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Archived: Highfield Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Highfield Surgery on 18 January 2017. Overall the practice is rated as good.

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

  • People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.

  • Risks to patients were comprehensively assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were sufficiently trained and had the appropriate knowledge and experience to effectively deliver care and treatment.

  • Patient outcomes were in line with or above local and national averages.

  • Patients said they were treated with compassion, dignity and respect and that they were suitably involved in their care and decisions about their treatment.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 April 2017

The practice is rated as good for providing safe services.

  • People were protected by comprehensive safety systems and there was a focus on openness, transparency and learning when things went wrong.

  • There was a system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence that events had been consistently recorded, discussed and shared.

  • Practice staff used opportunities to learn from incidents to support improvement.

  • Information about safety was valued and was used to promote learning and improvement, and was shared with outside agencies.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. Risks to patients were identified and dealt with.

  • Arrangements for managing medicines kept patients safe.

Effective

Good

Updated 6 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with regional and national averages. The most recent published results showed that the practice achieved 95% of the total number of points available compared with the clinical commissioning group (CCG) and national averages of 96% and 95% respectively.

  • 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 all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 April 2017

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 all aspects of care. For example, 92% of patients said the last GP they saw or spoke to was good at treating them with care and concern, compared with CCG average of 88% and the national average of 85%. 99% of patients said the last nurse they saw or spoke to was good at treating them with care and concern, compared with the CCG average of 92% and the national average of 91%.

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

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Managers and staff told us they were committed to providing the very best care for patients, and patient feedback aligned with this.

  • Feedback from patients about their care and treatment was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice had measures in place to identify, respond to and support the needs of carers.

Responsive

Good

Updated 6 April 2017

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 CCG to secure improvements to services where these were identified. For example, extended hours appointments were available at evenings and weekends.

  • Home visits were offered for those whose circumstances resulted in difficulty for them to attend the practice premises.

  • There was continuity of care with urgent appointments available the same day.

  • There were longer appointments available for patients who needed them, for example patients with a learning disability, elderly patients, and patients with complex needs.

  • Results from the National GP Patient Survey published during July 2016 showed that patients’ satisfaction with how they could access care and treatment was in line with or above local and national averages.

    85% of patients said they were able to get an appointment to see or speak to someone last time they tried, compared with the CCG average of 88% and the national average of 85%. 92% of patients said the last appointment they got was convenient, compared with the CCG average of 93% and the national average of 92%.

  • 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 6 April 2017

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

  • The practice had a clear vision to deliver high quality care to all patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a range 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 for 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 (PPG) was active.

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

Checks on specific services

People with long term conditions

Good

Updated 6 April 2017

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

  • The practice held registers of those patients 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. We saw that nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

  • Performance for diabetes related indicators was in line with CCG and national averages. For example, 79% of patients with diabetes had a total cholesterol measurement at or under the recommended level, compared with CCG and national averages of 83% and 80% respectively. The practice’s exception reporting rate for this indicator was 6%, compared with the CCG average of 11% and the national average of 13%.

  • Longer appointments and home visits were available when needed.

  • All patients with long-term conditions had a named GP clinical lead.

  • Structured annual reviews were provided to check health and medicine 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 6 April 2017

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

  • There were systems to identify and follow up children who were at risk, for example, children and young people who had a high number of Accident and Emergency (A and 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. We saw evidence to confirm this including care planning.

  • Performance for cervical screening indicators were in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 82%, compared with CCG and national averages also of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

  • We saw positive examples of engagement and joint working with midwives and health visitors.

Older people

Good

Updated 6 April 2017

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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent same-day appointments when needed.

  • Practice staff worked closely with other health care professionals to deliver care to older people, for example community nursing staff.

  • The practice offered enhanced checks for patients aged 75 and above.

  • The practice offered double appointments for older people.

  • The practice directed older people to appropriate support services.

Working age people (including those recently retired and students)

Good

Updated 6 April 2017

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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Patient engagement with online services was high.

  • Appointments were offered to accommodate those unable to attend during normal working hours. For example, extended hours appointments were available evenings and weekends.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 April 2017

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

  • Performance for mental health related indicators was in line with CCG and national averages. For example, the percentage of patients with dementia whose care plan had been reviewed in the 12 months was 95%, compared with CCG and national averages of 85% and 84% respectively. The practice’s exception reporting rate for this indicator was 7%, compared with the CCG average of 6% and the national average of 7%.

  • Patients experiencing poor mental health (including those with dementia) had a care plan in place and were invited to see a GP for a comprehensive review at least once a year.

  • Double appointments were available for those patients with mental health needs or dementia.

  • The practice regularly 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 6 April 2017

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

  • The practice held registers of patients living in vulnerable circumstances.

  • We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.

  • The practice had a dedicated list of patients registered as having a learning disability and had offered health checks for all of these patients. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

  • The practice provided help and support for patients who were carers.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice 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.