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Fakenham Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fakenham Medical Practice on 23 March 2016. Overall the practice is rated as good

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

  • The appointment system was flexible and ensured that patients who requested to be seen on the same day were.
  • The practice had good facilities including disabled access. There were two lifts for those patients who could not manage the stairs.
  • Information about the services and how to complain was available. The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).
  • The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.
  • There were systems, policies and procedures to keep patients safe and to govern activity for example, infection control.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

We saw one area of outstanding practice;

  • The PPG with financial support from the practice published a quarterly newsletter which was delivered to the home of every patient (approx. 8000). The newsletter delivered in Winter 2015/16 contained information on data sharing and consent, an article on how health commissioners seek to reshape the local healthcare system and the medical conditions that the duty nurse can deal with.

The areas where the provider must make improvements are:

  • Ensure that risk assessments for fire safety are undertaken at both the main site and the branch site and that any identified actions are completed in a timely manner.

  • Review the management of medicines to ensure that patients are safe from harm. This must include ensuring that staff are working within their scope of practice and have the appropriate qualifications to prescribe medicines to patients.

  • Record the immunisation status for all clinical staff and review in line with the prevention of infection control policy to ensure that patients and staff are kept safe.

  • In addition the provider should;

  • Improve the clinical audits undertaken by completing the second cycle to ensure improvements have been implemented and embedded in practice.
  • Review the business continuity plan ensuring that information needed to manage major incidents such as power failure and emergency contact numbers is included.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 October 2016

We reviewed the actions taken by the practice in response to the requirement notice issued to them following the inspection on 23 March 2016. We found that safety systems had been improved.

Effective

Good

Updated 17 May 2016

The practice is rated as good for providing effective services.

Data from the Quality and Outcome framework 2014/2015 showed high exception reporting in some domains when compared with other practices in the locality. The practice met with the CCG, identified that the exception reporting policy had not been applied correctly, they developed a co-ordinated plan and reviewed. Practice data for 2015/2016 showed that, to date, improvements had been achieved.

Staff referred to guidance from the National Institute for Health and Care Excellence.

Staff had received training appropriate to their roles, any further training needs had been identified, and training was planned. There was evidence of appraisals and personal development plans for all staff.

Staff worked with multidisciplinary teams including community nurses, health visitors, care co-ordinator, and a mental health link worker for older people. The practice had 244 patients who had been identified as vulnerable and had, as a result of joint working, a written care plan held in their medical records.

There were 47 patients on the register for patients with learning disabilities, all of these patient’s had received an annual review.

Caring

Good

Updated 17 May 2016

The practice is rated as good for providing caring services.

The GP national patient survey data published in January 2016 showed that patients rated the practice in line with others for several aspects of care. For example, the percentage of patients who usually had an appointment or spoke with their preferred GP was 62% compared with the CCG average of 60% and the national average of 59%.

Patients told us they were treated with compassion, dignity, and respect and they were involved in care and treatment decisions. We saw that staff treated patients with kindness and respect and in a way that was individual to those patients that needed extra support. For example, the practice was large and over three floors, reception staff acted as guides and pushed wheelchairs for those who needed help.

Confidentiality was maintained. The practice demonstrated that they prioritised patient centred care.

The practice had identified 3% of their patients as carers and provided them with a carer’s pack which gave information including details of support groups.

Responsive

Good

Updated 17 May 2016

The practice is rated as good for providing responsive services.

Practice staff described how they were aware of the needs of their practice population, and tailored their care and services accordingly.

The practice had reviewed the demand for appointments and had developed a duty system using GPs and nurses to see patients on the day if requested. Telephone consultations and home visits were available when necessary. Dispensary staff delivered medicines for patients who were housebound.

Appointments were available at the branch site for those that lived closer; patients could also be seen at the main practice if needed.

At registration, the practice identified armed forces veterans; GPs had received a briefing on the specialist services that were available to them.

The premises were suitable for patients who had a disability or those with limited mobility, the practice provided wheelchairs for those that needed them.

There was a complaints system in place that was fit for purpose. The complaints received had been dealt with in a timely and appropriate manner.

Well-led

Good

Updated 17 May 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 this.

There was a clear leadership structure and staff felt supported by management.

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, this was not robust and there was a lack of oversight to ensure that risks were managed effectively to keep patients and staff safe.

The partners encouraged a culture of openness and honesty. The practice had systems in place for reporting safety incidents, investigating and taking action. Regular meetings were held to ensure shared learning.

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

There was a strong culture on continuous learning and improvement.

Checks on specific services

People with long term conditions

Good

Updated 17 May 2016

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

Nursing staff had roles in chronic disease management; data showed that patient outcomes were in line when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met. The practice held weekly meetings attended by GP, nurse and administration staff to ensure that patients received appropriate re-calls and follow up.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available if required. Practice staff followed up patients who did not attend their appointments by telephone.

Families, children and young people

Good

Updated 17 May 2016

The practice is rated as good for the care of families 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 patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

The practice website offered an excellent range of information for young people. The information contained links on where young patients could access help if needed as well as the services available in the practice.

The practice was part of the C-Card scheme; this scheme enabled young patients to access free condoms.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors, and school nurses.

Older people

Good

Updated 17 May 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. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care. The practice provided visits to local care homes.

The practice regularly reviewed attendances at the accident and emergency department to ensure that those patients identified as vulnerable to admission were reviewed.

We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs.

Working age people (including those recently retired and students)

Good

Updated 17 May 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, including 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 reflected the needs for this age group.

The practice did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them.

Telephone consultations were available for those patients who wished to seek advice from a GP. NHS health checks were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 May 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 multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Staff told us that 70.2% of patients with dementia had received advance care planning and had received an annual review. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

The practice was supporting a local initiative; a practice nurse was part of the steering group which hoped to develop Fakenham into a Dementia friendly community.

People whose circumstances may make them vulnerable

Good

Updated 17 May 2016

The practice is rated as good for the care of those whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered longer appointments and carried out annual health checks.

The practice performance for the number of patients with learning disabilities that had received an annual review was 100%.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them.