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Inspection Summary


Overall summary & rating

Good

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eskdaill Medical on 09 February 2016. Overall the practice is rated as good.

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

  • The practice had a clear vision and had recognised the needs of patients in the community it served.

  • The partners had worked constructively to instil an open and transparent approach to safety. A clear system, which was made known to all staff, was in place for reporting and recording significant events.

  • Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff, undertook regular clinical reviews and followed up-to-date medicines management protocols.

  • We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were encouraged to access training to ensure they had the skills, knowledge and experience to deliver effective care and treatment.

  • Feedback from patients was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the 25 completed CQC comment cards confirmed these views.

  • Results from the GP Patient Survey July 2015 were generally positive, with some outcomes higher than local and national outcomes. For example, 80% of patients would recommend the practice to someone new to the area, which was above the local and national averages.

  • Information about services and how to complain or provide feedback was available in the waiting area and published on the practice website. Where appropriate improvements were made to the quality of care as a result of complaints and concerns. Outcomes from complaints were shared and learning opportunities identified as appropriate.

  • Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP. 75% of patients described their experience of making an appointment as good, which was higher than local and national averages.

  • The practice shared a purpose built, modern building with other care providers. They had access to good facilities and modern equipment in order to treat patients and meet their needs.

  • There was a clear leadership structure and we noted there was positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management.

  • The practice proactively sought feedback from staff and patients in a variety of ways, which it acted on.

  • The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff understood their responsibilities to raise concerns and to report incidents or ‘near misses’. The GP partners and managers encouraged staff involvement.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected incidents patients received support, information and an apology as appropriate to the circumstances. The practice put steps in place to identify learning and changes to processes to avoid a possible repeat incident.
  • The practice had well established systems in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. For example, this included arrangements for monitoring standards of infection prevention, the safety and security arrangements in place for the management and issuing of prescriptions and medicines.

Effective

Good

Updated 26 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed the practice had performed well, obtaining 99% of the total points available to them, for providing recommended care and treatment to their patients. This outcome was higher than the average scores across England.
  • Staff referred to guidance from the National Institute for Health and Care and Excellence (NICE) and used it as required to assess and deliver care in line with current evidence based guidance.
  • The practice was positively engaged with an ongoing programme of Clinical audits, which demonstrated a commitment to quality improvement, professional development and patient care.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Personal and professional development was encouraged and supported.
  • There was clear evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. The practice staff participated in regular multidisciplinary meetings to meet the needs of patients and deliver appropriate care and support.

Caring

Good

Updated 26 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed that patients reported they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. 85% of patients described their overall experience of the practice as good, which was higher than the local CCG average of 83% and equal to the national average.

  • Although only 46% of patients with a preferred GP said they usually got to see or speak to that GP. This compared to a CCG average of 55% and national average of 60%.

  • Feedback from the 25 completed CQC comment cards was consistently positive. Patients told us they were impressed by the attitude and approach of the staff.

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

  • Information for patients about the services available was easy to understand and accessible. The practice had a comprehensive and well produced practice leaflet. Posters and leaflets were also available in the waiting area and information was available on the practice website.

Responsive

Good

Updated 26 August 2016

The practice is rated as good for providing responsive services.

  • The identification of the needs for individual patients was at the centre of planning and delivery of services at the practice. 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.
  • 88% of patients said the receptionist at the practice were helpful, which was comparable with the CCG average of 85% and a national average of 87%.
  • Whilst 75% of patients described their experience of making an appointment as good, which again was comparable with the CCG average of 72% and national average of 73%.
  • Urgent appointments were available 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 evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff as appropriate. The practice encouraged positive feedback and celebrated success appropriately.

Well-led

Good

Updated 26 August 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver good 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. The practice had appropriate policies and procedures to govern activity and held regular governance meetings. Systems were in place to review, update and amend policies and procedures to ensure best practice guidelines were incorporated and followed by staff. The practice had a comprehensive and detailed Development Plan which identified existing responsibilities and possible future developments.
  • There was a clear and accessible governance framework, which supported the delivery of good quality care to patients. 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, transparency and honesty. The practice had systems in place for 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 practice benefitted from an active and engaged ‘virtual’ patient participation group.
  • As a GP training practice, there was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 26 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.
  • 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 constructively with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held clears records of the number of patients with long term conditions. These patients are seen at the surgery on a regular basis and invited to attend specialist, nurse-led clinics.

  • The practice offered longer appointments to these patients and home visits were available when needed.

  • Arrangements were in place to ensure patients with diabetes were invited for a review of their condition twice yearly.

  • 98% of the patients on the diabetes register had influenza immunization in the period from 1 August to 31 March 2015.

  • Nurse led clinics ensured annual reviews and regular checks for patients with asthma and COPD were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. All patients who are admitted to hospital were reviewed by the practice respiratory nurse after discharge.

Families, children and young people

Good

Updated 26 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.
  • 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.
  • 81% of women aged between 25 - 64 years of age whose notes record that a cervical screening test had been performed in the preceding five years, was 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 supported a number of initiatives for families with children and young people. For example, the practice benefitted from health visitors sharing the same building and child assessments details recorded within records at the location, hosted regular clinics provided by the community midwife and offered a broad range of contraception services.
  • Immunisation rates for all standard childhood immunisations were broadly similar to local CCG performance averages. The practice provided flexible immunisation appointments.

Older people

Good

Updated 26 August 2016

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

  • The practice had accurate and clear information about the patients it cared for. There were 15% of patients over 65 years of age and 2% over 85 years. Most lived at their own homes, some with carers or other support. The practice had 479 carers recorded on their register, which represented 3.7% of the patient list.
  • The practice had 1.1% of patients living in residential care homes, over twice the national average of 0.5%.
  • 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. GPs were able to offer home visits to those patients who were unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
  • The practice had clear objectives to avoid hospital admissions where possible. For example, when GPs visited patients who lived in residential care homes they ensured that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.

Working age people (including those recently retired and students)

Good

Updated 26 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 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 easy access to telephone appointments and telephone consultations.
  • Extended opening hours were available Saturday morning and Tuesday evening.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 August 2016

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

  • 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 88%.
  • 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 hosted staff of the Wellbeing Team and Primary Care Liaison Workers.

  • 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 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 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, such as homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability. GPs also made regular visits to patients with learning difficulties who lived at a local care home.
  • The practice regularly worked positively and collaboratively with other health care professionals in the case management of vulnerable patients.
  • The practice informed 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.