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Inspection Summary


Overall summary & rating

Good

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Halifax Road Surgery on 3 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 and were encouraged to develop their role.
  • 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 availability of appointments.
  • Feedback from patients about their care was consistently and strongly positive.
  • 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 that 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 clear vision which had 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.
  • 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.

We saw one area of outstanding practice:

The nurses developed practice specific care plans for patients and used evidence based templates to record reviews. For example, diabetic patients attended an initial appointment with the healthcare assistant for height, weight, blood pressure, lifestyle discussion, foot and memory assessments which were recorded on the template. All results were sent to the patients on an individual care plan with goals to be considered before the second appointment with their named practice nurse.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 June 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 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. Learning was based on a thorough analysis and investigation.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected 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. All GPs and nurses were trained to Safeguarding level three.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 1 June 2016

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. For example, the nurses had created bespoke templates to undertake patient reviews from NICE guidance.
  • The nurses had lead roles in the management of patients with long term conditions.
  • Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group (CCG). Ninety two per cent of patients with hypertension had a blood pressure reading in the preceding 12 months which was within the normal parameters, compared to the CCG average of 85% and the national average of 84%.
  • The practice used proactive methods to improve patient outcomes and worked with other local providers to share best practice.

  • Clinical audits were undertaken by clinical and administrative staff and these demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff had received additional training to expand their roles and mentor others.
  • There was evidence of personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Data showed that uptake rates for flu vaccinations and screening were better than CCG and national averages.

Caring

Good

Updated 1 June 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care. For example, 93% said the GP was good at listening to them compared to the CCG average of 87% and national average of 89%.

  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • We observed a strong patient-centred culture.
  • Patients receiving treatment for long term conditions had a named nurse.
  • 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.

Responsive

Good

Updated 1 June 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.
  • In response to the closure of a nearby GP practice, Halifax Road Surgery was able to accommodate 350 new patients onto their list.
  • 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 offered extended hours which included appointments with GPs, nurses, healthcare assistants and the phlebotomist.
  • 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 availability of appointments.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice introduced a practice newsletter and communicated effectively with patients, particularly during significant staff changes.

  • 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 1 June 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 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.
  • 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.
  • 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 1 June 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.
  • The practice nurse prescribers managed the care of patients with long term conditions.
  • The healthcare assistant was undertaking a diploma in diabetic care and worked closely with the nurses to undertake patient reviews and care planning.
  • Performance for diabetes related indicators was better than the CCG and national average. Ninety one per cent of patients with diabetes, on the register, had a record of a foot examination and risk classification within the preceding 12 months (with 1% exception reporting) compared with the CCG average of 89% (6% exception reporting) and the national average of 88% (8% exception reporting).
  • The practice created bespoke, evidence based templates and personalised care plans for patients with long term conditions.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a named nurse.
  • All patients had 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 and nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • All test results, hospital and discharge letters were reviewed jointly by the clinical team after morning surgery daily.
  • They provided in-house electrocardiograms (ECG) and Prostap injections (for patients who have prostate cancer).
  • Chronic Obstructive Pulmonary Disease screening was undertaken and 95% of patients diagnosed on or after 1 April 2011) had their diagnosis confirmed by post bronchodilator spirometry compared to the CCG average of 92% and the national average of 90%.
  • They offered flexible appointment times including early mornings and evenings for review appointments.
  • There was effective monitoring of patients with long term conditions and staff liaised with other healthcare professionals where deterioration of conditions were identified.

Families, children and young people

Good

Updated 1 June 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.
  • Performance for asthma related indicators was better than the CCG and national averages. 83% of patients with asthma, on the register, had an asthma review in the preceding 12 months that included an assessment of asthma control compared to the CCG average of 79% and the national average of 75%.
  • 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.
  • The practice’s uptake for the cervical screening programme was 86%, which was better than the national average of 82%.
  • The practice provided sexual health services and contraceptive implant fitting.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice could evidence positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 1 June 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.
  • Annual health checks were offered to patients aged over 75.
  • The practice nurses carried out annual reviews of patients in their own home where patients were housebound.
  • Uptake for national screening programmes was high. For example, 62% of patients aged 60 to 69 were screened for bowel cancer in the preceding 30 months compared to the national averages of 58%.
  • Flu vaccination rates for the over 65s were 80%, and at risk groups 60%. These were above the CCG and national averages of 73% and 53% respectively.

Working age people (including those recently retired and students)

Good

Updated 1 June 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 offered a ‘Commuter’s Clinic’ on Monday and Wednesday mornings from 7.30am and on Wednesday evenings until 7.30pm for working patients who could not attend during normal opening hours.
  • Extended hours appointments were available with GPs, nurses, the healthcare assistant and phlebotomist and included appointments for 24 hour blood pressure monitoring, spirometry and ECGs.
  • 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 hosted a Kirklees Council funded Better Health at Work service one day a week. The service provided advice and support for people experiencing work related health or stress concerns.
  • The practice used text messages to confirm and remind patients of their appointments.
  • Data from the National GP survey showed that patients were happy with the practice’s opening hours. 90% of patients were satisfied with the practice’s opening hours compared to the CCG average of 76% and national average of 75%.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 June 2016

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

  • 69% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%
  • Performance for mental health related indicators was similar to the CCG and national averages. Eighty eight percent of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months compared to the CCG and national averages of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • Patients on long term benzodiazipines were referred to the Kirklees Clarity Project which aims to reduce the overall prescribing of this medication (benzodiazipines are medicines used to treat both anxiety and sleeping problems).
  • 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 received Dementia Friends training and had a good understanding of how to support patients with mental health needs and dementia.
  • The practice hosted a counselling service which patients were referred to as necessary.

People whose circumstances may make them vulnerable

Good

Updated 1 June 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.
  • 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 people.
  • 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.
  • The practice identified patients who were also carers. The team worked with a local carer’s organisation and provided a carer’s noticeboard to highlight local support organisations.
  • The practice supported the local Kirklees Council Safe Space scheme and was designated as a safe place. A safe place is somewhere a vulnerable person aged over 16 can go if they feel lost or need help.