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Inspection Summary


Overall summary & rating

Good

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Healthcare on 6 July 2016. Overall the practice is rated as good.

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

  • There were robust systems in place to monitor and maintain safety in the practice.
  • Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were regarded as opportunities for learning and improving patient care.
  • Patients’ needs were assessed and care delivered in line with best practice guidance.
  • The practice team was well trained and had the skills and experience to deliver effective care and treatment.
  • Patients’ feedback and comment cards described the care as very good and professional. They said that they were treated with kindness, dignity and courtesy. Patients told us that they felt involved in their care and decisions about their treatment.
  • 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 told us that it was easy to make an appointment with a named GP and that they valued the continuity of care. Urgent appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Food vouchers could be issued to vulnerable patients.
  • The practice director had devised a flowchart in conjunction with the GPs to help non-clinical staff to prioritise urgent calls. The flowchart had been adopted by other practices in the locality.
  • The practice was visibly clean and hygienic. There were arrangements for assessing and mitigating the risks from healthcare associated infections.
  • There was a clear leadership structure and staff said that they felt supported by management.
  • 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. For example, the branch surgery now opened on a Friday afternoon in order to improve access as a result of patient suggestions.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

An area of outstanding practice was identified as follows:

  • The practice director and deputy had attended a Food Bank training programme in June 2016, which enabled them to issue food vouchers to patients suffering from food poverty. This service was also available to patients from other practices.

The Practice should make improvements as follows:

  • Continue to proactively identify carers (currently 1%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 August 2016

The practice is rated as good for providing safe services.

  • The system for reporting and recording significant events was effective. Incidents were fully investigated. Staff understood their responsibilities with regard to raising concerns and reporting incidents and near misses.
  • There was an open approach to learning and improving when anything went wrong. Lessons were shared to make sure that action was taken to improve safety in the practice.
  • When things went wrong patients received support, information and a written apology. They were told about any actions to improve processes to prevent a recurrence.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • The practice assessed risks to patients and had systems for managing specific risks such as fire safety, infection control and medical emergencies.
  • There were enough staff on duty to keep patients safe and the practice was clean and tidy.

Effective

Good

Updated 24 August 2016

The practice is rated as good for providing effective services.

  • Patients received care and treatment which took account of National Institute for Health and Care Excellence (NICE) and local guidelines.
  • Data from the Quality and Outcomes Framework (QOF) 2014/15 showed patient outcomes were mostly at or above average compared to the national average.
  • Clinical audits were carried out regularly and the findings used to improve the quality of care.
  • Staff had the skills, knowledge and experience appropriate to their roles to enable them to deliver effective care and treatment.
  • Appraisals were carried out on an annual basis and personal development plans were agreed for all staff.
  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice as average or slightly higher than others for several aspects of care.
  • Patients told us that they were treated with compassion, dignity and respect and that GPs and nurses involved them in decisions about their care and treatment. Views expressed on comment cards aligned with these opinions.
  • Views of external stakeholders were positive about the standard of care provided. For example, the managers of three local care homes said that the GPs were very caring and approachable.
  • Patient information about the services provided by the practice was easy to understand and accessible.
  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 24 August 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 met patients’ needs. For example, the practice had signed up to the local extended hours service, which was funded by the Prime Minister’s Challenge Fund.
  • Patients we spoke with said that they appreciated the continuity of care and that it was easy to make an appointment with a GP. Urgent appointments were available on the same day.
  • Patients could access appointments and services in a way and at a time that was convenient for them.
  • 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. For example, the branch surgery now opened on Friday afternoons, which had improved access.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Food vouchers were available for vulnerable patients suffering from food poverty.
  • There was a clear complaints system, which was easy to understand. We saw that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders as appropriate.

Well-led

Good

Updated 24 August 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 it.
  • There was a clear leadership structure and staff felt supported by management. A comprehensive range of policies and procedures was in place to govern activity and staff knew how to access them.
  • 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 that appropriate action was taken.
  • The practice gathered feedback from staff and patients, which it acted on. There was an active Patient Participation Group (PPG), which influenced practice development. A PPG is a group of patients registered with the practice who worked with the practice team to improve services and the quality of care.
  • There was a comprehensive induction process and there were regular staff meetings. Staff told us that they were encouraged to develop their skills and improve the standard of service delivery.
  •  There was a strong focus on continuous learning and improvement at all levels. For example, staff were expected to attend the monthly educational sessions, which were co-ordinated by the practice director and open to staff from local practices. 
Checks on specific services

People with long term conditions

Good

Updated 24 August 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.
  • 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. Reviews for these patients were organised so that they only had to attend one annual review instead of having a separate review for each long term condition.
  • 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 nursing team provided healthy lifestyle advice (smoking cessation, weight loss) and NHS health checks.
  • An in-house pharmacist carried out reviews of patients with asthma and chronic lung disease, supported by the GP therapeutic lead.
  • Data from the Quality and Outcomes Framework (QOF) achievement for 2014/15 showed that 75% of patients with diabetes had received a recent blood test to indicate their longer term diabetic control was below the highest acceptable level. This was 3% above the Clinical Commissioning Group (CCG) average and 3% above the national average.
  • Data showed that 75% of patients with asthma had their care reviewed within the last 12 months, which was 1% below the CCG average and in line with the national average.
  • The practice clinical team had received additional training in long term care. For example, a GP held a diploma in diabetes care and co-ordinated the care of more complex diabetic patients. 

Families, children and young people

Good

Updated 24 August 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.
  • Same day appointments were offered to all children under the age of five.
  • Cervical screening was 78%, which was 3% below the Clinical Commissioning Group average and 4% below the national average.
  • A range of contraceptive services was available at the practice (including coils and implants). Smears were offered in extended hours, which provided a greater choice for patients who could not attend during the core opening hours.
  • A vasectomy service was provided by a GP, who used to be a partner at the practice.
  • 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.

Older people

Good

Updated 24 August 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. Longer appointments were available if needed.
  • The practice maintained a register for patients who required palliative care. Home visits and rapid access appointments were provided for these patients, who often had complex medical needs.
  • The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
  • Patients who found stairs difficult were able to be seen in consulting rooms on the ground floor.
  • A named GP carried out weekly visits to four local care homes, which provided continuity of care.

Working age people (including those recently retired and students)

Good

Updated 24 August 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 provided continuity of care.
  • Patients could book routine GP appointments online as well as request repeat prescriptions. At the time of the inspection 43% of patients had signed up to use the online services.
  • Telephone appointments could be booked as an alternative to visiting the practice.
  • Text messages were sent to remind patients about appointments.
  • The practice had set up a Facebook page, which was used to keep patients up to date.
  • Patients who had signed up to the Electronic Prescription Service could have prescriptions sent to a pharmacy close to their home or work.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 August 2016

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

  • 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 9% below the CCG average and 11% below the national average. We were told that this was due to a coding error relating to temporary patients in care homes.
  • 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 a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
  • A GP was the mental capacity lead for the practice and 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 24 August 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 homeless people, travellers and those with a learning disability.
  • Vulnerable patients were flagged on the practice’s computer system, so that they were immediately identifiable to staff and could be given an appropriate level of service.
  • The practice had 35 patients on the learning disability register. We saw that 25 had received their 2015/16 review and that eight had declined.
  • Longer appointments were available for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Vulnerable patients and their families were given advice about how to access various support groups and voluntary organisations.
  • The practice director and deputy had attended a training programme to enable them to issue food vouchers to vulnerable patients suffering from food poverty.
  • A GP was the child protection lead for the practice and triaged child referrals for the city.
  • Staff had received training and 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 71 patients as carers, which represented 1% of the practice list.