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Newent Doctors Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 19 April 2016

We carried out an announced comprehensive inspection at Newent Doctors Practice on 1 March 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 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.
  • 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. 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. (Duty of Candour is a legal duty to ensure providers are open and transparent with patients who use services. It also sets out specific requirements providers must follow when things go wrong with care and treatment, including informing patients about the incident, providing reasonable support, providing truthful information and an apology when things go wrong).

The areas where the provider should make improvement are:

  • Ensure that appropriate actions are taken following medicines incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 April 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 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. However, one medicines incident had been logged but no actions were taken to ensure a similar incident would not reoccur.The prescribing lead for the practice advised that an appropriate resolution would be identified, shared at practice level and implemented accordingly.

Effective

Good

Updated 19 April 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 for the locality and 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.

  • Practice nurses were all trained in smoking cessation.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 April 2016

The practice is rated as good for providing caring services.

  • 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. The practice leaflet ensured patients were aware of the practice appointment system and clinics that were available.

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

On the day of our inspection we saw many thank you cards and also a ‘heart felt thank you’ letter from a patient to their GP which was published in a local magazine

Responsive

Good

Updated 19 April 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 Clinical Commissioning Group to secure improvements to services where these were identified. For example, a practice nurse conducted an audit to identify whether newly diagnosed type two diabetics were attending structured education programmes when referred to a local hospital within the first nine months of diagnosis. The results showed that 64% of patients were not attending; this prompted the practice nurse to implement an education session within the surgery. Upon re-audit the attendance rate has already risen to 73% with further appointments scheduled throughout March which gives potential for a 96% attendance rate since recommendations have been implemented.

  • 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 a trust fund which paid for counselling support at the surgery for patients that were referred from their GP.

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

Checks on specific services

People with long term conditions

Good

Updated 19 April 2016

The practice is rated as good for the care of patients 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. Both of the nurses leading on diabetes had attended the Warwick training course and a third nurse specialised in stroke and heart disease.

  • Performance for overall diabetes related indicators was 95% which was comparable to the clinical commissioning group (CCG) average of 95% and national average of 89%.

  • 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. The practice held quarterly multidisciplinary meetings with community based staff.

  • Diabetes education was offered in house and audit results identified that this had significantly improved patients attendance levels.

  • To support patients to receive care closer to home the practice offered diabetic eye screening, aneurysm screening, acupuncture and phlebotomy services.

Families, children and young people

Good

Updated 19 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 relatively high for all standard childhood immunisations.

  • 75% of patients with asthma on the register had a review in the last 12 months which was comparable to the national average of 75%.

  • Patients told us children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 85% which was above the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. The practice held child flu clinics during the schools October half term to support high attendance and access rates.

  • We saw positive examples of joint working with midwives, health visitors and school nurses through minutes of monthly multidisciplinary safeguarding meetings.

  • There were district nurses, health visitors and midwives based services located at the practice and a child physiotherapist and a speech and language therapist also held regular clinics at the practice.

Older people

Good

Updated 19 April 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in shingles, influenza and pneumococcal immunisations.

  • The practice participated in the care home enhanced service and provided regular reviews and visits for patients.

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

  • The practice worked together with a local transport provider ‘dial a ride’ to ensure that suitable appointments were available for patients using this service.

  • There were podiatry and physiotherapy services based at the practice to provide services closer to home for older patients.

Working age people (including those recently retired and students)

Good

Updated 19 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 reflects the needs for this age group.

  • The practice offered extended hours appointments for working age patients from 7am to 8am Monday to Friday.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 April 2016

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

  • 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher 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.

  • A mental health nurse and a consultant psychiatrist for the elderly attended the practice to see patients that were referred by their GP.

  • 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 trust fund which paid for counselling support at the surgery for patients that were referred from their GP; this has been running for 20 years.

  • 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. Performance for mental health related indicators was 100% which was above the CCG average of 97% and national average of 82%.

People whose circumstances may make them vulnerable

Good

Updated 19 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 homeless patients, travellers and those with a learning disability.

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

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients and also held quarterly meetings.

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

  • The practice accommodates regular clinics for a consultant psychogeritician, a drug and alcohol team and a community psychiatric nurse.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff was 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 took part in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.