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Inspection Summary


Overall summary & rating

Good

Updated 11 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Littledown Surgery, Bournemouth on Wednesday 15 June 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.
  • The practice were committed to working collaboratively with patients who had complex needs to ensure they received coordinated care. For example, one of the GPs provided a project to improve care for patients over the age of 75, in order to reduce hospital admissions and improve recognition of cognitive impairment. The project had reduced hospital admissions and had reduced the length of hospital stay.
  • 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 a proactive carers lead who had identified 3% of the practice population as carers. The ongoing support included carers coffee mornings, facilitation of outside speakers, carers health checks, links to local services for carers, and an annual newsletter of useful information.
  • The practice had actively sought feedback from patients and dementia specialists about the building which had resulted in changes in signage, flooring and seating. There were 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 was organised and had effective governance structures in place.
  • 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.
  • The practice demonstrated a strong, visible, person-centred culture and staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. For example, the practice had been proactive in the care of patients with dementia.
  • Patients were truly respected and valued as individuals and were empowered as partners in their care. For example, the practice worked closely with a voluntary coordinator which had resulted in patients accessing befriending and transport services which increased social activity, reduced isolation and reduced the number of times the patient attended the practice for emotional support.

We saw an area of outstanding practice:

There was evidence of quality improvement which was used by the practice to improve services. For example, one of the GPs provided a project for patients over the age of 75 to improve care, reduce hospital admissions and improve recognition of cognitive impairment. The GP had performed two cycles of an audit which demonstrated avoidable hospital admissions dropped from 33% in 2014 to 22% in 2015. The audit also showed an increase in dementia diagnosis. For example, seven patients had been diagnosed in 2014 and this had increased to 16 patients in 2015. The audit also saw a 50% reduction in the duration of hospital stay.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 August 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.
  • Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent.
  • There were appropriate arrangements for the efficient management of medicines.
  • Health and safety risk assessments, for example, a fire risk assessment had been performed and was up to date.
  • The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Good

Updated 11 August 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.
  • The practice were committed to working collaboratively with patient who had complex needs to ensure they received coordinated care. For example, one of the GPs provided a over 75 project to improve care for patients over the age of 75, in order to reduce hospital admissions and improve recognition of cognitive impairment. The project had reduced hospital admissions and had reduced the length of hospital stay.

Caring

Outstanding

Updated 11 August 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 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.
  • Patents were respected and valued as individuals and were empowered as partners in their care. Feedback from people who use the service, those who are close to them and stakeholders is continually positive about the way staff treat patients. Patients told us that staff go the extra mile and the care they receive exceeds their expectations. For example, the practice worked closely with a voluntary coordinator who described the practice staff as responsive and proactive in referring patients to the voluntary sector.
  • The practice demonstrated a strong, visible, person-centred culture and staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. For example, the practice had been proactive in the care of patients with dementia. The practice had been the first Dementia Friendly practice in Bournemouth. The practice had also requested and acted upon specialist advice regarding the environment to ensure it was dementia friendly.
  • The practice proactively identified carers within the practice patient list and worked closely with the voluntary services coordinator to signpost patients to services which included coffee mornings, counselling services, support groups and befriending organisations.

Responsive

Good

Updated 11 August 2016

The practice is rated as good for providing responsive services.

  • 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.

Well-led

Good

Updated 11 August 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 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 11 August 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.
  • 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.
  • The practice had a proactive carers lead who had identified 3% of the practice population as carers. The ongoing support included carers coffee mornings, facilitation of outside speakers, carers health checks, links to local services for carers, and an annual newsletter of useful information which was targeted at this group of people.

Families, children and young people

Good

Updated 11 August 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.
  • 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. The community health visiting team were based at the practice which enabled effective communication.

Older people

Outstanding

Updated 11 August 2016

The practice is rated as outstanding 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 practice provided a project to improve care for patients over the age of 75, its aim is to reduce hospital admissions and improve recognition of cognitive impairment. The project had reduced hospital admissions and had reduced the length of hospital stay.

  • The practice worked well with a voluntary coordinator who signposted patients to most appropriate voluntary sector services – often with older people to address loneliness and social isolation.
  • A leg ulcer service was offered by both practice nurses, including one who was a former community nurse and leg ulcer specialist.

  • Multidisciplinary team meetings were held and included community matrons, nurses, social services and voluntary services coordinators.

Working age people (including those recently retired and students)

Good

Updated 11 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice offered weekly evening appointments for patients who were unable to attend the practice during normal hours.
  • 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 had a successful cervical smear uptake rate. The rate for the practice was89%, compared with 76.2% for the local clinical commission group area.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 August 2016

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

  • 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.
  • In house counselling was available at the practice and the voluntary coordinator signposted patients to support groups where appropriate.
  • 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.
  • The practice demonstrated a strong, visible, person-centred culture and inspired to offer dementia care that was kind and promoted people’s dignity. For example, the practice had been proactive in the care of patients with dementia. The practice was the first Dementia Friendly practice in Bournemouth. All staff had received Dementia Friends training which had increased staff awareness and had increased dementia diagnosis rates. The practice had also received specialist advice regarding the environment and acted upon this to ensure it was dementia friendly.

People whose circumstances may make them vulnerable

Good

Updated 11 August 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. Each of the 11 registered patients, with a learning disability, was invited by letter and this had been followed up with a telephone call. The practice had re written the invitation leaflet for the health checks to make it more user friendly and had also communicated with the learning disability specialist nurse for advice. The practice told us this had still resulted in just four patients attending for a health check.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, practice staff have worked with local groups to develop a Carers Café at a nearby Church. This was promoted to carers during the coffee mornings and patient groups.
  • 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 had listened to feedback from vulnerable groups and made changes to the environment. For example, the practice manager had invited a wheelchair user around the building to discuss how the practice could improvement access. In line with their feedback and to improve access for others the exterior door had recently been replaced with an automatic one, and the reception desk had been lowered to become more accessible for wheelchair users.