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Dr Henderson and Partners Good Also known as Bassett Road Surgery

Inspection Summary


Overall summary & rating

Good

Updated 20 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Henderson and Partners (also known as Bassett Road Surgery) on 7 April 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 uses various in-house resources such as the complex needs matron and a pharmacist to optimise health outcomes.
  • 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 make an appointment with a GP but sometimes longer 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.
  • 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.

We saw two areas of outstanding practice:

  • The practice understood the needs of patients needing end of life care and homeless people, they had introduced a priority colour coded system that gave immediate access to a GP so their clinical care needs were assessed immediately and outcomes optimised.

  • The practice had identified the care needs of the homeless. In conjunction with local partners the practice supported the delivery of the Homeless Healthcare service for South Bedfordshire which included weekly outreach visits, health checks and meetings with clinical and social care partners to provide for their needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 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.

  • 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.

Effective

Good

Updated 20 June 2016

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 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.

Caring

Good

Updated 20 June 2016

The practice is rated as good 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.

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

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

Responsive

Good

Updated 20 June 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and NHS Bedfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice provided the Homeless Healthcare service for South Bedfordshire in response to the needs of this population.

  • Patients said they found it easy to make an appointment with a GP but sometimes longer 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 20 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 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 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 20 June 2016

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 focused on patients who were at risk of developing long term conditions and on optimising the care of housebound patients, by having a dedicated complex needs matron and an in-house pharmacist to regularly review their care and outcomes.

  • Performance for diabetes related indicators was better than the national average.

  • 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 20 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.

  • 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 comparable to the CCG average of 83% and the national average of 82%.

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

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

Older people

Good

Updated 20 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.

  • All patients over 75 had a named GP.

  • There was a lead GP for each care home aligned to the practice for continuity of care and the practice offered weekly ward rounds at each of the care homes.

  • A complex needs matron supported the implementation of the unplanned admission enhanced service and looked after the care of the most vulnerable patients.

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

  • The PPG in conjunction with local partners had produced a booklet detailing support available locally for the over 75s.

Working age people (including those recently retired and students)

Good

Updated 20 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 offered extended hours on Wednesday mornings (from 7am), Wednesday evenings (until 8pm) and on Saturdays to meet the needs of working age people.

  • The practice was proactive in offering online services such as guidance on benefits, medical certificates, physiotherapy exercises, advice on addiction, diet and screening.

  • The practice offered a full range of health promotion and screening such as smoking cessation clinics, alcohol advisors and aneurysm screening that reflected the needs of this age group.

  • Patients could also access the local Citizens’ Advice Bureau within the practice premises.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 June 2016

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

  • 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

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

  • Staff had good understanding of how to support patients with mental health needs and 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.

  • GPs with expertise in psychiatry and substance misuse were able to offer counselling within consultations.

  • The practice had access to a mental health nurse from the local community NHS trust who worked with the GPs in offering screening referral to other services and signposting to local support groups.

  • The complex needs matron in conjunction with the GP undertook comprehensive initial assessments in the early identification of potential dementia.

  • 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.

  • The effectiveness and appropriateness of polypharmacy (patients receiving multiple medications) were reviewed by the in house pharmacist.

People whose circumstances may make them vulnerable

Good

Updated 20 June 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.

  • The practice supported the delivery of the Homeless Healthcare service for South Bedfordshire which included weekly outreach visits, health checks and meetings with clinical and social care partners to provide for their needs.

  • Homeless patients and patients needing end of life care were given priority access to a GP by the use of coloured card system so their clinical outcomes were always optimised.

  • 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.

  • Carers support was provided by receptionist carer champions, who highlighted local services and other information for carers including through the PPG booklet

  • 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.