice’s mental health register had received an annual health check during 2014-15.

  • 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.

  • The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.

  • It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 11 February 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. Homeless people could register with the practice, although there were none listed at the time of our inspection.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients 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.

  • The practice provided good care and support for end of life patients. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team, and a GP informed us that additional visits had been provided at the weekend, or at night if a death certification had been required.

  • The practice adopted an approach that they termed as ‘kid gloves’ for vulnerable patients and carers. This ensured that the practice took a more supportive approach with individuals in recognition of their condition or circumstances. For example, if they were late for their appointment time.

  • The practice had carried out annual health checks for people with a learning disability, and 84% had attended for an annual review during 2014-15. It offered longer appointments for people with a learning disability.