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Hillsprings Health and Wellbeing Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 10 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillsprings Health and Wellbeing Centre (known as Hillsprings Surgery) on 22 March 2016. The overall rating for the practice was Requires Improvement. We found two breaches of legal requirements and as a result we issued a warning notice in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment

We also issued a requirement notice in relation to:

  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance

We undertook an announced focused inspection on 31 August 2016 to follow up on the warning notices. We found that the provider met legal requirements in relation to Regulation 12.

Both the full comprehensive report on the March 2016 and the focused inspection on 31 August 2016 can be found by selecting the ‘all reports’ link for Hillsprings Health and Wellbeing Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 6 April 2017. Overall the practice is now rated as good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they had been offered an appointment on the day they contacted the practice. Urgent appointments and pre-bookable appointments were also available.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas practice where the provider should make improvements:

  • Ensure that patient records demonstrate that high risk medicines are being prescribed safely.
  • Formalise and record clinical supervision which takes place between the nurse practitioner and GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 May 2017

The practice is rated as good for providing safe services.

  • The practice had made improvements to the process for recording, investigating and learning from incidents that may affect patient safety.
  • The practice had made improvements to the systems, processes and practices in place to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 10 May 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the national average. The practice had improved the clinical exception rate for 2015/2016 to 16.3% (down from 17.1% for 2014/2015).
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of up to date 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.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 10 May 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others for several aspects of care.
  • Comment cards we reviewed showed that 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 accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 10 May 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. The practice had been involved in projects to reduce hospital admission for patients with chronic lung conditions and care of patients with heart conditions that may lead to strokes.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with said they had been offered an appointment the same day as contacting the practice. Urgent appointments were available the same day as well as pre-bookable appointments.
  • One comment card indicated that the availability of appointments had improved recently, although three others mentioned the challenges of getting through to the practice by phone.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and evidence from 15 examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 May 2017

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. They told that communication had improved, especially through the meeting structure and minutes of meetings. Staff said they felt more involved and aware of what was happening within the practice.
  • The practice had policies and procedures to govern activity.
  • There have been improvements in the governance processes within the practice. The practice had a governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

People with long term conditions

Good

Updated 10 May 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 87% compared with the CCG and national average of 77%.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • Patients were offered a structured annual review to check their health and medicines needs were being met. The practice had a structured system for inviting patients for their review or identifying patients who did not attend.
  • 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 10 May 2017

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

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Older people

Good

Updated 10 May 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided a service to patients in four care homes and carried out regularly weekly visits. The same GP visited to provide continuity of care.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients on the hospital admission avoidance register when discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Working age people (including those recently retired and students)

Good

Updated 10 May 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • 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.
  • Patients could book appointments up to three weeks in advance.
  • The practice offered all patients aged 40 to 75 years old a health check with the nursing team.
  • The practice offered a range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 May 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
  • Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients experiencing agreed care plan documented in the preceding 12 months was 96%
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 10 May 2017

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 and those with a learning disability.
  • The practice provided as service to two local care homes for people with a learning disability. The nurse practitioner worked closely with the services and provided home visits and offered an annual review of their medication and physical health needs, with guidance from the designated GP clinical lead.
  • The practice offered longer appointments for patients with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.