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Inspection Summary


Overall summary & rating

Outstanding

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodbury Surgery on 20 September 2016. Overall the practice is rated as outstanding.

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. Woodbury Surgery was proactive in identifying frailty and managing vulnerable patients and those with long term health conditions registered at the practice. An intuitive IT system facilitated the early identification of patients who could also be at risk of developing long term conditions enabling early interventions to take place.
  • 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.
  • There was high patient satisfaction, with all 46 patients confirming 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.
  • People’s individual needs and preferences were central to the planning and delivery of tailored services.We saw several examples of this illustrated by: Longer 15 minute appointments as a standard; seeing patients in the setting they were most comfortable with; a flexible and responsive service by clinical staff for housebound patients; bridging gaps bringing services closer to home such as specialist clinics for patients with long term conditions and building a trusting rapport with hard to reach vulnerable groups such as the travelling community. 

  • 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.
  • The GP partnership provided a total team approach to monitoring the health and well being of patients with innovative new ways of providing care and treatment.
  • The leadership, governance and culture at Woodbury Surgery was used to drive and improve the delivery of high-quality person-centred care.
  • Learning was celebrated and the practice was proactive in using opportunities to improve services by seeking and acting upon feedback from staff, patients and other stakeholders.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP and other specialists to ensure patients received a comprehensive holistic review that met all health and social care needs. The practice understood the impact of living with chronic and life limiting conditions such as chronic kidney disease. Clinics were held with consultant and specialist nurse input facilitating closer monitoring of these patients.

The practice had invested in a software risk management system, which enabled patient records to be analysed to produce risk profiles and target audit activity and health screening. For example, the system enabled the practice to identify patients and led to timely diagnosis of coeliac disease so that they could receive appropriate support and treatment to manage this condition.

Action the provider should take to improve:

Ensure that pre appointment checks for locum staff are carried out for every new period of cover at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 December 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. Evidence seen demonstrated that the practice took the approach that safety was everybody’s business. This was illustrated by two examples: The proactive support of women experiencing domestic violence; Approach to reviewing patients with learning disabilities, which included carers and other supporters involved in their care.

  • Risks to patients were assessed and well managed to achieve the best outcomes for patients.

  • Safety net systems were effective and demonstrated by actions taken following a significant IT failure affecting communications and patient records systems earlier in the year

Effective

Good

Updated 29 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average. The practice had an active management approach to reducing exception reporting through using their bespoke software to support proactive care delivery.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement and focussed on positive benefits for patients.

  • 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 29 December 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. The practice was proactive in using a survey approach regularly to obtain feedback from patients about the quality and development of services.

  • The practice aim was to empower patients as active partners in their care, which was well under development. The practice was actively working with the community of Woodbury and surrounding areas and had developed good links with the third sector service ‘Neighbourhood Friends’ to provide additional support such as transport for vulnerable and older people.

  • 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.

Responsive

Outstanding

Updated 29 December 2016

The practice is rated as outstanding 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. Services were tailored to meet the needs of vulnerable people and delivered in a way to ensure flexibility, choice and continuity of care. This was demonstrated by: Longer appointments as standard; a flexible and responsive service by clinical staff for housebound patients; bridging gaps bringing services closer to home such as specialist clinics for patients with long term conditions and building a trusting rapport with hard to reach vulnerable groups such as the travelling community; hosting screening clinics at the practice.

  • Services were taken to patients who found it difficult to attend the medical centre such as patients with complex learning disabilities providing comprehensive assessment and support for them.

  • 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 dispensary on site, which most patients were able to use. The practice was awarded funding for a small electric car and starting a prescriptions delivery service to vulnerable and isolated patients.

  • 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

Outstanding

Updated 29 December 2016

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

  • The leadership, governance and culture were used drive and improve the delivery of high quality person-centred care.

  • The practice mission statement focussed on the partnership with patients in a safe and supportive environment.GP partners recognised could be further developed in line with the practice aspirations to empower patients. Staff were proud to work at the practice and had a shared vision to deliver high quality care and their responsibilities in relation to it.

  • Leaders inspired and motivated staff to contribute the development of services for patients and were supported by management. The practice had a raft of policies and procedures to govern activity and held regular governance meetings. There was high staff retention and the leadership team working with staff to achieve this through flexible ways of working.

  • 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. For example, invested in a software risk management system, which enabled patient records to be analysed to produce risk profiles and target audit activity and health screening.

  • 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

  • There was innovative engagement with staff and patients. This was illustrated by several different ways the practice sought feedback, in person, using regular surveys and through three patient groups. All 48 patients involved in the inspection gave strongly positive feedback, which reflected the GP survey results and the practice’s own regular surveys.

  • There was a strong focus on continuous learning and improvement at all levels. Woodbury Surgery was a teaching practice providing placements for medical students and was working towards approval to provide placements for registrar GPs.

Checks on specific services

People with long term conditions

Outstanding

Updated 29 December 2016

The practice is rated as outstanding for people with long-term conditions in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • There was a holistic approach to assessing, planning and delivering care and treatment to people who had long term conditions and early interventions for those who could be at risk of developing them.

  • Anticipatory risk management provided timely interventions for patients who could be at risk of developing long term conditions.Examples seen included: the identification of at risk patients and led to timely diagnosis of coeliac disease so that they could receive appropriate support and treatment to manage this condition. The identification of and monitoring of patients who had previously had gestational diabetes for whom there was a known risk that they could go on to develop diabetes in later life.

  • Performance for diabetes related indicators was better than the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 94.5%. (CCG 89.2% and 88.3% national averages).

  • There was effective management all patient registers through it’s bespoke software to recall patients for review and had achieved lower exception reporting (Longer appointments and home visits were available when needed.

  • Woodbury Surgery facilitated access for patients and had brought several services closer to home, particularly for people living with chronic and life limiting conditions. For example, the practice ran a monthly clinic for patients with chronic renal disease which had specialist consultant and nursing input.

Families, children and young people

Outstanding

Updated 29 December 2016

The practice is rated as outstanding for families, children and young people in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • 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, in particular for children aged five years achieving 100% for these in 2015/16.

  • 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 practice’s uptake for the cervical screening programme was 87.5%, which was better than the CCG average of 82.5% 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

Outstanding

Updated 29 December 2016

The practice is rated as outstanding for the care of older people in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, practice nurses had carried out home visits to housebound patients to review their health and give flu vaccine.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The nursing team provided outreach services for housebound patients, regularly carrying out health and well being reviews of any patients with long term conditions.During the Autumn months, this also included an outreach flu vaccination service for thse patients.

  • GPs proactively managed patient risks providing responsive triage to determine the support patients needed when contacting the practice.For example followed up every telephone call to the practice within 30 minutes of the patient phoning to assess their needs.

Working age people (including those recently retired and students)

Outstanding

Updated 29 December 2016

The practice is rated as outstanding for working age people (including those recently retired and students) in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • 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. For example, an aortic aneurysm screening clinic was being held on the day of the inspection for eligible men aged 65 years.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 29 December 2016

The practice is rated as outstanding for people experiencing poor mental health (including people with dementia) in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • 90.6% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than to the national average of 84%.

  • Performance for mental health related indicators was better than the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93.7%. This was above average compared with the CCG (87.2%) and national averages (88.5%).
  • 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 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 29 December 2016

The practice is rated as outstanding for people whose circumstances may make them vulnerable in the Responsive and Well-Led domains; the ratings for these domains mean the population groups are also rated outstanding.

  • Services were tailored to meet the needs of vulnerable people and delivered in a way to ensure flexibility, choice and continuity of care.This was illustrated by:

  • Woodbury practice had effective management systems in place to proactively manage patients at risk of unplanned hospital admissions.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. For example, a flexible approach ensured that staff looking after patients, family members and carers were fully involved in assessment and planning of care for patients with complex learning disabilities.

  • The practice had developed a trusting rapport with traveller families and understood their culture needs.Six families and their extended families had returned to a temporary site each year to access health reviews for their children and parents and were registered at the practice.

  • The practice regularly worked with other health, social and third sector care professionals in the case management of vulnerable patients. For example, the practice worked in partnership with the third sector organisation ‘Neighbourhood Friends’ to provide and develop a range of supporting services for older, vulnerable patients registered at the practice. A prescriptions delivery service was due to start for vulnerable and isolated patients.

  • The practice informed and actively supported vulnerable patients needing to access various support groups and voluntary organisations. For example, vulnerable patients were provided a safe haven at the practice whilst escaping domestic abuse.

  • 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.