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Buckden and Little Paxton Surgeries Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Irwin, Goodwin and Fargnoli on 17 March 2016. Overall the practice is rated as outstanding.

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.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • 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.
  • Feedback from patients about their care was consistently and strongly positive.
  • 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 that 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 a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, the practice implemented a lymphoedema clinic following patient request. This meant that patients requiring this service did not have to travel to secondary care providers.
  • The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the patient participation group (PPG) notice board.
  • The practice worked alongside the PPG to develop education events for patients. They organised a ‘Dementia Day’ held at the practice, which was well attended and well received by patients. Furthermore, the PPG were in contact with local schools and had a plan in place to present health education sessions. The practice recognised the barriers to engaging with younger patients, and was keen to build positive relationships and promote good health.
  • The practice was innovative and proactive in setting up new services in the area. For instance, the practice promoted exercise programmes to patients identified as at risk of cardiovascular disease at NHS health checks. The senior partner at the practice had organised for a weekly parkrun to take place nearby after recognising the need for local, free of cost exercise groups in the area. We received positive feedback from patients about these services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 May 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 action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 5 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were above average compared to both local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • The practice was at or below the CCG average for emergency admissions, accident and emergency presentations and outpatient referrals.
  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 5 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice higher than others for almost all aspects of care.
  • Feedback from patients about their care and treatment was consistently and strongly positive.
  • The practice was engaged with the Carers’ Prescription Service and had a carers champion within the team, who regularly communicated with the service on behalf of patients who were carers. There was a plan in place for representatives from the Carers’ Prescription Service to present at the practice’s clinical governance meeting in April 2016.
  • 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.
  • Views of external stakeholders about the practice were very positive and aligned with our findings.

Responsive

Outstanding

Updated 5 May 2016

The practice is rated as outstanding 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 (CCG) to secure improvements to services where these were identified. For example, the practice worked with the Local Commissioning Group to set up an anticoagulation service, meaning that patients could receive care closer to home.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the senior partner at the practice organised a local parkrun event to promote exercise to patients identified at NHS health checks.
  • We found many positive examples to demonstrate how patients’ choices and preferences were valued and acted on. For example, the practice implemented a lymphoedema clinic following patient request. This meant that the patient requiring this service did not have to travel to secondary care providers.
  • The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the PPG notice board.
  • 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.
  • 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

Outstanding

Updated 5 May 2016

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

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice had a very engaged PPG which influenced practice development. For example, the practice held a ‘Dementia Day’ following a suggestion from the PPG, which was well attended. Furthermore, the PPG had a plan in place to hold education events at local schools.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff told us they felt empowered to make suggestions and recommendations for practice.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Outstanding

Updated 5 May 2016

The practice is rated as outstanding 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.
  • The practice implemented a lymphoedema clinic following patient request. This meant that the patient requiring this service did not have to travel to secondary care providers.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 100%, which was above the CCG average by 10.5% and above the national average by 10.8%. Exception reporting for these indicators was 13.7%, which was comparable to local and national averages.
  • Longer appointments and home visits were available when needed.
  • All of 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 5 May 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 relatively 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, and we saw evidence to confirm this.
  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82%, which was in line with the national average.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The PPG had a plan in place to hold education events at local schools.

Older people

Good

Updated 5 May 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice looked after older adults living in two local residential homes, with a dedicated doctor assigned to each home to maintain continuity of care.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
  • The practice was at or below the CCG average for emergency admissions, accident and emergency presentations and outpatient referrals.

Working age people (including those recently retired and students)

Outstanding

Updated 5 May 2016

The practice is rated as outstanding 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 reflects the needs for this age group. The senior partner at the practice organised a local parkrun event to promote exercise to patients identified at NHS health checks.
  • Extended hours appointments were available between 6.30pm and 8pm on Mondays.
  • The practice offered in house minor surgery, vasectomy services and dermatology clinics.
  • The practice offered email contact to patients.
  • The practice offered pre-bookable telephone appointments on certain days from 7.30am and from 6.30pm.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 5 May 2016

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

  • 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above both local and national averages.
  • 95% of patients experiencing poor mental health had a comprehensive care plan, which was above the CCG and national averages.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they might have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 5 May 2016

The practice is rated as good for the outstanding 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.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice was engaged with the Carers’ Prescription Service and had a carers champion within the team, who regularly communicated with the service on behalf of patients who were carers. There was a plan in place for the Carers’ Prescription Service to present at the practice’s clinical governance meeting in April 2016.
  • The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the PPG notice board.
  • Local drug and alcohol services held regular clinics at the practice for patients with substance misuse issues.
  • 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.