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Archived: Yardley Wood Health Centre Good

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Inspection Summary


Overall summary & rating

Good

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yardley Wood Health Centre on 10 October 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.
  • There was a clear leadership structure, a strong commitment to teamwork and staff told us they felt valued, informed and involved in improving the service.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 found it easy to use the new GP triage system that had been implemented in July 2016. Patients told us this had made access to an appointment much better and they could always get an urgent appointment the same day. Pre- bookable appointments with a named GP were usually accessible within three weeks.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • The practice should continue to make improvements to the appointment system and access to the practice by telephone in order to improve patient satisfaction rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and staff understood and fulfilled their responsibilities to report concerns. There were some good examples of improvement and learning following significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice. This included taking action in response to patient safety and medicines alerts.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They 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 patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed. However, the practice had not risk assessed the need for non-clinical staff who acted as chaperones to have an appropriate disclosure and barring service check.

Effective

Good

Updated 13 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated some 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice.

Caring

Good

Updated 13 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than other or similar to 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.

  • 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 patient and information confidentiality.

  • The practice had improved the bereavement support they provided to their patients and families as a result of learning from a significant event to prevent any reoccurrence. This demonstrated a caring, patient focused culture.

  • The practice had identified that 3% of their registered patients were also carers and supported them accordingly.

Responsive

Good

Updated 13 February 2017

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example the practice provided an anticoagulation service to its patients and patients registered at some other local practices which meant patients did not need to travel to a hospital for this service.

  • There were innovative approaches to providing integrated patient-centred care. The practice manager and a GP led on the local ACE project which took a proactive approach to supporting the health needs of older patients.

  • 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. For example, the GP triage system was implemented in July 2016 and pre-bookable appointments were made available from 7am for working age patients.
  • Patients could access appointments and services in a way and at a time that suited them. For example, for non-urgent issues, patients completed an online request to have a health question answered by a GP; triage appointments were bookable online during the evening for next day call backs.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 13 February 2017

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 it.

  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

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

Checks on specific services

People with long term conditions

Good

Updated 13 February 2017

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 provided active management and support to patients taking long term anticoagulation medicines. This extended to a number of patients registered at other practices in the local area.

  • Performance for diabetes related indicators was similar to national average scoring 85%. This was 6% below CCG and 5% below national average scores.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients 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 13 February 2017

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.

  • 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 practice’s uptake for the cervical screening programme was 81% which was similar to the CCG average of 84% and the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies and included a baby room where parents could talk with health professionals or other parents while their children played.

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

Older people

Good

Updated 13 February 2017

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 in partnership with other health and social care professionals.

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

  • Twice weekly ward rounds were completed at a local nursing home that was supported by the practice. This enabled proactive management of patient’s needs.

  • Two members of the management team led a local pilot project (ACE). The scheme was aimed at older people who had not had contact with their practice for 12 months or lived alone. A community team visited and completed a full health assessment. Results were shared with the GP for further action.

Working age people (including those recently retired and students)

Good

Updated 13 February 2017

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 reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 February 2017

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

  • According to the quality and outcomes framework results for 2015/2016, 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This compared to 84% CCG and a national average of 84%.

  • The overall performance for mental health related indicators was slightly better than average scoring 89%. This was 2% lower than CCG and 3% lower than national average scores.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice 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.

  • 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 patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 13 February 2017

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.

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

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed 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.

  • The practice used a special coding system on the patient records system. This alerted staff that the appointment should not be cancelled. For example if the patient was a carer or required the appointment to receive test results.
  • The practice had identified that 3% of their registered patients were also carers and provided then with appropriate support.