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Burn Brae Medical Group Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burn Brae Medical Group on 30 July 2015. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they had a robust patient focussed approach to reviewing the health needs of patients with long term conditions.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • 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
  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw numerous areas of outstanding practice including:

  • The practice made sure all staff had the knowledge and skills to identify and act upon safeguarding concerns. In addition to the training appropriate to their roles, the practice held an annual safeguarding training event to give the staff the opportunity to discuss different safeguarding scenarios and to ensure they were skilled and confident in safeguarding.

  • The practice was innovative and reflective of how they could improve the health outcomes for patients. This was evidenced through the active approach to clinical and other audits, and being at the forefront nationally in the care planning approach for long term conditions. The practice performed higher than local and national averages on a number of the indicators in the Quality Outcomes Framework, including those related to hypertension, mental health, dementia and diabetes mellitus.

  • The practice took patient involvement in health and well-being very seriously. They took an active approach to involving patients in monitoring and improving their health. This was evidenced in the care planning approach for patients with long-term conditions.

  • Following consultation with young people, the practice had implemented a young patient drop in service one afternoon a week, outside school hours, to encourage them to access primary health services. The practice had conducted a further survey to seek young people’s views on what barriers there were to accessing services. To help the practice plan how they could overcome these barriers. The practice developed a leaflet aimed at young people to inform and encourage them about the services offered by the practice. They had achieved accreditation in the ‘You’re Welcome’, the Department of Health ‘Quality criteria for young people friendly health services’.

  • There was strong evidence throughout the practice that team spirit and motivation was high. Of particular note was the general feeling of ‘no one is left behind’ and the emphasis on improving health outcomes for all.

  • There was a strong focus on continuous learning and improvement at all levels within the practice. The practice had an ethos of patient empowerment and this was evident across a number of areas, such as reviewing the health of patients with long-term conditions and engagement with young people.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The practice used every opportunity to learn from internal and external incidents, to support improvement. Information about safety was highly valued and was used to promote learning and improvement. The practice had effective processes in place to safety manage prescribing of medicines. The practice held an annual safeguarding training event to give the staff the opportunity to discuss different safeguarding scenarios and to ensure they were skilled and confident in safeguarding. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.

Effective

Good

Updated 19 November 2015

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 neighbouring practices in the Clinical Commissioning Group. The practice used innovative and proactive methods to improve patient outcomes and it linked with other local providers to share best practice. The practice performed higher than local and national averages on a number of the indicators in the Quality Outcomes Framework, including those related to hypertension, mental health, dementia and diabetes mellitus.

Caring

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for providing caring services. Data showed that patients rated the practice higher than others for almost all aspects of care. Feedback from patients about their care and treatment was consistently and strongly positive. We observed a patient-centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on. Views of external stakeholders were very positive and aligned with our findings.

Responsive

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for providing responsive services. The practice had initiated positive service improvements for its patients that were over and above its contractual obligations. It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG). The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure service improvements where these had been identified.

Patients told us it was easy to get an appointment with a named GP or a GP of choice, there was continuity of care and urgent appointments available on 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for being well-led. It had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. High standards were promoted and owned by all practice staff and teams worked together across all roles. Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. The practice carried out proactive succession planning. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice gathered feedback from patients using new technology, and it had a very active patient participation group (PPG) which influenced practice development.

Checks on specific services

People with long term conditions

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. The practice was at the forefront nationally in the care planning approach for long term conditions and took an approach that supported patient engagement and empowerment in their health outcomes. For those people 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 an annual health fair to promote healthier living, self-management of chronic diseases and minor illnesses and to help patients and the general public better understand the work of the practice. This promoted local organisations to patients which could offer them support.

Families, children and young people

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

The practice had taken action to overcome barriers to young people accessing services, and had achieved accreditation in the ‘You’re Welcome’, the Department of Health ‘Quality criteria for young people friendly health services’.

Older people

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. 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 held a health fair annually to promote healthier living; self-management of chronic diseases and minor illnesses, to help patients and the general public better understand the work of the practice and to help patients to know about local organisations which could offer them support.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. The practice held a register of patients experiencing poor mental health and there was evidence they carried out annual health checks for these patients. The practice regularly worked with the multi-disciplinary teams in case management of people experiencing poor mental health, including those with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. They had systems in place to follow up patients who had attended Accident and Emergency (A&E).

People whose circumstances may make them vulnerable

Outstanding

Updated 19 November 2015

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

There were aspects of the practice which were outstanding and this related to all population groups. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It offered longer appointments for people with a learning disability and had carried out annual health checks by the GP lead in this area.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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.