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Westerhope Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westerhope Medical Group on 21 October 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.
  • Risks to patients were assessed and well managed. Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
  • 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.
  • 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
  • Demand for appointments was continually monitored and the number of GP appointments increased if necessary. Nurse practitioners had been employed on a locum basis to free up GP appointment time
  • Both the main and branch surgeries had good facilities and were well equipped to treat patients and meet their needs.
  • 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. For example, apologies were issued where complaints had been upheld or errors discovered.

There were areas where the provider should make improvements. The practice should:

  • Take action to ensure confidentiality at the Denton Road branch surgery is maintained by ensuring the computer screen behind the reception desk cannot be seen through the window in the entrance hall.

  • Review the systems in pIace to gain assurance that all cascaded patient safety alerts are acted upon appropriately

  • Review the flooring in use in the treatment room of the main surgery at Stamfordham Road in line with best practice infection prevention and control guidance

  • Repair or replace the carpet on the stairs leading to the upper floor of the Denton Road branch surgery premises. Although patients were not required to use these stairs, the missing carpet and resulting uneven surface could present a slip or trip hazard for staff

  • Ensure updated Legionella risk assessments are completed for the main and Denton Road branch surgeries

  • Review the process currently in place to deal with patients who frequently failed to attend appointments to improve the quality of service and access for others

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services. We found significant events were recorded, investigated and learned from. Appropriate recruitment checks had been carried out for staff including Disclosure and Barring Service (DBS) checks for those who acted as chaperones. There were infection control arrangements in place and all three premises were clean and hygienic. Systems and processes in place for the safe management of medicines were generally good but the practice did not have a process in place to ensure appropriate action had been taken in relation to patient safety alerts. There were also a few premises related issues such as carpet in the treatment room of the main surgery (which presented an infection control risk); missing carpet on one of the stair treads at the Denton Road branch surgery (which could present a slip or trip hazard for staff) and a lack of legionella risk assessments at the main and Denton Road branch surgery.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services. Nationally reported Quality and Outcomes Framework (QOF) data showed the practice had performed well in providing recommended care and treatment to their patients. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included promoting good health, and providing advice and support to patients to help them manage their health and wellbeing. Staff worked with other health care professionals to help ensure patients’ needs were met. There was an effective staff appraisal system and, overall, staff had access to the training they needed to carry out their duties. Staff had completed a variety of clinical audits and used these to improve patient outcomes.

Caring

Good

Updated 21 January 2016

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. Results from the National GP Patient Survey showed patients were satisfied with the quality of the care and treatment they received from their GPs and nurses. During the inspection we saw staff treating patients with kindness and respect, and they maintained patient confidentiality. The only exception to this was that due to the layout of the building at the Denton Road branch surgery and position of the computer screen on the reception desk, the data on the computer screen could easily be seen through a window between the entrance hall and the reception back office area.

Responsive

Good

Updated 21 January 2016

The practice is rated as good for providing responsive services. They reviewed the needs of its local population and engaged with the clinical commissioning group (CCG) in an attempt to secure improvements to services where these were identified. Patients said that it was hard to get through to the surgery by phone and that they experienced difficulty in getting an appointment with a GP. However, they also said urgent appointments were available the same day and that there was continuity of care. The practice was taking action in response to these concerns by monitoring demand and increasing the number of GP appointments as and when possible. They had also installed a semi-automated telephone system with call queuing facility. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 21 January 2016

The practice is rated as good for being well-led. They had a clear vision for the future and staff were clear about their responsibilities in relation to these. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The practice had a patient participation group (PPG) which was active. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 21 January 2016

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

The practice had recently introduced a combined long term condition review for patients with more than one long term condition. The practice computer system was used to flag when patients were due for a review, which was designed to coincide with a patients birthday month. The length of the appointment was adjusted dependent on individual need.

There were lead GPs for common long term conditions such as diabetes, cardiovascular disease and mental health issues and the practice nurses had all received specific training in spirometry, diabetes, asthma, chronic heart disease and chronic obstructive pulmonary disease. The practice held a weekly diabetes clinic.

Longer appointments and home visits were available when needed following triage by a nurse practitioner. The practice actively participated in the CCG ‘Ways to Wellness’ social prescribing initiative which is a service designed to add to a patient’s medical support by supporting patients with a long term conditions to better manage their condition.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma compared to the local CCG average of 96.6% and national average of 97.4%.

Families, children and young people

Good

Updated 21 January 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, such as those subject of child protection plans or at risk of sexual exploitation.

Children’s clinics and immunisations were available across all three sites and immunisation rates were mostly higher than local CCG and national averages. The practice had worked with health visitors to target children requiring pre-school boosters and had managed to ensure that over 90% of relevant children had received these. Nationally reported data showed that the majority of the practice childhood immunisation rates were in line with or above national averages. For example, the meningitis C vaccination had been given to 98.1% of the practices 12 month old population (national average 97.1%); 98.3% of two year olds (national average 95.5%) and 98.9% of five year olds (national average 94.5%).

Antenatal clinics were held on a Tuesday, Wednesday and Friday at the Westerhope surgery and on a Monday at the Blakelaw clinic. Appointments were available outside of school hours and the premises were suitable for children and babies.

The percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80% (national average 82%).

Older people

Good

Updated 21 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. They offered proactive, personalised care to meet the needs of the older people in its population. For example, the practice participated in the direct enhanced service to prevent unplanned admissions to hospital and had been proactive in identifying patients at high risk of hospital admission or re admission. These patients (and their family members and/or carers if requested) were invited to attend an hour long appointment to consider their specific needs, develop care plans and discuss do not resuscitate (DNA CPR) agreements if appropriate.

The practice was responsive to the needs of older people, including offering home visits. Patients over the age of 75 had a named GP.

The practice had developed a red/amber/green (RAG) rated palliative care register and worked well with other multi-agency practitioners to ensure end of life patients were well supported. One of the practice partners was the local clinical commissioning group (CCG) lead for palliative care.

Working age people (including those recently retired and students)

Good

Updated 21 January 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 was proactive in offering online services which included booking appointments and ordering repeat prescriptions. There was a full range of health promotion and screening that reflected the needs for this age group, including a women’s health clinic which covered areas such as diet, smoking and breast awareness. The practice also offered a contraception service which included emergency contraception and the insertion and removal of contraceptive implants.

The practice offered extended opening hours on a Monday and alternate Wednesday/Thursday evenings at two of their surgeries. Telephone consultations were available on request. Minor surgery clinics were available as and when required.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.

Lead GPs had been identified for patients suffering from dementia and mental health conditions and these patients were offered physical health checks. Primary Care psychology staff, including counsellors, low intensity mental health workers, mental health practitioners and psychologists attended the surgery regularly to deliver advice, support and therapy to patients in need of their services.

People whose circumstances may make them vulnerable

Good

Updated 21 January 2016

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

The GPs had received training to help them understand the requirements of the Mental Capacity Act and also on safeguarding adults and domestic violence. Requests for information for multi-agency risk assessment conferences (MARAC), which considered the needs of people at high risk of abuse and/or domestic violence, were dealt with quickly by the GP who knew the patient best and this information was coded and added as an alert to the patient’s computer record.

Patients with a learning disability were offered an annual review which was often carried out as home visits or at later appointments at quieter times as these were considered to be less stressful for the patient.

The practice GPs were experienced in caring for patients where substance misuse was an issue and had a number of patients on withdrawal programmes. The practice worked with a practitioner from the local Drug, Alcohol and Addictions Service, who attended the practice once a month, to support these patients.