You are here

Haden Vale Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haden Vale Medical Practice on 28 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. However, learning was not always shared with all staff members.
  • 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.
  • Most 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.

We saw one area of outstanding practice:

The practice employed an ‘elderly social care co-ordinator’ who organised coffee mornings every two weeks and trips away. We saw that a group of patients had gone away during Christmas and another residential event was planned for the summer. The elderly care co-ordinator also acted as an advocate to access other social services and visited patients in their homes. Some patients told us that the social events and coffee mornings helped them deal with bereavement and other issues they had experienced. They told us that the activities of the care co-ordinator had made a positive impact on their physical and mental wellbeing as they could access peers for support through the activities organised.

The areas where the provider should make improvement are:

  • Ensure learning from all incidents, significant events and complaints are shared appropriately with staff to prevent re-occurrence

  • Ensure emergency equipment is being checked regularly to confirm they are in working order.

  • Ensure practice performance for diabetes and mental health related indicators are improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 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. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Evidence looked  at showed lessons were shared to improve safety in the practice for some incidents. The practice had 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. Equipment was regularly serviced and maintained through external contractors. However, emergency equipment was not regularly checked to confirm they were in working order.

Effective

Good

Updated 7 July 2016

The practice is rated as good for providing effective services. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages for most domains. 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.

Caring

Good

Updated 7 July 2016

The practice is rated as good for providing caring services. Results from the national GP patient survey showed patients rated the practice comparable to other practices locally and nationally 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 employed an elderly care co-ordinator who organised regular coffee morning and social events. They visited patients at home and also acted as an advocate to access other social services. Information for patients about the services available was easy to understand and accessible. We observed a friendly atmosphere throughout the practice during our inspection. We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 7 July 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. For example, the practice was taking part in the Primary Care Commissioning Framework (PCCF), a CCG initiative to help deliver improvements in clinical outcomes for patients. Most 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. To improve access and reduce delays the practice had introduced a telephone triage system. 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. However, learning from complaints was not regularly shared with staff.

Well-led

Good

Updated 7 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. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff meetings. The practice taught medical students and had a vision to become a teaching practice for trainee GPs. As part of the vision to improve and offer more services the practice had plans in place to extend the premises.

Checks on specific services

People with long term conditions

Requires improvement

Updated 7 July 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice had recently employed a nurse and they had a lead role in chronic disease management such as diabetes and COPD. We saw that achievement for diabetes and COPD indicators were significantly lower compared to local and national averages. The GPs carried out reviews for diabetes and COPD before the nurse started. We were told that although reviews were being carried out they were not always recorded and were not as structured.

Longer appointments for conditions such as diabetes were available and home visits were available when needed. 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.

Families, children and young people

Good

Updated 7 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. The practice offered a full family planning service and offered coil and implants service. 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 and health visitors.

Older people

Good

Updated 7 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 and had a range of enhanced services, for example dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice employed an elderly care co-ordinator who also visited patients in their homes and acted as an advocate to access other social services. They organised coffee mornings every two weeks for the elderly and their carers. Records we looked at showed that it was well attended with 20 or more people attending. The coffee morning was subsidised by the practice. The elderly care co-ordinator also organised other social events. For example, during Christmas a group of patients had gone to Devon for four days and this was organised by the care co-ordinator.

The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital. These patients were reviewed and care plans developed to reduce the need for them to go into hospital.

Working age people (including those recently retired and students)

Good

Updated 7 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. For example, the practice operated extended hours service which was useful for parents with children and those who worked. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information was made available at the practice to sign post patients to various support groups and services. This was also available on the practice website. 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.

Data we looked at showed that the practice achievement for mental health QOF indicator was significantly lower. We were told that the practice found it difficult to engage some patients and the practice did not have a nurse for a significant period which also contributed to this.

People whose circumstances may make them vulnerable

Good

Updated 7 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 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.