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Hessle Grange Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 16 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hessle Grange Medical Practice on 17 & 18 February 2016. 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they were able to get same day appointments however some patients told us it could be difficult to make appointments. GPs had ‘personal lists’ providing all patients with a named GP and continuity of care.
  • 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Ensure there is an audit trail of blank prescriptions forms.

  • Ensure the practice has a written strategy and supporting business plan which outlines their vision and plans for the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 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 were shared to make sure action was taken to improve safety in the practice.

  • Patients affected by significant events received a timely apology and were told about actions taken 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 16 June 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were comparable to the local CCG and national average.

  • 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 staff.

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

Caring

Good

Updated 16 June 2016

The practice is rated as good for providing caring services.

  • Data from the national survey showed that 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. We observed a patient-centred culture.

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

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

Responsive

Good

Updated 16 June 2016

The practice is rated as good for providing responsive services.

  • The practice 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 worked with the CCG and the community staff to identify their patients who were at high risk of attending accident and emergency (A/E) or having an unplanned admission to hospital. Care plans were developed to reduce the risk of unplanned admission or A/E attendances.

  • Patients said urgent appointments were available the same day however it could be difficult to get appointments particularly in advance. There was continuity of care.

  • Telephone consultations were available for working patients who could not attend during surgery hours or for those whose problem could be dealt with on the phone.
  • 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.

Well-led

Good

Updated 16 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. 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.

  • 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.

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

Checks on specific services

Older people

Good

Updated 16 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. Patients over the age of 75 had a named GP.

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

  • Nationally reported data for 2014/2015 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 1.9% above the local CCG average and 2.1% above the England average.

  • The practice was delivering ‘The Care Home Scheme’. This ensured patients living in care homes had structured annual reviews which included a review of medication by a pharmacist, review of clinical care and advanced care planning.

People with long term conditions

Good

Updated 16 June 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. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 78.3%. This was 3.8% below the local CCG average and 2.2% below the England average.

  • Longer appointments and home visits were available when needed.

  • Patients with LTCs 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 GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 16 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 who were at risk. For example, children and young people who had a high number of A&E attendances or who failed to attend hospital appointments.

  • Immunisation rates were high for all standard childhood immunisations. For example, rates for all immunisations given to children aged 12 months, 24 months and five years were 95% or above.

  • 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 85.8%. This was 0.9% above the local CCG average and 4% above the England average.

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

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

    The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

  • Relationship counselling services were held weekly in the practice.
  • One patient told us during a difficult pregnancy they had always received excellent care from the practice.
  • There was a young person’s confidentiality policy and information was available on how to access contraception and sexually transmitted disease services.

Working age people (including those recently retired and students)

Good

Updated 16 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.

  • 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.

  • Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

People whose circumstances may make them vulnerable

Good

Updated 16 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

  • The practice offered longer appointments for people with a learning disability.

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

  • The practice 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.

  • Telephone interpretation services were available and information leaflets in different languages were provided when required.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 June 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 80.5% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was 3.7% below the local CCG average and 3.5% below the England 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 66.7%. This was 24.2% below the local CCG average and 21.6% below the England 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 carried out advanced 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.

  • 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 people with mental health needs and dementia.