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Inspection Summary


Overall summary & rating

Good

Updated 25 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Goodheart Surgery on 22 March 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.
  • 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.
  • 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. This means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

We saw some areas of outstanding practice including:

  • A palliative care coordinator was responsible for all aspects of communication and support for patients on their list. The palliative care coordinator also liaised with other agencies in the locality to arrange supported respite care for patients and family members. Staff had attended funerals of patients that had passed away to support direct family members and their relatives.

  • The practice had developed a support plan called ‘caring hands’. This included sections for palliative patients and patients with learning disabilities to identify their specific needs for example; ‘what’s important to me’, ‘how best to support me’ and ‘what does a good and bad day look like for me’. This allowed the practice to keep an on-going record of patient’s direct and changing health care support needs.

  • The practice had developed ‘language cards’. These were available in different nationality formats with a patient’s own nationality flag to identify them and had common health related questions for the patient to identify.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 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, people received reasonable support, truthful information, a verbal and written apology and 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 people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 25 May 2016

The practice is rated as good for providing effective services.

  • Some data showed patient outcomes were below average for the locality.

  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 25 May 2016

The practice is rated as outstanding for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care.

    • 90% said the GP gave them enough time compared to the CCG average of 84% and national average of 87%.

    • 97% said they had confidence and trust in the last GP they saw compared to the CCG average of 94% and national average of 95%.

    • 100% said they had confidence and trust in the last nurse they saw compared to the CCG average of 97% and national average of 97%.

    • 90% said they found the receptionists at the practice helpful compared to the CCG average of 85% and national average of 87%.

  • Feedback from patients about their care and treatment was consistently and strongly positive.

  • We observed a strong patient-centred culture.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, staff attended patients’ funeral services to support families and we saw records that the practice had developed a support plan called ‘caring hands’. .

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 25 May 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 (CCG) to secure improvements to services where these were identified. The practice worked with the CCG and the community professionals to identify their patients who were at high risk of attending accident and emergency or having an unplanned admission to hospital.

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

  • 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.

  • 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.

Well-led

Good

Updated 25 May 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. 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. 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 in place for knowing about notifiable safety incidents

  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group (PPG).

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

Checks on specific services

People with long term conditions

Good

Updated 25 May 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were generally good. However, performance for diabetes related indicators was 84.5%; this was 4.5% below the local CCG average and 4.7% below the national average. The practice had taken remedial action to improve the score by implementing a system that identified patients who required a review.

  • 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 25 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.

  • Nationally reported data from 2014/2015 showed patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 70.5%, which was 5.3% below the local CCG average and 4.8% below the national average.  The practice had taken remedial action to improve the score by implementing a system that identified patients who required a review.

  • 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.

  • Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 88%, which was 6.2% above the local CCG average and 6.2% above the national average.  

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

Older people

Good

Updated 25 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 offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example end of life care.

  • It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs. For example housebound patients were visited by the nurse and health care assistant as often as required.

  • The practice had care plans in place for 4.9% of their population. This had benefited frail elderly patients who wished to remain in their own home.

  • Almost a quarter of the patient list size was over the age of 65 years and contributed to the majority of patient consultation time.

  • The practice had implemented care plans for dementia care patients and double appointments were allocated for a more in depth review to take place.

  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Data showed the uptake of flu vaccinations for the over 65 years was above the national average.

Working age people (including those recently retired and students)

Good

Updated 25 May 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 as well as a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 May 2016

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

  • Nationally reported data from 2014/2015 showed 77.8% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was 7.7% below the local CCG average and 6.2% below the national average.  The practice had taken remedial action to improve the score by implementing a system that identified patients who required a review.

  • Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record, in the preceding 12 months was 95.3%. This was 7.1% above the local CCG average and 7% above the national average.  

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

  • 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

Outstanding

Updated 25 May 2016

The practice is rated as outstanding 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.

  • 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.

  • 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.

  • A palliative care coordinator was responsible for all aspects of communication and support for patients on their list. The palliative care coordinator also liaised with other agencies in the locality to arrange supported respite care for patients and family members. Staff had attended funerals of patients that had passed away to support direct family members and their relatives.