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Inspection Summary


Overall summary & rating

Good

Updated 28 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Nelson Medical Group on 23 November and 7 December 2017 as part of our inspection programme.

At this inspection we found:

  • The practice had clear systems to keep patients safe and safeguarded from abuse.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
  • Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 100% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
  • Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
  • There was a focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.

The one area where the provider should make improvements is:

  • Investigate how the published QOF exception rate data for 2016/2017 is different to that captured on their own systems.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 December 2017

Effective

Good

Updated 28 December 2017

Caring

Good

Updated 28 December 2017

Responsive

Good

Updated 28 December 2017

Well-led

Good

Updated 28 December 2017

Checks on specific services

People with long term conditions

Good

Updated 23 July 2015

The practice is rated as good for the care of patients with long-term conditions.

Nationally reported QOF data for 2013/14 showed the practice had achieved good outcomes in relation to the majority of conditions commonly associated with this population group. For example, they had obtained 100% of the points available to them for providing recommended care and treatment to patients with chronic obstructive pulmonary disease (COPD). This was 0.7 percentage points above the local CCG average and 2.9 points above the England average.

Staff had taken steps to reduce unplanned hospital admissions by improving services for patients with complex healthcare conditions. All the patients on the practice’s long-term conditions registers received healthcare reviews that reflected the severity and complexity of their needs. Clinical staff had the training they needed to provide good outcomes for patients with long-term conditions.

Families, children and young people

Good

Updated 23 July 2015

The practice is rated as good for the care of families, children and young people.

Staff had identified the needs of families, children and young people and put plans in place to meet them. Nationally reported QOF data, for 2013/14 showed the practice had achieved 100% of the total points available to them for providing maternity services and child health surveillance. These achievements were above the England averages (i.e. 0.9 and 1.2 percentage points above respectively) and in line with the local CCG averages.

Systems were in place for identifying and following-up children who were considered to be at risk of harm or neglect. Where comparisons could be made, we found the average percentages for the delivery of childhood immunisations were just below the overall averages for the local CCG. Ante-natal appointments were offered by healthcare professionals attached to the practice and new mothers had access to a baby clinic service. Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 23 July 2015

The practice is rated as good for the care of older patients.

Nationally reported Quality and Outcome Framework (QOF) data for 2013/14 showed the practice had achieved good outcomes in relation to majority of the conditions commonly associated with older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was 0.7 percentage points above the local Clinical Commissioning Group (CCG) average and 2.9 points above the England average.

Staff provided proactive, personalised care to meet the needs of older people. The practice provided a range of enhanced services including, for example, a named GP who was responsible for overseeing the care and treatment received by older patients. Clinical staff had received the training they needed to provide good outcomes for older patients. Staff were responsive to the needs of older patients and offered home visits and access to same-day appointments for those with urgent needs.

Working age people (including those recently retired and students)

Good

Updated 23 July 2015

The practice is rated as good for the population group of working-age patients (including those recently retired and students.)

Staff had identified the needs of the working age and recently retired population and had developed services which met their needs. Nationally reported QOF data for 2013/14 showed patient outcomes relating to the conditions commonly associated with this population group were above the local CCG and England averages. For example, the practice had achieved 100% of the total points available to them for providing care and treatment to patients with cardiovascular disease. This was 4.6 percentage points above the local CCG average and 12 points above the England average.

The practice was proactive in offering on-line services to patients. For example, patients could order repeat prescriptions and book appointments on-line. Health promotion information was available in the waiting area and there were links to self-help information on the practice website. The practice provided additional services such as travel vaccinations and a smoking cessation service. The practice was part of a group of local GP practices that were working in partnership to provide extended hours appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 July 2015

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

Nationally reported QOF data for 2013/14 showed the practice had achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 98.5% of the points available to them for providing recommended care and treatment for patients with mental health needs. This was 2.6 percentage points above the local CCG average and 8.1 points above the England average. They had also received 100% of the points available to them for treating patients with dementia. Again, this was above the local CCG and England averages.

The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests. Where appropriate, care plans had been completed for patients who were on the register. The practice regularly worked with other community healthcare professionals to help ensure patients’ needs were identified, assessed and monitored.

People whose circumstances may make them vulnerable

Good

Updated 23 July 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable.

Systems were in place in place to identify patients, families and children who were at risk or vulnerable. Nationally reported QOF data, for 2013/14, showed the practice had achieved good outcomes for patients with learning disabilities. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with learning disabilities. This was 10.3 percentage points above the local CCG average and 15.9 points above the England average.

Staff worked with relevant community healthcare professionals to help meet the needs of vulnerable patients. They sign-posted vulnerable patients to various support groups and other relevant organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children and took action to protect vulnerable patients. Staff understood their responsibilities regarding the sharing of information, the recording safeguarding concerns and contacting relevant agencies.