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Inspection Summary


Overall summary & rating

Good

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Leys Health Centre on 24 February 2016. Overall the practice is rated as good, improvements are required in providing responsive services.

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.
  • Medicines were managed safely.
  • 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.
  • National data suggested patients received their care in line with national guidance.
  • 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.
  • Patients said they found it difficult to make an appointment with a GP.
  • 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.
  • Governance arrangements were in place for non-clinical aspects of the service.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We found one area of outstanding practice:

  • The practice considered and went beyond its contractual obligations in providing support to some its most vulnerable patients. For example:

    • The practice had led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved. Patients provided feedback and we were shown case studies where patients reflected positively on the scheme. Outcomes included better social contact, long term planning to meet needs and greater independence in tackling problems.
    • Staff worked with patients who they were aware had problems associated with poor housing conditions, including working with external organisations to try and improve these patients physical and mental wellbeing.
    • Staff identified that some patients did not find leaflets on their care and treatment easy to use. Therefore nurses developed pictorial guides along with written guidance on the practice leaflets for diabetes and asthma care.

The areas the provider must make improvements are:

  • Ensure the appointment system and appointment availability enable patients to book appointments in a reasonable timeframe.

Areas the provider should make improvements:

  • Ensure nurses are aware of the principles and requirements of the Mental Capacity Act 2005
  • Review means to increase in the uptake of learning disability health checks.
  • Identify how to promote better awareness of the bowel cancer screening to help increase uptake on the screening programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 May 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 safety incidents occurred, investigations took place and any action to improve processes was undertaken 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.
  • Medicines were managed in a way that kept patients safe.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 6 May 2016

The practice is rated as requires improvement for providing effective services.

  • The practice had a register of 59 patients with a learning disability and only 16 had a health check to date.
  • There was training and guidance on consent including the Mental Capacity Act 2005 and obtaining consent from children. However, nurses were not all aware of the principles of the Act.
  • National data showed patient outcomes were mostly similar to the average for the locality and higher than the national average.
  • Staff assessed patients’ 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice similarly or slightly below average in 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 confidentiality.

Responsive

Good

Updated 18 January 2017

The practice is rated as good for providing responsive services.

At our last inspection in February 2016 we found that patients found it difficult to make an appointment. The national GP survey showed very poor feedback regarding patient access to appointments. A new appointment system had been implemented in February 2015 but no comprehensive review of the system had taken place since to deduce how well it was working for patients and to identify any improvements which were required.

At this inspection we saw that a number of channels for communicating with patients had been utilised to improve two way communication. This enabled increased patient feedback and more information being provided to patients regarding the appointment system. Recruitment had been undertaken and we saw more routine appointments were available. There were also improved outcomes in the national GP survey in July 2016 compared to January 2016.

Well-led

Good

Updated 6 May 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 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.
  • 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 acting on notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice had not sought all the feedback from patients it could have in relation to the appointment system.
Checks on specific services

People with long term conditions

Good

Updated 6 May 2016

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

  • The practice followed guidance in the management of chronic diseases.
  • Patients at risk of hospital admission were identified and had care plans written where appropriate.
  • The practice achieved 97% on its quality outcomes framework scores (QOF) in 2015. QOF is a quality system to measure the performance and quality of patient care and treatment.
  • The care of long term conditions was audited to identify where improvements in the management of a specific condition could be made.
  • Longer appointments and home visits were available when needed.
  • There was a process to offer a periodic structured review to check patients’ health.
  • There was monitoring of patients on long term medicines.
  • 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 6 May 2016

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

  • The practice had led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved.
  • Local schemes which the practice participated in had reduced teenage pregnancy rates in the local area.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG averages. Vaccinations given to under two year olds were 90% (regional average 90%) and for five year olds they were 85% (regional average 95%).
  • Staff were aware of the circumstances and rights when gaining consent from patients under 16.
  • Baby changing facilities were available.
  • GPs worked with midwives and health visitors in the provision of care.

Older people

Good

Updated 6 May 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 patients in its population.
  • Care plans were available for patients deemed at high risk of unplanned admissions.
  • Access for patients with limited mobility was good including for those with mobility scooters.
  • There were named GPs for this group of patients.
  • Screening for conditions which patients in this population group may be at risk of was provided, such as dementia

Working age people (including those recently retired and students)

Good

Updated 6 May 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.
  • Extended hours appointments were available including on Saturday mornings. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • Patient feedback on the availability of appointments from the national survey and on the day of inspection was poor.
  • Phone consultations were offered to patients.
  • Online appointment booking was available.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 May 2016

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

  • Performance for mental health related indicators was 96% compared to the CCG average of 95% and national average of 93%.
  • 93% of patients eligible for a care plan had one in place and reviewed in 2015/16.
  • During 2014/2015, there were 231 patients assessed for dementia with 14 diagnoses.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved.

People whose circumstances may make them vulnerable

Good

Updated 6 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Learning disability health check figures were low.
  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for vulnerable patients.
  • GPs regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • A mentoring scheme offered young people with social, emotional or potential mental health problems with support.
  • 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.
  • Staff worked with patients who they were aware had problems associated with poor housing conditions, including working with external organisations to try and improve these patients physical and mental wellbeing.
  • Staff identified that some patients did not find leaflets on their care and treatment easy to use. Therefore nurses developed pictorial guides along with written guidance on the practice leaflets for diabetes and asthma care.