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Archived: Dr Purnell and Partners Good

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Inspection Summary


Overall summary & rating

Good

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Purnell and partners on 11 February 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 effective systems in place to report and record significant events which enabled learning to be shared.
  • Risks to patients were assessed and well managed through ongoing monitoring. There was a robust programme of infection control audit in place which was facilitated by the infection control lead nurse.
  • 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. Where a need was identified, further training was provided.
  • Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patients praised the kind, caring and compassionate nature of staff and said they were always treated as individuals.
  • Staff said they saw their roles as more than a job and explained that two members of staff had given up their time off to take a patient on a day trip to the coast last year following the death of their spouse.
  • 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. We observed staff working to ensure the needs of patients were met on the day in spite of no available appointments on the system.
  • 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.

We saw several areas of outstanding practice:

  • The practice sought to treat patients holistically and offered additional services internally where possible including access to a practice chaplain and support from the Citizens Advice Bureau. There was an emphasis on treating the health needs of patients whilst also giving consideration to social needs, by assisting patients with completing forms for example. Staff consistently went over and above to meet the needs of their patients; including going out of their way to make the lives of patients easier. For example, staff routinely escorted patients who required assistance to the nearest bus stop.
  • Staff advocated for the needs of their patients within the practice and externally. For example, a member of staff contacted the local hospital to ensure support was in place for a patient who required a wheelchair.
  • Data from the GP patient survey and feedback received as part of the inspection demonstrated that patients felt they received a level of care which exceeded their expectations. For example, a number of comments cards described staff within the practice as exceptional.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 April 2016

The practice is rated as good for providing safe services.

  • There were effective systems in place to report and record significant events. The practice had recorded a range of clinical and non-clinical events and all staff were aware of the process.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients were offered support and given explanations about what had happened and told about any actions which had been implemented to prevent the same thing happening again. Apologies were offered where appropriate.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Regular meetings were held between the practice and attached health and social care staff to monitor patients at risk.
  • Risks to patients and staff were assessed and well managed. There was a rolling programme of health and safety audit in place to monitor health and safety issues in each specific area of the practice.

Effective

Good

Updated 21 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average. The practice had achieved 98.7% of the total number of points available which was marginally above local and national averages of 95.4% and 94.7%. 
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits were based on relevant topics and demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. The practice worked closely with their attached care co-ordinator who attended the practice three days per week on average and hosted regular meetings with the wider multidisciplinary team.

Caring

Outstanding

Updated 21 April 2016

The practice is rated as outstanding 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, 94% of patients 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. We received 91 completed comments cards which were overwhelmingly positive about the caring attitude of staff.
  • We observed a strong patient-centred culture with patients at the heart of everything the practice sought to do.
  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, we saw evidence that staff had gone the extra mile to ensure that support was in place for a frail patient to have a wheelchair available when attending their hospital appointment. We observed staff accommodating the needs of an unwell patient at short notice near the end of the working day.
  • We found positive examples to demonstrate how patients choices and preferences were valued and acted on. For example we observed staff speaking with patients in the waiting area to ensure they were comfortable whilst waiting.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. We observed that staff had a good knowledge of their patients and displayed a friendly and open manner in their communication with them.

Responsive

Good

Updated 21 April 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. For example, in response to feedback the practice had made extensive improvements to their car parking area to ensure this was more accessible.
  • 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. Urgent appointments were offered on a daily basis after morning surgery and during the afternoon surgery.
  • 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 and other stakeholders.

Well-led

Good

Updated 21 April 2016

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

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this. The practice shared their mission statement with patients through notices in the waiting area and in the practice leaflet.
  • 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 practice and staff meetings.
  • 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 practice sought feedback from staff and patients, which it acted on. The patient participation group was active and met regularly making suggestions for improvements and raising funds to support the practice.

Checks on specific services

People with long term conditions

Good

Updated 21 April 2016

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Care plans were in place for the patients identified as being at risk of admission.
  • Performance for diabetes related indicators was 96% which was above the CCG average of 90.2% and the national average of 89.2%.
  • The percentage of patients with hypertension having regular blood pressure tests was 89.2% which was above the CCG average of 85.6% and the national average of 83.6%.
  • 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. 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.

Families, children and young people

Good

Updated 21 April 2016

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

  • 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. Urgent appointments were always available on the day.
  • We saw good examples of joint working with midwives and health visitors.

Older people

Good

Updated 21 April 2016

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

  • The practice offered proactive and personalised care to meet the needs of older people. They worked with the multidisciplinary team to identify frail and vulnerable patients, and those at high risk of hospital admission, to plan and develop individual care packages.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those who needed them. Longer appointments could be booked if these were required.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Working age people (including those recently retired and students)

Good

Updated 21 April 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. This included access to telephone consultations and same day urgent appointments.
  • The practice was proactive in offering online services and GP appointments were offered through the online booking system.
  • Health promotion and screening was provided that reflected the needs for this age group. For example the practice offered smoking cessation services and encouraged patients to attend for national cancer screening programmes.
  • The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG average of 83.2% and the national average of 81.8%.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 April 2016

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

  • 93.3% of patients with a mental health condition had a documented care plan in their records in the previous 12 months which was above the CCG average of 91.6% and the national average of 88.3%. The practice’s exception reporting rate for this indicator was 6.3% which was below the CCG average of 17.5% and the national average of 12.6%.
  • Data showed 90.6% of patients with dementia had received a face to face review in the last 12 months which was above the CCG average of 85.3% and the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the 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.
  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 21 April 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 those with a learning disability. The practice records indicated they had 24 patients on the learning disability register and 20 of these had received an annual review at the time of the inspection.
  • They offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice 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.
  • The practice offered additional services to patients whose circumstances may make them vulnerable such as access to the Citizens’ Advice Bureau and a practice chaplain.