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Inspection Summary


Overall summary & rating

Good

Updated 30 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Field Surgery on 9 November 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. The practice engaged proactively with the patient participation group (PPG) and had established a system whereby a member of the PPG would be involved with interviews for clinical posts.

  • The practice had identified a higher than average number of patients with multiple long term conditions and responded to this issue in 2013 by developing a tailored recall programme to better structure care and reduce the need for multiple visits each year. This was prior to the House of Care approach being rolled out as a CCG initiative.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 November 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 30 November 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 had identified a higher than average number of patients with multiple long term conditions and responded to this issue in 2013 by developing a tailored recall programme to better structure care and reduce the need for multiple visits each year. This was prior to the ‘House of Care’ approach being rolled out as a CCG initiative.

Caring

Good

Updated 30 November 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.

Responsive

Good

Updated 30 November 2016

The practice is rated as good 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. For example; the practice worked with 10 other practices to provide an extended hours ‘hub’ service from 8am to 4pm on weekends and Bank Holidays.
  • The practice had adopted the local extended hours initiative, providing appointments from 8am until 8pm Monday to Friday.
  • 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.
  • Patients could access telephone appointments if they were unable to attend the practice in person.
  • 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.
  • The practice had developed a long term conditions recall process aiming to recall patients in a more structured way and eliminate unnecessary visits to the surgery.
  • The practice was involved in the ‘Pharmacy First’ scheme and sign-posted patients as an alternative to a GP appointment. The ‘Pharmacy First’ scheme was aimed to encourage people to go to their local pharmacy for self-care advice on a range of minor ailments.
  • The practice offered a range of online services including booking appointments, ordering repeat prescriptions and viewing medical records. These services were well utilised by the practice with 38% of patients signed up for online access.
  • The practice were involved in the electronic prescription service with 40% of patients having a nominated pharmacy and over 70% of repeat prescriptions being issued electronically directly to the pharmacy. This made the process of obtaining medication simpler for patients.
  • The practice website was designed and maintained by a GP partner at the practice, this was regularly monitored to make sure relevant information was available to patients.
  • The practice operated social media and video sharing websites to provide information to patients and receive feedback from them.

The practice hosted a number of services for patient convenience. For example; vasectomy and ultrasound services.

Well-led

Good

Updated 30 November 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 30 November 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.
  • Performance against diabetes related indicators was better than the CCG and national averages. For example; 96% of patients with diabetes, on the register, had a record of a foot examination and risk classification. This was better than the CCG average of 88% and national average of 89%.
  • 100% of patients newly diagnosed with diabetes, on the register, had a record of being referred to a structured education programme within 9 months after entry onto the diabetes register. This was better than the CCG average of 89% and national average of 92%.
  • 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 identified a higher than average number of patients with multiple long term conditions and responded to this issue in 2013 by developing a tailored recall programme to better structure care and reduce the need for multiple visits each year. This was prior to the ‘House of Care’ approach being rolled out as a CCG initiative.
  • The practice introduced personalised care plans for patients with diabetes, chronic obstructive pulmonary disease (COPD), dementia and asthma. This was aimed at helping patients to be involved in ownership and management of their condition. COPD is the name for a group of lung conditions that cause breathing difficulties.
  • The practice was involved in the avoiding unplanned admissions scheme which identified the 2% of the patient list who were most at risk of unplanned hospital admission and ensured care plans and interventions were in place to reduce this risk.

Families, children and young people

Good

Updated 30 November 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 accident and emergency (A&E) attendances.
  • The practice ran a childhood immunisations recall system and immunisation rates were relatively high for all standard childhood immunisation.
  • 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 84%, which was better than the CCG average of 79% and the national average of 82%
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered emergency appointments and any child requiring emergency treatment would be seen the same day.
  • The practice hosted a midwife run antenatal care clinic.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 30 November 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 urgent appointments for those with enhanced needs.
  • The practice employed a clinical co-ordinator whose role involved co-ordinating care plans from the unplanned admissions service and liaising with carers regarding patient care.
  • The practice operated daily home visits by a variety of staff including GPs, practice nurses, health care assistants and the clinical care coordinator.
  • All patients had a named GP and the practice encouraged continuity of care where possible.
  • The practice hosted a memory clinic every week and staff within the practice had received training through the ‘Dementia Friends’ scheme.
  • The practice hosted and supported abdominal aortic aneurysm (AAA) screening. AAA screening is a way of detecting a dangerous swelling of the aorta.

Working age people (including those recently retired and students)

Good

Updated 30 November 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. These were utilised by patients at the practice, with 38% of patients registered to use online services.
  • The practice promoted the electronic prescriptions service, resulting in 40% of patients having a nominated pharmacy and over 70% of repeat prescriptions being sent electronically. This made the process of obtaining medication simpler for patients.
  • Appointments were available outside of working hours and this included weekends and Bank Holidays.
  • Patients could access telephone appointments if they were unable to attend the practice in person.
  • The practice operated social media and video sharing websites to provide information with patients and receive feedback.
  • The practice offered NHS health checks to all patients aged between the ages of 40 and 74

People experiencing poor mental health (including people with dementia)

Good

Updated 30 November 2016

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

  • 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 87% and national average of 84%.
  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan, documented in the record, in the preceding 12 months. This was higher than the CCG average of 85% and national average of 89%.
  • 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.
  • The practice hosted a memory clinic to provide patients with care closer to home.
  • The practice worked in conjunction with the community mental health team to provide injectable treatments for patients with schizophrenia and other psychoses.

People whose circumstances may make them vulnerable

Good

Updated 30 November 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 had a recall system in place for patients with learning disabilities and nominated staff to assist patient attendance including their carers.
  • The practice offered longer appointments for patients with a learning disability and a side room was available for patients to use if they did not feel comfortable in the waiting area.
  • 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.
  • 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 was equipped to meet patient’s needs; all areas were wheelchair accessible and there was a hearing loop installed on reception.