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Bowling Highfield Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bowling Hall Medical Practice on 17 November 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. Staff understood their responsibilities to raise concerns and report incidents and near misses.
  • 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.
  • Patients said they could book urgent appointments when they needed to and these were often available the same day.
  • The practice had good facilities and was 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. We found positive working relationships between the staff.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas outstanding practice:

  • The practice had good links with University and led on an undergraduate and post-graduate scheme for nurses to train to become practice nurses.

  • The practice had gained awards from The Royal College of General Practitioners (The Quality Practice Award) and Investors in People.

  • The practice held multi-agency Common Assessment Framework (CAF) meetings at the surgery, a process for recording concerns about a vulnerable child to help identify in the early stages their needs and promote a co-ordinated approach to service provision.

  • The practice worked closely with a charity “Carers Resource” who commented regarding the high level of commitment in the practice towards carers. They had a register of carers at the practice, held information sessions and also had a dedicated carer’s notice board. As a result more patients were supported.

The areas where the provider should make improvement are:

  • The practice should undertake regular second clinical audits cycles to keep people safe, including their minor surgery suite i.e. having done an audit and introduced changes the practice should do a re audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 March 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 learned and shared widely throughout the practice, action was taken to improve safety in the practice and improve patient care.

  • When there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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 service had a dedicated Safeguarding lead who demonstrated a good understanding of the needs of the local population and promoted this within the practice.

  • The practice held multi-agency Common Assessment Framework (CAF) meetings at the surgery, a process for recording concerns about a vulnerable child to help identify in the early stages their needs and promote a co-ordinated approach to service provision.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 3 March 2016

The practice is rated as good for providing effective services.

  • Staff referred to best practice guidance including the National Institute for Health and Care Excellence and used it routinely.

  • Data showed patient outcomes were average for the locality.

  • A holistic multi-disciplinary Long Term Conditions clinic had been introduced to meet patient needs, reducing the need for further additional appointments.

  • 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 well with multidisciplinary teams, to understand and meet the range and complexity of people’s needs.

  • The practice produced a quarterly Patient Newsletter which was developed with input from the PPG.

  • The business manager was involved in local and national groups

  • The practice had developed templates with patients to help them manage conditions such as back pain, headache and sexual health.

Caring

Good

Updated 3 March 2016

The practice is rated as good for providing caring services.

  • 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 also saw that staff treated patients courteously, with kindness and respect, and maintained confidentiality. Staff had recently completed customer care training.

  • The practice worked closely with a local charity “Carers Resource” and actively supported carers.

  • Patient feedback regarding the practice was generally positive; however data showed that patients rated the practice lower than Clinical Commissioning Group (CCG) averages for some aspects of care such as access to appointments.

Responsive

Good

Updated 3 March 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.

  • Patients and staff said urgent appointments were available the same day

  • 96% of patients said that the last appointment they had was convenient.

  • 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice has an active PPG called “Patient Voice”. The members we spoke to were able to give examples of where changes to the practice had been made, following their input.

Well-led

Good

Updated 3 March 2016

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

  • It had a clear vision and strategy as to how it would continue to meet patients’ needs in the future. 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 governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. There were systems in place 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 in place for knowing about notifiable safety incidents

  • The practice proactively sought feedback from staff and patients, which it acted on. The Patient Voice group was active and encouraged.

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

  • The practice is a training practice for both medical and nursing students.

Checks on specific services

People with long term conditions

Good

Updated 3 March 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 practice held a multi-disciplinary Long Term Conditions clinic weekly

  • Outcomes for patients with diabetes were similar to the national average

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 3 March 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

  • The practice were aware of a high number of children on protection plans and multi-agency CAF meetings were held at the surgery.

  • 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 numbers of women attending for cervical screening was in line with national averages.

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

  • The Nurse Practitioner holds a weekly term time clinic at a local boarding school for children who are resident at the school.

  • We saw good examples of joint working with midwives, health visitors and school nurses.

  • The practice ensured that it contacted and supported new parents shortly after the birth of their child.

Older people

Good

Updated 3 March 2016

The practice is rated as good for the care of older people.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was higher than national averages.

  • 100% of patients over 75 who had a fragility fracture since 2012 were treated with an appropriate bone sparing agent. This is recognised as good practice.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

  • We found easy access for those with poor mobility.

  • A large nursing home had recently been built in the area and the practice were proactively working with the home and other GP practices to make sure that the new residents were supported adequately.

  • The practice held a flu clinic in a local pharmacy to improve access for older patients.

  • The practice held Palliative Care Gold Standard meetings involving District Nurses, GP’s and the Macmillan nurse.

Working age people (including those recently retired and students)

Good

Updated 3 March 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 had introduced some online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice offered a text messaging service to remind patients about appointments and consent for this was sought from patients before implementation.

  • The practice offered a late night surgery from 6:30pm-8pm on a Monday.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 March 2016

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

  • 91% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months and 95% of people identified as experiencing poor mental health had an agreed care plan in the last 12 months.

  • Weekly counselling sessions were offered at the practice.

  • 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 about how to access various support groups and voluntary organisations.

  • 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 3 March 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 homeless people, travellers and those with a learning disability

  • It offered longer appointments for people with a learning disability and annual health checks.

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

  • It had told vulnerable patients about how to access various support groups and voluntary organisations.

  • The practice worked closely with a charity “Carers Resource” who commented regarding the high level of commitment in the practice towards carers. They had a register of carers at the practice, held information sessions and also had a dedicated carer’s notice board.

  • 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.