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West Hallam Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Hallam Medical Centre on 28 June 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents. All opportunities for learning from incidents were maximised.

  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit drove quality improvement in all areas of activity. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Resources were deployed to ensure individual patient healthcare needs were optimised. Data showed that the practice was performing highly when compared to practices nationally.

  • Patient feedback regarding care and treatment received was consistently positive.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice was involved in a new ways of working project, aimed at maximising GP time and efficiency.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements. Staff were passionate about their roles and responsibilities, they felt valued within the practice and feedback regarding leadership was consistently positive.

We saw areas of outstanding practice including:

Data which included Quality and Outcomes Framework (QOF) showed the practice consistently achieved high results across the areas of practice. These included those with long term conditions, older people and patients who had a learning disability. The practice did not exception report in some areas of practice or it was low when compared to CCG and national averages.

The practice proactively engaged with their patient population and understood their individual needs and requirements. This was demonstrated in quality monitoring activities such as a mental health audit and the identification of a large number of patients who had carers responsibilities.

The practice had introduced a new model of care in the delivery of its services which represented a move away from traditional GP led care. Staff with specialist skills had been recruited or upskilled within the practice. Patient health care needs were optimised by alignment with staff skill set and expertise. Patients, including those with long term conditions had benefitted from this new model of working and outcomes were evident. These included an increase in reviews being undertaken in 2015/16 for those patients with long term conditions.

Data showed that the practice’s emergency hospital admissions had continually decreased from March 2013 to February 2016. The practice had the lowest number of emergency admissions by locality across 18 practices within the CCG.

The practice worked in collaboration with four local practices on a project to drive improvement in care for older people and reduce emergency admissions from care homes. This had resulted in an 8% reduction in emergency admissions in the preceding 12 months.

However there was an area of practice where the provider should make improvement:

  • Consider whether dispensing ‘near misses’ should be recorded and a system put in place to learn lessons from these events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 October 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. All staff knew how to report incidents and a number of documents we were provided supported this assurance process.

  • Lessons were shared to make sure action was taken to improve safety in the practice. Detailed records included analysis of the events and risk assessment to reduce potential reoccurrence. Learning outcomes were shared in practice meetings.

  • When things went wrong patients received information, reasonable support, and a verbal or 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. This included infection control procedures and appropriate training of staff in safeguarding. Most systems were in place in relation to medicines management, but the systems for recording near misses to ensure learning could be strengthened.

  • Risks to patients were assessed and well managed. This included health and safety, ensuring sufficient staff in place to meet patient needs and suitable emergency procedures if a patient presented with an urgent medical condition.

Effective

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients. For example, audits were targeted at improving patient care in population groups which included older people and those with a mental health condition. The practice could demonstrate clear outcomes for these patients.

  • Data showed that the practice was consistently performing highly when compared to local and national practices. For example, in the Quality and outcomes framework (QOF) the practice received 99% of total points available. This was above the CCG average of 97% and national average of 95%.

  • The practice’s overall exception reporting was 6.4% which was better than the CCG average of 11.1% and national average of 9.2%. The practice had not exception reported any patients in some areas of activity. The practice staff told us they had identified with their individual patients’ needs and proactive engagement resulted in low exception reporting.

  • Proactive engagement was also evidenced in other areas such as the high achievement of annual health checks for those patients who had learning disabilities and the high uptake of the flu vaccination programme.

  • Staff worked regularly with multidisciplinary teams, including the attached care co-ordinator to understand and meet the range and complexity of patients’ needs. The practice had moved away from the traditional model of GP led care and utilised wider clinical resource to meet patient needs, whilst maintaining access to GP expertise when required. An outcome included an increase in the number of patients with long term conditions receiving reviews in 2015/16.

Caring

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for providing caring services.

We observed a strong patient-centred culture:

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. This included 94% of patients said the GP was good at listening to them compared to the clinical commissioning group (CCG) average of 90% and the national average of 89%. Data also showed that 100% of patients had confidence and trust in the last nurse they saw or spoke to compared to the CCG average of 97% and national average of 97%.

  • Patient comment cards completed showed that they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice sought to identify their patients’ needs and this was demonstrated in the high number of carers which were held on their register. We spoke with a representative from a local carers association who told us the practice were proactive and keen to provide these patients with additional help and support.

  • A variety of information for patients about the services available was easy to understand and accessible. This was also included on the practice website.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 4 October 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with four other local practices (known as the Belper 5) in planning how its services were provided. The practice had identified areas where they could strengthen their services provided responding to the specific needs of its patient population.

  • There were innovative approaches to providing integrated patient-centred care. The practice sought to ensure patient health care needs were optimised by alignment with staff skill set and expertise. This resulted in more GP appointments being made available for those patients with the most complex needs. CCG data we reviewed showed that the practice’s emergency hospital admissions had continually decreased from March 2013 to February 2016. The practice had the lowest number of emergency admissions by locality across 18 practices within the CCG.

  • Patients said they found it easy to make an appointment, including with a named GP. There was continuity of care, with urgent appointments available the same day. This was reflected in feedback from the national GP patient survey. For example: 97% of patients said the last appointment they got was convenient compared to the CCG average of 93% and national average of 92%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included disabled facilities, a hearing loop and translation services.

  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints received was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 4 October 2016

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

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. The practice undertook collaborative working with four other local practices in a GP cluster to identify where services could be improved. They then planned for new ways of working to maximise GP time and efficiency.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. All staff we spoke with told us they were involved in how the practice was run and that their skills were being fully utilised and developed. They praised the partners for their leadership ability.

  • The practice had an active patient participation group who met regularly to discuss the development of the practice and patient feedback obtained through surveys. We saw detailed records of meetings held which supported a collaborative approach to further develop the practice.

Checks on specific services

People with long term conditions

Outstanding

Updated 4 October 2016

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

  • National data showed the practice was performing in line with the local CCG average for its achievement within eleven diabetes indicators.The practice achieved92% of the available QOF points compared with the CCG average of 93%. Achievement was above the national average of 89%.

  • 100% of patients with chronic obstructive pulmonary disease (COPD) had received a confirmed diagnosis. This was above the CCG average of 92% and national average of 90%. None of these patients had been exception reported. The CCG exception reporting average was 11.5% and national average was 9.8%.

  • The practice had 2,153 patients with chronic diseases registered. All these patients were offered a structured annual review to check their health and medicines needs were being met.

  • The practice had adopted a new recall system and new model of working which aligned individual patient healthcare needs with the most appropriate clinician to meet their needs. Practice supplied data showed that 2,079 patients had received structured reviews within the last year although this data had not been verified and published. For those patients with the most complex needs, wider clinical staff worked together with the care co-ordinator to deliver a multidisciplinary package of care with access to a named GP when required. Recent data showed the practice was the lowest in the locality for emergency admissions into hospital.

  • The practice had recently recruited a prescribing pharmacist whose role involved the treatment of patients who had COPD and asthma flare ups.

  • The practice offered in house warfarin testing and spirometry for those patients who would benefit.

Families, children and young people

Good

Updated 4 October 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 for all standard childhood immunisations ranged from 93% to 98%. This was similar to CCG averages which ranged from 91% to 98%.

  • The practice had adopted a policy of following up any childrens missed appointments at the practice or at hospital to identify the reasons for non attendance.

  • 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.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw that joint working took place with midwives and health visitors, and any safeguarding concerns were routinely discussed at practice management meetings.

Older people

Outstanding

Updated 4 October 2016

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

  • The practice had participated in a CCG project aimed at streamlining the medical care offered to patients living in residential care homes. Identified outcomes included improved end of life care for patients and closer and more effective liaison with other health professionals, including care homes staff.

  • The practice undertook additional work which included training of care home staff so they felt confident and empowered to care for their patients’ needs with less reliance on the emergency services to assist. The practice also met with relatives of patients to raise awareness of health considerations and other associated issues. Feedback from care home managers was particularly positive. Data also showed an 8% reduction in emergency admissions in the preceding 12 months.

  • The practice participated in the ‘Belper 5’ project to enable collaborative working with other local surgeries to improve community care for patient, especially the frail elderly.

  • Quality and Outcomes (QOF) data showed the practice had achieved 100% of available points in osteoporosis indicators. Achievement ranged from 5% to 8% above GGC averages and exception reporting was between 10% and 16% lower than CCG averages.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had utilised the skills of a trainee advanced care practitioner to undertake these visits under supervision from the GP partner.

  • Data supplied by the practice showed that flu vaccination rates in 2015/16 for the over 65s were 82% (CCG average 73%) The practice ran flu clinics at a local community facility to encourage uptake and offer flexibility to patients.

Working age people (including those recently retired and students)

Good

Updated 4 October 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. Appointments could be booked from 8am to 6.30pm weekdays with an extended hours surgery on Wednesdays until 8.30pm.

  • As a result of the practice’s new model of working, GP appointment availability had increased, waiting times for urgent appointments decreased and the practice had noted a 50% reduction in those requesting a telephone consultation.

  • 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.

  • 88% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing above the CCG average of 84% and national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 October 2016

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

  • 91% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was similar to the CCG average of 92% and above the national average of 88%. None of these patients had been exception reported. CCG average for exception reporting was 20.9% and national average was 12.6%.

  • The practice had undertaken an audit to identify any patients with serious mental health problems who were not already included on the mental health register. Patients who were recorded on the register were highlighted for additional advice and treatment including various annual screenings. The audit identified 7 patients who were not included on the register and these patients were therefore included. A further 7 patients were highlighted for additional reviews.

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 85% and national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included patients with dementia residing in care homes and the CCG project that the practice participated in also directly benefitted these patients.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. A variety of information was provided to patients at the practice.

People whose circumstances may make them vulnerable

Outstanding

Updated 4 October 2016

The practice is rated as outstanding 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. There were 30 patients on the learning disability register, and all of these had received an annual health check in the last twelve months.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals including the care co-ordinator in the case management of vulnerable patients.

  • The practice had identified a high number of patients with carers responsibilities, 25% of the practice list size. The practice had engaged with a local carers organisation and provided a monthly clinic in the practice to offer help and support to carers.

  • 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.