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Drs Charlton, Russell, Stevens & Stone Outstanding Also known as Orchard Court Surgery

Inspection Summary


Overall summary & rating

Outstanding

Updated 21 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Court Surgery (Drs Charlton, Russell, Stevens & Stone) on 2 March 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for safe, caring, responsive and for being well led. It was also outstanding for providing services for all the population groups. It was good for providing effective services.

Our key findings across all the areas we inspected were as follows:

  • There were comprehensive systems in place to keep people safe, which took account of current best practice. The whole team was engaged in reviewing and improving safety. There was an open culture in which all safety concerns raised by staff and patients who used services were highly valued as integral to learning and improvement.
  • The practice was proactive to anticipating and managing risks.
  • The team was making use of clinical audit tools, intelligence monitoring tools, appraisals, clinical supervision and staff meetings to assess the performance of the practice and its staff.
  • Staff recognised and respected the totality of patients’ needs. They always took account of patients’ personal, cultural, social and religious needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

  • 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.
  • Patients could access appointments and services in a way and at a time to suit them.
  • The involvement of other organisations and the local community was integral to how services for patients were planned.
  • The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
  • There was a high level of staff satisfaction. Staff were proud of the practice they worked for and spoke highly of the culture.

The practice demonstrated, across all the population groups, elements of outstanding practice. This related to all the domains, primarily in those of safe, caring, responsive and well led. Some examples are detailed below:

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Information about safety was highly valued and was used to promote learning and improvement. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
  • The practice actively promoted diabetic patient education schemes and a locally procured CCG scheme and could demonstrate a high uptake from patients when compared to other practices in the CCG.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, including attendance at multi-disciplinary meetings from the voluntary sector
  • The practice had comprehensive systems in place for managing medicines and audits showed this had had a resulting positive outcome for patients.
  • We were provided with multiple examples which demonstrated the practice’s commitment to work collaboratively with other partners to improve outcomes for people. Examples included the falls prevention team, Darlington Healthy Hub, and the Darlington rehabilitation stroke unit.

  • Staff applied a holistic approach to managing patients. We were provided with multiple examples where staff had supported patients with other aspects of their lives, such as their social life to enhance their health and wellbeing. Staff had sourced activities for patients in their own time and shared this with patients. Patient feedback was aligned to this.
  • The practice actively used local and national data to examine their performance and look for areas where they could improve. For example, the practice had carried out a review following a published national asthma deaths report in 2014 and had taken a number of actions in its local context in response to the themes from the national report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for providing safe services. This practice was safer than other similar practices and was improving consistently. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The practice used every opportunity to learn from internal and external incidents, to support improvement. Information about safety was highly valued and was used to promote learning and improvement. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. The whole team was engaged in reviewing and improving safety and safeguarding systems. There were enough staff to keep patients safe.

Effective

Good

Updated 21 May 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality and nationally. Staff referred to guidance from National Institute for Health and Care Excellence (NICE) and used it routinely. Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. Staff were qualified and had the skills they needed to carry out their roles effectively. They were supported to maintain and further develop their professional skills and experience. Staff worked with multidisciplinary teams and there was evidence there was a coordinated approach to this. Staff were proactive in supporting people to live healthier lives and used every opportunity to identify where their health and wellbeing could be improved.

Caring

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for providing caring services. Data showed that patients rated the practice higher than others for almost all aspects of care. Feedback from patients about their care and treatment was consistently strongly positive. We observed a patient-centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how patient’s lives were enhanced through the caring and supportive actions of staff. Patients’ choices and preferences were valued and acted on.

Responsive

Outstanding

Updated 21 May 2015

The practice is rated as outstanding 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. 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. Staff recognised and respected the totality of patients’ needs. They always took account of patients’ personal, cultural, social and religious 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 with staff and other stakeholders was evident.

Well-led

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for being well-led. The practice had a clear vision with quality and safety as its top priority. High standards were promoted and owned by all practice staff and worked together across all roles. Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. There were comprehensive systems in place to monitor and improve quality and identify risk. Staff were systematic in their approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain value for money. The practice carried out proactive succession planning. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice gathered feedback from patients and it had an active patient participation group (PPG). Staff had received inductions, regular performance reviews and was supported to develop in their career and into new roles.

Checks on specific services

Older people

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for the care of older people. There were aspects of the practice which were outstanding.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people, for example, data showed the uptake of flu vaccinations for the over 65 years was above the national average. 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, in dementia and 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. The practice adopted a holistic approach to the care of patients in this group. This was encouraged by working closely with other services, for example the Council run ‘Responsive Integrated Assessment Care Team’ (Riact) which worked to provides people with support to live independently in their own homes.

People with long term conditions

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for the care of people with long-term conditions. There were aspects of the practice which were outstanding.

The General Practice High Level Indicators (GPHLI) and QOF data showed outcomes for patients in this group were good. Patients were supported by GPs and nursing staff to manage their condition. Appointments were coordinated to help ensure the patient had a seamless pathway between the staff members on the same day, reducing the need for patients to attend on multiple occasions. The practice applied a holistic approach to the management of patients with long-term conditions. Staff encouraged patient self-management when deemed appropriate and patients were seen to have these plans in place for COPD and asthma when patients’ symptoms were exacerbated. Staff supported patients to review inhaler techniques. The practice actively promoted diabetic patient education schemes and a locally procured CCG scheme and could demonstrate a high uptake from patients when compared to other practices in the CCG. The practice followed the gold standards framework for end of life care. It held monthly meetings to discuss those with end stage disease. The meetings were regularly attended by external partners such as community matron, district nurse, McMillan nurse and the hospice.

Families, children and young people

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for the care of families, children and young people. There were aspects of the practice which were outstanding.

The whole team was engaged in safeguarding systems. All staff had received training in safeguarding children and demonstrated an understanding and awareness of their responsibilities to raise safeguarding concerns. They also received training in child sexual exploitation and Clare’s Law. We were provided with examples where staff had raised safeguarding concerns that had been acted on. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice held safeguarding meetings every three months with a high level of attendance from staff within the practice, for example up to five GPs and two nurses. There was evidence of joint working with health visitors, district nurses, school nurses and midwives attending the safeguarding meetings. We saw areas such as ‘looked after children’, high number of A&E attendances and children who did not attend appointments were discussed and actions taken.

The practice had comprehensive systems in place for monitoring and managing children who did not have their immunisations booked or who did not attend their appointment. Immunisation rates were relatively high for all standard childhood immunisations. Systems were also in place for managing the uptake of cervical smears and GPHLI data showed the practice uptake of cervical smears was higher than the national average.

The practice provided a range of contraceptive, pre-conceptual, maternity and child health services with some clinical staff holding specific qualifications in these areas. Systems were in place to check patients with IUS and implants and recall them to the practice. The practice had a designated area on their website for young people which detailed the services available to them at the practice and the Darlington area.

The practice offered combined appointments for mother and baby six week postnatal check with the eight week immunisation to reduce the number of appointments needed at the practice. They also allocated slots so mothers could visit the practice as close to collecting other children from school to again reduce their trips. The practice had systems in place for carrying out incomplete baby registration searches to ensure that babies who were registered at birth elsewhere were followed up for registration at the practice.

Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies.

Working age people (including those recently retired and students)

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for the care of working age people (including those recently retired and students). There were aspects of the practice which were outstanding.

The needs of patients in this population group had been identified. They had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering extended opening hours and online services as well as a full range of health promotion and screening that reflected the needs for this age group.

The practice worked in partnership with the Pathways to Work (PAS) scheme. Patients benefited from an employment support advisor from the Job Centre being available at the practice one day a week. They provided advice on a full range of work related issues. PAS worked directly with Occupational Health Teams. They also accessed weight management advice, smoking cessation support and healthy lifestyle advice through Community Health Trainers. Close links were in place with the counselling services within the practice to build on support they offered. The practice offered NHS Health Checks to all its patients aged 40 to 75 years and patients were passed to the relevant member of staff if any concerns were identified. For example, ECGs and blood tests were carried out immediately at the practice. Practice data showed that 81% of patients in this age group had been checked opportunistically. We were told if any issues were identified at these checks that processes were in place to pass them onto a GP.

People whose circumstances may make them vulnerable

Outstanding

Updated 21 May 2015

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. There were aspects of the practice which were outstanding.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Patients with a learning disability had care plans in place that were regularly reviewed when they had their medicines reviewed. Appointments were arranged to suit the patients’ needs. The staff were aware of their vulnerable patients. We were told of examples whereby patients in vulnerable circumstances had been identified and how staff had intervened to provide help, chased appointments to secondary care and worked in close partnership with other health and social care professionals. This had led to an improved patient experience and outcome.

Data showed outcomes for patients who were deemed vulnerable were good. For example the percentage of patients in the influenza clinical at risk group that received the seasonal vaccination was above the national average

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, including attendance at multi-disciplinary meetings from the voluntary sector. They 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.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 21 May 2015

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

Data from QOF showed the practice performed above the national average in a number of related areas. For example; the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 98% compared to the national average of 86%. GPHLI showed 98% of patients experiencing poor mental health had received a physical health check and 98% of patients had received an assessment for depression. The systems in place for recalls and medication reviews of patients in this group helped facilitate physical health checks for patients.

The practice had a primary mental health link worker and a counsellor who worked out of the practice at certain times. The practice worked in collaboration with the North East Council of Addiction (NECA). They offered facilities for staff from the NECA service to see patients with addictions at the practice if it was felt this would encourage engagement.

A specific health visitor external to the practice supported travellers in the area. We were provided with an example that demonstrated how staff had respected a patient’s situation. They had been creative in overcoming barriers to help a patient receive care.