You are here

Abbey House Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbey House Medical Practice on 17 November 2015. Overall the practice is rated as outstanding. We found the domains of caring and responsive were outstanding which resulted in the practice being outstanding overall.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • 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 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.
  • 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 provided a young person’s drop in clinic where they could consult with a GP with a special interest in young person’s health and discuss issues such as sexual health, bullying and self-harm.

  • The practice had a personalised care system where each GP carried out twice yearly care home reviews involving the pharmacist and care home staff to include medication review as well as clinical assessment and dementia review. Each GP also had an allocated personal assistant (PA) who worked specifically for them and dealt with queries from their patients and their allocated care homes. This allowed them to become familiar with these patients reducing the need for patients and attached staff to continually repeat information and provided continuity and co-ordinated care and ensured that queries were dealt with promptly.

  • The practice had introduced a patient services assistant who was also the carers lead and was based in the reception area in a specific room accessible to patients.It was their role to help patients who needed to speak to a member of staff in private, or who were distressed. However there was an area of practice where the provider needs to make improvements.

Importantly the provider should:

  • Implement a system to ensure the content of asthma care plans is available to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep patients safe.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality in most areas, although there were some specific areas where achievement was below the CCG average, which the practice were addressing. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for providing caring services. Data showed that patients rated the practice higher than others in almost all aspects of care. The practice had taken additional measures to ensure patients dignity and privacy by the introduction of a patient services assistant whose role was specifically to assist patients requiring private discussions, those who had concerns regarding services and those registering with the practice.  They were able to assist and signpost to relevant support services and provide explanations to patients when they expressed concerns about services or had cause to complain. Patients consistently reported they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. The practice had also introduced systems to allow patients and care home staff prompt access to their named GP promoting continuity and personal service. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. 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. There was access daily to a duty GP and prescribing nurse for those patients who required on the day treatment or consultation  The practice had outstanding 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 that the practice responded quickly to issues raised.  The practice had reviewed and implemented a new telephone and appointment systems in response to patients views and complaints which allowed easier access to appointments and services.  They also provided additional services in response to the needs of the population such as young people’s services and educational support for patients regarding their long term conditions. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 21 January 2016

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure which had identified specific staff for allocated roles and staff felt supported by management. The practice had introduced specific systems allocating administrative staff to each GP and reception staff to assist new patients registering with the practice. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. A PPG is a group of patients who represent the views patients and work with the practice to make improvements.  Staff had received inductions, regular performance reviews and attended staff meetings and events.  The practice supported and trained staff and encouraged and enabled progress within the organisation.

Checks on specific services

People with long term conditions

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of people with long-term conditions because the practice was outstanding in the two domains of caring and responsive which impacts on the population as a whole.  Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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.  The practice also offered educational sessions to newly diagnosed patients with diabetes to help them learn how to manage their condition. They also had an allocated long term condition co-ordinator to alert nursing staff to new patients to enable them to be seen promptly and that scheduling for review was monitored. The practice had identified GP leads for specific disease areas who were responsible for ensuring that all areas were being provided with regular monitoring and optimum treatment.

Families, children and young people

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of families, children and young people because the practice was outstanding in the two domains of caring and responsive which impacts on the population as a whole.  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 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. We saw good examples of joint working with midwives, health visitors and school nurses. The practice had a GP with a special interest in young people’s health and they offered a drop in clinic to provide an opportunity for young people to discuss health issues, such as sexual health, self-harm and bullying.

Older people

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of older people because the practice was outstanding in the two domains of caring and responsive which impacts on the population as a whole. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and prompt access to appointments for those with enhanced needs. They practice had developed systems to review and update care and treatment, working closely with pharmacy and care home staff to provide better co-ordination of care. They also had allocated practice staff who dealt with specific groups of patients. For example, each GP was responsible for an allocated care home and visited at least weekly. They also had their own personal assistant who dealt specifically with the staff at the care home. Twice yearly care home reviews were undertaken involving the pharmacist and care home staff to include medication review as well as clinical assessment and dementia review.

Working age people (including those recently retired and students)

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students) because the practice was outstanding in the two domains of caring and responsive which impacts on the population as a whole. 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 provided a Community Skin Cancer Service for patients from all practices in the area under a separate contract and this was carried out by one of the GPs with long term experience and expertise in this field of work.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia) because the practice was outstanding in the two domains of caring and responsive and which impacts on the population as a whole. Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice had a councillor and hosted the wellbeing team at the practice and referrals were made as required.

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 (A&E) where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Outstanding

Updated 21 January 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable because the practice was outstanding in the two domains of caring and responsive which impacts on the population as a whole. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Vulnerable patients had been signposted to additional support services, 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.