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Archived: St Augustines Medical Practice Good

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Inspection Summary


Overall summary & rating

Good

Updated 2 September 2016

Letter from the Chief Inspector of General Practice

In January 2016 a comprehensive inspection of St Augustines Medical Practice was conducted. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good. During that inspection we found concerns related to the management of blank prescription security and the systems in place to monitor this risk. The practice also needed to ensure all action was taken to mitigate risks in relation to fire evacuation procedures. The report setting out the findings of the inspection was published in April 2016. Following the inspection we asked the practice to provide an action plan detailing how they would improve on the areas of concern.

We visited the practice and carried out an announced focused inspection of St Augustines Medical Practice on 10 August 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvement since our last inspection on 27 January 2016. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report of 27 January 2016.

At this inspection we found:

• Risks to patients were assessed and well managed.

• Systems were in place to monitor and ensure the security of blank prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 September 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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. The practice had introduced a new policy and process for management of blank prescriptions and shared this across the practice team.

  • The practice had liaised with the local Fire safety service and introduced a number of improvements to mitigate any risks in relation to fire evacuation procedures and the safety of the premises.

Effective

Good

Updated 26 April 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group. For example:

  • The percentage of patients with diabetes on the register whose blood sugar level targets were within the target range (2014/2015) was 84% which was higher than the national average of 78%.

  • The percentage of patients with diabetes on the register whose blood pressure was in the target range (2014/2015) was 81% which was higher than the national average of 78%.

  • The percentage of patients with diabetes on the register who had their flu immunisation (2014/2015) was 98% which was higher than the national average of 94%.

  • The percentage of patients with high blood pressure whose blood pressure was in the target range was 81% which was in line with the national average of 84%.

  • The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan (2014/2015) was 91% which was higher than the national average of 88%. Patients with a serious mental health problem were all invited to an annual health check.

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

  • The practice held a weekly educational/professional meeting to discuss clinical topics, this had included guest speakers. Topics included new cancer referral guidelines, managing complex patient groups, mindfulness and updates on NICE guidelines. All clinical staff had protected learning time.

Caring

Good

Updated 26 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice in line with the local and national averages for the level of care however patients we spoke to rated their care as excellent 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.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the GPs applied for special dispensation to provide a medicine to a patient from the practice to save multiple visits to hospital.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

  • We observed a strong patient-centred culture.

  • 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 26 April 2016

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 meet patients’ needs.

  • Practice staff 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 had purchased two medical devices for patients with certain lung conditions to save patients having to attend a hospital for diagnosis and monitoring.

  • 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.

  • The practice had reviewed the duty doctor system and divided the day into shorter sessions, to allow the duty doctor to focus on the urgent calls, to share the demand across the GPs. This had resulted in greater availability for urgent home visits throughout the day, for older patients and patients who would benefit from these.

  • 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 26 April 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 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 knowing about 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 focus on continuous learning and improvement at all levels.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

Checks on specific services

People with long term conditions

Good

Updated 26 April 2016

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

  • The practice had a very high prevalence of chronic diseases 63.4% compared to the national average of 54%, for example 70% more than the national average of patients with heart failure, 20% more than the national average of patients with a atrial fibrillation (a heart condition) which for the majority of patients requires regular blood monitoring and 60% more than the national average of patients who have experienced a stroke.

  • Nursing staff had lead roles in chronic disease management and led clinics for patients with lung disease, asthma and diabetes.

  • Patients at risk of hospital admission were identified as a priority and the practice had developed care plans for those at risk of admission for just over 2.2% of their population over the age of 18. One example we saw was a care plan with steps to manage a patient’s chronic lung condition which had helped the patient manage their condition through the winter avoiding a hospital admission.

  • The practice offered an in house test for the diagnosis and monitoring of respiratory conditions (spirometry) at both practice locations which reduced the need for those patients to travel to a hospital. This was also taken to housebound patients to monitor their condition.

  • The percentage of patients with diabetes on the register whose blood sugar level targets were within the target range (2014 to 2015) was 84% which was higher than the national average of 78%.

  • The percentage of patients with diabetes on the register whose blood pressure was in the target range (2014 to 2015) was 81% which was higher than the national average of 78%.

  • The percentage of patients with diabetes on the register who had their flu immunisation (2014 to 2015) was 98% which was higher than the national average of 94%.

  • The percentage of patients with diabetes on the register whose cholesterol was in the target range was 87% which was higher than the national average of 81%.

  • 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. This included weekly meetings with the community and specialist teams including community matrons, health visitors for the actively ageing. The practice met daily with the palliative care nurses and district nurses for those at the end of life.

Families, children and young people

Good

Updated 26 April 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.

  • The percentage of patients with asthma who had their asthma reviewed in the last 12 months (2014 to 2015) was 76% in line with the national average of 75%.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The percentage of patients aged 25 to 64 who had their cervical screening within the last five years was 82% in line with 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, health visitors and school nurses.

  • The practice offered an additional 24 week antenatal check for women to improve continuity of care.

Older people

Good

Updated 26 April 2016

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

  • 27% of the registered practice population were aged over 65 (national average 17%). They also had the highest number of patients in the local clinical commissioning group of patients prescribed anticoagulant medicines which required regular blood tests. The practice had kept 94% of these patients in the target range by testing at the surgery which was significantly higher than the expected standard of 80%.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. 15% of all those aged over 75 had a personalised care plan.

  • The practice looked after approximately 150 patients in local nursing homes, and conducted weekly ward rounds to monitor and review the patient’s needs. In one local nursing home all the patients looked after by the practice had a personalised care plan.

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

Working age people (including those recently retired and students)

Good

Updated 26 April 2016

The practice is rated as good for the care of working-age patients (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 offered a 7.45am blood test appointment for patients who were unable to attend during the traditional working day.

  • The practice offered extended hours on a Monday evening until 8pm and alternate Saturday mornings to increase access outside of traditional working hours.

  • The practice offered a daily triage service so those at work could access care by phone when urgently needed.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 April 2016

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

  • The practice looked after approximately 170 patients with dementia and worked closely with the older persons psychiatric services to care for this group of patients. All the patients with dementia in a nursing home had a personalised care plan to avoid unnecessary hospital admissions as they recognised these patients are distressed by an unfamiliar environment. One of the GPs had specialist knowledge and could undertake memory tests which meant some of these patients did not have to attend a hospital.

  • The practice had developed an electronic template which provided information, on local support groups, support for carers, dementia advice websites, information on lasting power of attorney and prompts to ensure all the appropriate blood tests had been completed.

  • 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

  • The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan (2014 to 2015) was 91% which was higher than the national average of 88%. Patients with a serious mental health problem are all invited to an annual health check.

  • The percentage of patients with a serious mental health problem whose alcohol consumption has been recorded in the preceding 12 months (2014 to 2015) was 94% which was higher than the national average of 90%.

  • 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 arranged for the local eating disorder service based at a local hospital to use a room at the practice to see a patient. The practice had a talking therapies service counsellor based at the practice. The practice had seen one patient on a weekly basis when they would not engage with the specialist mental health team to ensure continued care.

  • The practice would see patients on an opportunistic basis with mental health needs and dementia as they recognised these patients may be unable to engage with the appointment system.

  • 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 26 April 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those socially isolated, who were dependant on others and those with a learning disability.

  • The practice offered longer appointments and yearly health checks for patients with a learning disability, and last year completed 84%. All these patients had a care plan with a copy kept in their home.

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

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held food bank vouchers.

  • 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 had been proactive in undertaking training in increasing awareness and skills for identifying domestic violence in their patients.

  • The practice had set up a system to refer patients who may be socially isolated to groups and local activities which had been shared across the local clinical commissioning group due to its success.