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Dr SP Hughes and Partners Good

Inspection Summary


Overall summary & rating

Good

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr SP Hughes and Partners on 17 May 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.

  • 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.
  • Practice staff had developed good working relationships with community teams to ensure continuity of care.
  • The practice monitored performance using the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). We saw evidence of progress in performance as a result of regular monitoring and improvement work.
  • 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 treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • There was a clear leadership structure and staff felt supported by management
  • Partners were visible and supported all areas of the practice.
  • The practice had an effective in-house training programme and encouraged staff development.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice worked closely with the patient participation group.
  • The practice had been awarded the Practice Team of the Year Bedfordshire and Hertfordshire for 2016.
  • The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 December 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 learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, an explanation of events 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.
  • The practice maintained effective working relationships with other safeguarding partners such as health visitors.
  • There were appropriate systems in place to protect patients from the risks associated with medicines management and infection control.
  • Risks to patients were assessed and well managed and the practice had a thorough process for carrying out regular risk assessments.

Effective

Good

Updated 2 December 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.
  • Clinical staff were aware of the process used at the practice to obtain patient consent and were knowledgeable on the requirements of the Mental Capacity Act (2005).
  • The practice encouraged patients to attend national screening programmes for cervical, breast and bowel cancer.

Caring

Good

Updated 2 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published July 2016 showed patients rated the practice higher than others for several aspects of care. For example,
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • 93% of patients said the GP was good at listening to them compared to the clinical commissioning group (CCG) and national averages of 87%.
  • 94% of patients said the GP gave them enough time compared to the CCG average of 86% and the national average of 87%.
  • 94% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 94% and the national average of 95%.

  • 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.
  • The practice had identified approximately 1% of patients as carers and was continuing to identify and support carers within their population.

Responsive

Good

Updated 2 December 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 the Bedfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example,
  • the practice offered a range of enhanced services including avoiding unplanned admissions to hospital and minor surgery.
  • 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.
  • 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.
  • Pre-bookable appointments that could be booked up to five weeks in advance, urgent on the day appointments were also available for people that needed them. Appointments could be booked in person, on the telephone, on line or via the practice website.
  • 86% of patients said they could get through easily to the practice by phone higher than the CCG average of 76% and the national average of 73%.
  • Patients were able to receive travel vaccinations available on the NHS as well as those only available privately and the practice had developed an informative leaflet for travellers.

Well-led

Good

Updated 2 December 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision to deliver high quality health care in a responsive, supportive, courteous and cost effective manner with equality for all patients as a focus.
  • 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.
  • Partners took an interest in all areas of the practice and sat in on all departmental 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 practice was engaged with the patient participation group (PPG) and encouraged them to provide feedback on areas of improvement.
  • The practice had been awarded the Practice Team of the Year Bedfordshire and Hertfordshire for 2016.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 2 December 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.
  • Performance for diabetes related indicators was higher than the Bedfordshire Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 86%, where the CCG average was 76% and the national average was 78%.
  • The percentage of patients with hypertension having regular blood pressure tests was 84%, the same as the CCG and national averages of 84%. Exception reporting for this indicator was 2% compared to the CCG and national averages of 4%.
  • 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 multi-disciplinary package of care.
  • Patients with long term conditions were included on the avoidance of unplanned admissions scheme.
  • Some patients had advanced care plans including end of life planning.  

Families, children and young people

Good

Updated 2 December 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 88%, 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.
  • Family planning and contraceptive advice was available.
  • Early morning and late afternoon appointments as well as a number of ‘book on the day’ appointments were available and reception staff were trained to understand the needs of this group.
  • The practice participated in health promotion programmes aimed at reducing sexual health risks including contraception and safe sex advice and screening for sexually transmitted diseases including Chlamydia. The practice provided a wide range of contraception services.
  • The practice held fortnightly childhood immunisation clinics and an eight week baby check, GP clinics for babies were available at the same time. These clinics enabled the teams to offer a multi-disciplinary approach to safeguarding and child health.

Older people

Good

Updated 2 December 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided influenza, pneumonia and shingles vaccinations.
  • All patients in this group had a named GP and the practice recorded information in the patient record regarding next of kin and carers.
  • The practice worked closely with community staff including district nurses and community matrons to support these patients. Monthly multi-disciplinary team (MDT) meetings were held with these staff to discuss frail, housebound and/or elderly patients with complex needs.
  • A medicine delivery service was provided for patients unable to go to the practice dispensary.
  • The surgery adopted a number of measures aimed at helping elderly patients and those with sensory problems. There was an induction hearing loop system in the waiting room and signage was regularly reviewed to ensure that it was clear.
  • There was a drop off point for disabled patients outside the front door at the main surgery and wheelchair access was available. There was also designated disabled parking at the branch surgery.

Working age people (including those recently retired and students)

Good

Updated 2 December 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 reflects the needs for this age group.
  • The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
  • GP appointments were available from 8.00am to 6.00pm and an extended hours service was available until 7pm, twice monthly.
  • The practice provided an online access service for patients which included booking and cancelling appointments, requesting repeat prescriptions, viewing test results and sending messages to the surgery regarding prescriptions. The practice also had a website with links to online services.
  • Smoking cessation clinics were available at the practice and advice or referrals could be carried out to specialist services for weight management.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 December 2016

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

  • 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG and national averages of 84%.
  • Performance for mental health related indicators were otherwise comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 95% where the CCG average was 87% and the national average was 88%.
  • 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 support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended A&E 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.
  • The practice held clinics throughout the year to carry out health checks for this group.
  • There was a lead GP for patients experiencing mental health issues.
  • The practice worked closely with the local Alzheimer’s Society, they also attended the practice annual health evening for patients and the practice flu clinics to offer support.

People whose circumstances may make them vulnerable

Good

Updated 2 December 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 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 support groups and voluntary organisations some of which had rooms within the practice
  • 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.
  • Vulnerable adults were identified and discussed at multi-disciplinary team (MDT) meetings and regular meetings were held with health visitors when vulnerable children were discussed.
  • The practice had a system for recording vulnerable patients on the clinical system
  • The practice held palliative care meetings involving district nurses, community matrons Macmillan nurses, GPs and other local support organisations.
  • The practice had identified 146 patients (approximately 1% of the practice list) as carers. The practice was making continued efforts to identify and support carers in their population.
  • The reception manager was the carers lead.
  • The practice hosted a drug and alcohol worker as well as counsellors and wellbeing workers.