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School Hill Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at School Hill Medical Practice on 20 April 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. However, two of these areas required improvement and applying consistently including monitoring staff training requirements and recruitment checks.
  • Staff assessed patients’ needs and delivered care in line with current evidence based 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients could get same day appointments but some told us they experienced difficulties accessing the practice by telephone and making an appointment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice staff worked hard to overcome the restraints placed upon them due to working in a listed building.
  • 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.

  • We saw two areas of outstanding practice:

  • A GP, who specialised in sexual health, attended local secondary schools to discuss sexual health issues with year 9 pupils (13-14 years of age). This GP also attended “relationship days” and “Fresher’s” week at a local college. The practice operated a sexual health clinic available to all patients between 16 and 25 years of age within the CCG area.

  • The practice had started a dermatology clinic which allowed patients from any GP within the Clinical Commissioning Group area to be referred to for treatment. A feature of this clinic was tele-dermatology, this services was offered so that advice could be given on some conditions by viewing photographs of the affected skin area.

The area where the provider should make improvements are:

  • To ensure appropriate training for staff is completed and monitored and to ensure time frames for re-training are met. This includes training in respect including fire safety, manual handling, health and safety, the mental capacity act, safeguarding children and adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 July 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 except in regard of maintaining records of recruitment checks prior to starting employment and the practice did not keep on file information that had been used to satisfy the recruitment checks.

Effective

Good

Updated 20 July 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 although some role specific training was not up to date.
  • 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 20 July 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 20 July 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice had recently started a dermatology clinic which allowed patients from any GP within the Clinical Commissioning Group (CCG) to be referred to for treatment.
  • There are innovative approaches to providing integrated patient-centred care. The practice provided a sexual health clinic for patients aged 16 to 25 years of age. This clinic was accessible to patients who were not on the practice list.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
  • Patients can access appointments and services in a way and at a time that suits them.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice staff worked to overcome the difficulties that the listed building presented to them, for example, a GP would move to an alternative consulting room if a patient was unable to utilise the stairs.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 20 July 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. However, governance of areas such as recruitment and monitoring staff training requirements required some improvement.
  • 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 focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 20 July 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.
  • Data from 2014/15 showed the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% compared to the national average of 88%.
  • 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.
  • Practice nurses conducted home visits for routine annual reviews for those patients who were house bound.
  • Routine reviews were combined into one longer appointment for those with several chronic conditions to avoid multiple appointments.
  • Specific diabetes clinics, run by two GPs, where patients were seen by a nurse initially before consulting a GP to cover all of their annual review needs in one appointment.

Families, children and young people

Good

Updated 20 July 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.
  • Data from 2014/15 showed the percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82%. This was the same as the national average.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Unwell children were always seen on the day when appropriate.
  • We saw positive examples of joint working with midwives and health visitors.
  • A GP, who specialised in sexual health, attended local secondary schools to discuss sexual health issues with year 9 pupils (13-14 years of age). This GP also attended “relationship days” and “Fresher’s” week at the local college. In addition to this, the practice held a clinic on a Tuesday afternoon for patients aged between 16 and 25 years of age for all sexual health matters. This clinic was called ‘The circle room’. Approximately 70% of patients who attended this clinic were not on the practice’s patient list. The clinic was provided by a multi-disciplinary team consisting of a GP, nurse and healthcare assistant.
  • The sexual health clinic had been recognised for two awards. The GP Enterprise Award in 2011and the Cathy Harman award for innovation in sexual health by the British Association for Sexual Health and HIV (BASHH 2012). This clinic continued to have patients referred to it from neighbouring practices.
  • In response to patient feedback the practice no longer held specific immunisation clinics for children and allowed these to be booked throughout the week to be more convenient for patients. Parents who did not attend for childhood immunisations were contacted by letter and offered an appointment with a GP to discuss any concerns.
  • The practice had obtained “You’re welcome” status. This was a quality criteria organised by the Department of Health and laid out ten principles for providing health services that met the needs of young people.

Older people

Good

Updated 20 July 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 home visits and urgent appointments for those with enhanced needs.
  • Home visits were also available in the evening should the patient need this.
  • A named GP was in place for each nursing home that the practice had patients in. A monthly visit was made to the two largest care homes.
  • All patients in residential care homes had had a discussion with a GP detailing their resuscitation and place of care wishes.
  • The practice held monthly multidisciplinary team meetings with District Nurses and palliative care nurses.
  • GP’s had a clinical meeting every lunchtime. Visits were assigned and patients of concern were discussed- this helped to ensure continuity of care and enabled GPs to obtain advice from other doctors.
  • The practice had recently started a dermatology clinic which allowed patients from any GP within the Clinical Commissioning Group (CCG) to be referred to for treatment. This clinic also offered a tele-dermatology service to enable advice to be given for some skin conditions using photographs alone.

Working age people (including those recently retired and students)

Good

Updated 20 July 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.
  • Telephone appointments were available where appropriate.
  • The practice had extended hours on Monday, Wednesday and Thursday evenings until 7pm and Tuesday mornings from 7.45am. There were also extended appointments available every Saturday morning from 8.15am to 10.30am.
  • A GP offered a sexual health clinic.
  • The practice ran smoking cessation clinics and offered appropriate NHS health checks.
  • The practice offered online appointment booking and prescription requests in addition to a messaging service for on-going issues.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 July 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 better than the national average of 84%.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, this was better than the national average of 88%.
  • 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 screened all patients over 65 for memory issues at routine long term health condition reviews.
  • Patients experiencing poor mental health had been given a named GP for continuity of care.

People whose circumstances may make them vulnerable

Good

Updated 20 July 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.
  • 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.
  • Patients who suffered from either sight or hearing impairments were flagged on the computer system so that they could be assisted accordingly.
  • Patients with learning difficulties had an annual assessment with a nurse and a GP.