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Inspection Summary


Overall summary & rating

Good

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wallace House on 13 April 2016. 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 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.
  • 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.

The areas where the provider should make improvement are:

  • Review and make improvements to the disabled patient toilet facilities provided in line with the requirements of the Equality Act 2010.
  • Continue to monitor and ensure improvement to patient access to appointments and patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 June 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 learnt 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 and 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 1 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average. For example, the practice had achieved 99% of the total number of points available for Chronic Obstructive Pulmonary Disease (COPD) related indicators, compared to 97% locally and 96% nationally.
  • 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.
  • The practice was proactive in ensuring staff learning needs were met.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 1 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey results published on 7 January 2016 showed patients rated the practice in line with others for several aspects of care. For example, 94% of respondents said the last appointment they got was convenient compared to the CCG average of 90% and national average of 92%.
  • The practice offered flexible appointment times based on individual needs.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • 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.
  • The practice held a register of carers with 292 carers identified. There were two nominated Carers’ champion who promoted a carers pack which included information and advice about local support groups and services available.

Responsive

Good

Updated 1 June 2016

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 Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice had participated in the local Clinical Commissioning Group winter resilience scheme, offering additional appointments. This service had given patients the opportunity to attend the practice for emergencies rather than travel to the local Accident and Emergency unit.

  • The practice had good facilities and was well equipped to treat patients and meet their needs across two premises.
  • Urgent appointments were available on the same day and the practice had changed their appointment system in response to patient feedback.
  • 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 1 June 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.
  • 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 was an overarching governance framework which supported the delivery of the strategy and good quality care.
  • The practice 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 in place for identifying 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.
  • There was a strong focus on continuous learning and improvement and the practice worked closely with other practices, a local GP federation and the local Clinical Commissioning Group.

Checks on specific services

People with long term conditions

Good

Updated 1 June 2016

The practice is rated as good 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 overall performance for diabetes related indicators was in line with the CCG and national average. The practice had achieved 84% of the total number of points available, compared to 89% locally and 89% nationally.
  • 78% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the national average of 75%.
  • Longer appointments and home visits were available when needed.
  • All patients with a long-term condition 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 1 June 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 identified as being at possible risk, for example, children and young people who had a high number of Accident and Emergency 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, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 81% which was in line with the national average of 82%.
  • Appointments were available outside of school hours and child immunisation clinics took place at the branch surgery. Facilities at the practice were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 1 June 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
  • Regular visits to three local nursing homes and a specialist dementia unit were carried out by named GPs for continuity of care and emergency visits were also provided when needed. Staff at the specialist dementia unit described the service provided by the practice as very good.

  • The practice had completed 813 health checks for patients aged over 75 since October 2014, which was 73% of this population group.
  • The practice worked closely with a local multidisciplinary team which provided a rapid response service to support people with long term or complex conditions.

Working age people (including those recently retired and students)

Good

Updated 1 June 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.
  • It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
  • Data showed the practice had 60% of patients aged 60 to 69 years screened for bowel cancer, in the last 30 months compared to 60% locally and 58% nationally. The practice had 75% of female patients aged 50 to 70 years screened for breast cancer in the last 36 months compared to 72% locally and 72% nationally.
  • The practice was proactive in offering on line services such as appointment booking and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
  • It offered an appointment reminder text messaging service and appointment times were extended every Tuesday until 8pm and from 8am to 12pm every Saturday.
  • The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 June 2016

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

  • 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was in line with the national average of 84%.
  • Performance for mental health related indicators was above the CCG and national average. The practice had achieved 100% of the total number of points available (with 8% exception reporting), compared to 96% locally (12% exception reporting) and 93% nationally (11% exception reporting).
  • The practice carried out advanced care planning for patients with dementia.
  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
  • 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 may 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

Good

Updated 1 June 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 and had completed 30 out of 66 learning disability health checks since April 2015.

  • It offered longer appointments and annual health checks for people with a learning disability.
  • The practice had a system in place to identify patients with a known disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Vulnerable patients had been told how to access various support groups and voluntary organisations.
  • Staff had received safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.