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Archived: New Hall Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Hall Surgery on 26 January 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.

  • The practice responded and was engaged with notable local groups and stakeholders. For example the Alzheimer’s Society Pilot scheme, local care homes and leading on the confederation of six local practices.

  • 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. Discussions with staff and feedback from patients’ demonstrated staff were highly motivated and were inspired to offer care that was kind, caring and supportive and that met the needs of the population.

  • 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.

  • Leadership was reflective at the practice and involved the whole team in a cohesive way, which provided strong and decisive decision making around patient care.

  • Although already achieving high outcomes in a number of areas, the practice team wished to improve their services and the experience of patients. They actively explored ways in which to do this.

  • 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 named GP was responsible for specialist dementia related conditions and spent a period of time working with local care homes to review patients with a dementia diagnosis; including, medication reviews, health checks and referrals. Feedback from four Care home managers was positive regarding this arrangement and they welcomed the direct support from the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 April 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 14 April 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were above 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 14 April 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 several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Their choices and preferences were valued and where possible acted upon.

  • Discussions with staff and feedback from patients’ demonstrated staff were highly motivated and were inspired to offer care that was kind, caring and supportive and that met the needs of the population.

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

  • Information for patients about the services available was easy to understand and accessible.

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • A large proportion of the patients told us that staff went the extra mile and the care they received exceeded their expectations. For example all carers registered on the system were offered a health check and were registered by the practice to receive further support as required with the Carers Association and Age Concern.

Responsive

Good

Updated 14 April 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.

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

  • There were innovative approaches, to managing appointment systems to ensure patients are able to access care and services quickly and easily. For example one and two hour ring back to patients.

  • 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.

  • The involvement of other organisations and the local community was integral to how services were planned. The practice provided multiple examples of working with other organisations and the local community to demonstrate how the practice offered additional services to the community. For example flu vaccination care home visits, liaison with pharmacies to improve prescribing for care homes and an in house citizen advice service.

Well-led

Good

Updated 14 April 2016

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

  • It 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).

Checks on specific services

People with long term conditions

Good

Updated 14 April 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 good.

  • 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 14 April 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 82.6%, which was 6.8% above the local CCG average and 7.3% above the national average.

  • 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 82.8%, which was 1% above the local CCG average and 1% above the national average. 

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

Older people

Good

Updated 14 April 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.

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

Working age people (including those recently retired and students)

Good

Updated 14 April 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)

Outstanding

Updated 14 April 2016

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

  • Nationally reported data from 2014/2015 showed 84.6% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was 4.7% above the local CCG average and 4.5% above the national average.

  • 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 89.3%. This was 1.1% above the local CCG average and 1% 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. A named GP was responsible for specialist dementia related conditions and spent a period of time working with local care homes to review patients with a dementia diagnosis; including, medication reviews, health checks and referrals. Care home staff felt well supported and welcomed the direct support from GPs.

People whose circumstances may make them vulnerable

Good

Updated 14 April 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.

  • 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.

  • Patients received a two hour call back response time using the practice ring back system and on-call duty GP and a quicker time was available for more vulnerable patient groups.

  • 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.