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Hollinswood and Priorslee Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 7 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Hollinswood and Priorslee Medical Practice on 4 February 2016. The overall rating for the practice was Good, with the Well Led key question being rated as Requires Improvement. We found one breach of a legal requirement and as a result we issued a requirement notice in relation to:

  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

The full comprehensive report from the inspection on the 4 February 2016 can be found by selecting the ‘all reports’ link for Hollinswood and Priorslee Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 6 July 2017. Overall the practice is now 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 improvements had been made to the system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available.
  • Patients commented that there were challenges around making appointments. Patients said they did not always know which site to attend for their appointment and were unaware of the availability of extended hours appointments two evenings a week.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas of practice where the provider should make improvements.

The provider should:

  • Formalise and record clinical supervision which takes place between the nurse practitioner and GP.
  • Obtain a Disclosure and Barring Service (DBS) check pertaining to the current employment for the Advanced Nurse Practitioner.
  • Consider obtaining portable oxygen cylinders or a means of transporting the current cylinders around the building.
  • Ensure all staff are up to date with their required training.
  • Ensure that staff have access up to date policies that have been reviewed.
  • Review the GP survey results and identify action to improve patient satisfaction scores for consultations and interaction with the GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 August 2017

The practice is rated as good for providing safe services.

  • Improvements had been made to the system in place for managing and reviewing significant events.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety. Risk assessments had been completed for all three sites and included fire risk assessments and infection control audits.
  • Staff demonstrated that they understood their responsibilities although not all staff had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents. However, the oxygen cylinders were not easily transportable around the buildings.
  • The advanced nurse practitioner received mentorship and support and the lead GP reviewed a random sample of their consultations and provided feedback. However the feedback was not recorded.

Effective

Good

Updated 7 August 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the national average.
  • Staff were aware of current evidence based guidance and guidance was discussed at clinical meetings.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff. Staff said they were supported to develop their skills by the practice.
  • Not all staff had completed their required training updates.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 7 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice lower than others for satisfaction on consultations with GPs but were comparable for consultations with nurses.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment when they were seen by the nursing team but less so when they were seen by GPs.
  • Information for patients about the services available was accessible. Information about the availability of interpreting services was on display at all three sites.
  • We saw staff treated patients with kindness and respect.
  • We saw that patients were offered support following a bereavement.

Responsive

Good

Updated 7 August 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. The services were planned and delivered to take into account the needs of different patient groups and to help provider flexibility, choice and continuity of care.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients commented that there were challenges around making appointments. Patients said they did not always know which site to attend for their appointment and were unaware of the availability of extended hours appointments two evenings a week.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and evidence from three examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 August 2017

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. The practice aims were developing to take into account the changes in practice following the merger and the continual changes with the primary care setting.
  • Improvements had been made to the management structure within the practice. There was a clear leadership structure and staff felt supported by management.
  • The practice had policies and procedures to govern activity and had introduced a structured plan for meetings.
  • Improvements had been made to the governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities, although priority needed to be given to ensuring all staff were up to date with their training.
  • The provider was aware of the requirements of the duty of candour. In two examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. For example the practice nurses had identified an unmet need as they only offered morning appointments and patients regularly requested appointments in an afternoon. As a consequence the practice had introduced afternoon appointments.
Checks on specific services

People with long term conditions

Good

Updated 7 August 2017

The practice is rated as good for the care of people with long-term conditions.

  • The GPs had special interests in diabetes, cardiology and respiratory medicine.
  • Performance for diabetes related indicators was similar or above the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 88% compared with the CCG average of 75% and national average of 78%.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The practice had a structured system for inviting patients for their review or identifying patients who did not attend.
  • For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 7 August 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Systems were in place to follow up children who did not attend out patients appointments.
  • Immunisation rates were high for all standard childhood immunisations.
  • Priority was given to children for same day or next day appointments.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives and health visitors to support this population group.

Older people

Good

Updated 7 August 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Working age people (including those recently retired and students)

Good

Updated 7 August 2017

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

  • 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 needs of these populations 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 extended hours between 6.30pm and 8pm on Tuesdays at the main site and on Wednesdays at the Priorslee branch site.
  • The practice offered all patients aged 40 to 75 years old a health check with the nursing team.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 August 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited for an annual review of their physical health needs.
  • The percentage of patients experiencing specific mental health conditions with an agreed care plan documented in the preceding 12 months was 94% compared to the local CCG average of 91% and national average of 89%.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The patients had access to a counsellor working from the premises, enabling ease of access.
  • The practice proactively managed patients that presented to the emergency department with mental health conditions. When the practice received a notification from the emergency department, crisis team or mental health outreach team, the GPs followed up and reviewed the patient as appropriate.

People whose circumstances may make them vulnerable

Good

Updated 7 August 2017

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 had identified 29 patients on the learning disability register, who were invited to attend for an annual review.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.