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Inspection Summary


Overall summary & rating

Good

Updated 24 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rowcroft Medical Centre on 28 April 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were 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 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 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice had appointed a practice nurse lead to co ordinate and lead on the care and treatment for the care of patients with learning disabilities, dementia and the vulnerable elderly. Annual reviews were offered to all patients with learning disabilities, either at the practice or within the patient’s home. Home visits had resulted in improved outcomes for patients.

  • Patients recently diagnosed with dementia received a joint home visit by both the practice nurse lead and the practices care coordinator. This enabled a comprehensive assessment of the patient within the home environment. Liaison with, for example, community teams and social services resulted in a coordinated care package being initiated. This also led to good relationship building and gave the families confidence to contact a named person for advice. The practice had installed a dedicated direct telephone line with answer service, for ease of access for these patients, carers and families.

The areas where the provider should make improvement are:

  • The practice should improve the identification of patients who are also carers.

  • The practice should improve collaborative and effective working with the patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 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

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a 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.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 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 several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

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

  • The practice had taken steps to encourage patients who were carers to identify themselves, however the number of carers identified by the practice was significantly below the national average.

Responsive

Good

Updated 24 June 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 meet patients’ needs. For example, when a nursing home was opening within the practice boundaries the owners worked with the practice to develop a preferred model of care. This included one practice being totally responsible for all patients within the home. Following good outcomes, the practice worked with the clinical commissioning group for this model of care to be adopted by nursing homes across the county.

  • There were innovative approaches to providing integrated patient-centred care. The practice tailored the needs of individual people and delivered care in a way to ensure flexibility, choice and continuity of care. For example, the practice had appointed a practice nurse to lead in the care of patients with learning disabilities, dementia and the vulnerable elderly. Comprehensive care planning, effective working with the care coordinator, community teams and social services, combined with the installation of a direct telephone line for relatives and patients to call the nurse lead for advice and help, had led to improved patient outcomes.
  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. For example, the practice had a number of deaf patients registered with the practice. In order to respond to this need the practice had arranged for a member of the administrative team to attend deaf awareness training and basic sign language instruction. A patient who was deaf had been invited to the practice to talk to staff regarding the needs of people who were deaf in order to raise awareness for all staff.

  • 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. The practice had analysed and responded to the patient survey. In its communication with patients the practice recognised and commended the high scores the practice nurses had received and also communicated to patients’ areas it was working to improve.
  • 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 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.

  • Lessons were learnt from analysis of trends and action was taken to as a result to improve the quality of care. For example, in the reception area there was a notice for staff to record minor grumbles and incidents that had occurred. The purpose of this was to be proactive in identifying any trends that would allow the practice to make a change to procedures before they became major incidents or formal complaints

Well-led

Good

Updated 24 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 it.

  • 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.

  • 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 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 (PPG) had three members who were all relatively new to the role and lacked clarity as to their role. The practice was actively trying to engage more members.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 24 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 had employed a care coordinator, who worked effectively with the nurses managing chronic diseases to monitor patients who were at high risk of hospital admission.

  • Two nurses were responsible for reviewing patients who had been diagnosed with diabetes. Both had undertaken specialist training to carry out this role and both had recently received additional training to convert patients from oral medicines to injections in order to improve control of their blood sugars.

  • 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 patients 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 24 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.

  • 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (2014 to 2015) was 83%, which was similar to the local average of 84% and 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.

Older people

Good

Updated 24 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.

  • The lead practice nurse for vulnerable patients worked with elderly patients and achieved good outcomes. For example, a patient who was 102 years old, wanted to remain in their own home. The nurse liaised with a care company and community teams to deliver a 24 hour care package to respond to this. This led to the patient being able to remain in their own home for the remainder of their life.

  • When a nursing home was opening within the practice boundaries the owners worked with the practice to develop a preferred model of care. This included one practice being totally responsible for all patients within the home. The practice visited the home twice weekly in addition to visits as required. Following good outcomes, the practice worked with the clinical commissioning group for this model of care to be adopted by nursing homes across the county.

Working age people (including those recently retired and students)

Good

Updated 24 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 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 June 2016

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

  • The percentage of patients with a serious mental health illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 90% compared to a local average of 93% and a 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. Following diagnosis the nurse lead for dementia reviewed the patient in their own home this enabled a comprehensive assessment of the patient within the home environment. Liaison with the multidisciplinary team and social services teams resulted in a coordinated care package being initiated. This also led to good relationship building and gave the families confidence to contact a named person for advice via the direct telephone line.

  • 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

Outstanding

Updated 24 June 2016

The practice is rated as outstanding 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.

  • Annual reviews were offered to all patients with learning disabilities either at the practice or within the patient’s home. Home visits had resulted in improved outcomes for patients. For example, the opportunity had been taken to improve the skills of carers when caring for a patient with diabetes. Communications with carers had also been improved. Carers of patients with learning disabilities had access to a direct telephone line to speak to the nurse for help and advice.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice had a number of deaf patients registered with the practice. In order to respond to this need the practice had arranged for a member of the administrative to team to attend deaf awareness training and basic sign language instruction. A patient who was deaf had been invited to the practice to talk to staff regarding the needs of people who were deaf in order to raise awareness for all staff.

  • 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.