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Grovelands Medical Centre Good Also known as Dr D.A. Riley & Partners

Inspection Summary


Overall summary & rating

Good

Updated 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grovelands medical centre on 8 September 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.
  • All staff had received safeguarding relevant to their role and had also attended extra domestic abuse training due to the high levels of abuse cases within the local community.
  • 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.
  • The practice used innovative and proactive methods to improve patient outcomes. For example, reception staff were given extra training in talking to young patients about contraception in a discreet manner.
  • 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 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.

The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 November 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.

  • The practice had the necessary equipment for dealing with emergencies, although the management of emergency medicines could cause delays if they were needed.

  • Recruitment checks were conducted in line with current legislation.

Effective

Good

Updated 11 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were average compared to the national average.

  • Performance for osteoporosis related indicators was 100% compared to the local average of 61% and the national average of 81%.

  • Performance for dementia related indicators was 100% compared to the local average of 96% and the national average of 95%.

  • 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 a system to identify when staff had training and when it would need to be updated. Staff were given protected time to complete training.

  • 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.

  • The practice held regular sessions designed to improve public health outcomes, including Live well, contraception, travel and chronic disease clinics.

Caring

Good

Updated 11 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for some 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 11 November 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 (CCG) to secure improvements to services where these were identified. For example, the practice took part in the local stop smoking scheme and were in the top three performing surgeries in Berkshire.
  • The practice also participate in a scheme to improve the identification and support for patients who are at risk of female genital mutilation
  • 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.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 11 November 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 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 strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 11 November 2016

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

  • The lead GP and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was 93% which was higher than the clinical commissioning group (CCG) average of 80% and national average of 89%.

  • Longer appointments and home visits were available when needed

  • All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the lead GP worked with relevant health and care professionals to deliver a multidisciplinary package of care

  • The practice participates in the clinical commissioning group complex case management scheme which provides proactive care for those at highest risk of emergency admission.

  • Long term condition review clinics were held by the practice nurses. The nurses are trained in management of chronic obstructive pulmonary disease, cardiovascular disease, asthma and diabetes (including insulin initiation).

  • Performance for chronic obstructive pulmonary disease (COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (96%) and higher when compared to the national average (96%).

Families, children and young people

Good

Updated 11 November 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.

  • The practice were fully involved with safeguarding procedures. They held regular meetings with health visitors and had provided training in female genital mutilation and domestic abuse in response to their population.

  • Childhood immunisation rates for the vaccinations given was comparable to the CCG average. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from % (CCG average 81% to 93%) and five year olds from (CCG average 81% to 92%).

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice’s uptake for the cervical screening programme was %, which was comparable to the CCG average of and the national average of 82%.

  • 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, health visitors and school nurses.

  • The practice provides a range of in-house contraceptive services. Reception staff were given further training in communication with younger patients who may require access to contraception advice. This enabled them to offer an appropriate appointment in a discreet manner.

Older people

Good

Updated 11 November 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.

  • The practice worked with multi-disciplinary teams in the care of older vulnerable patients.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. For example, the number of emergency admissions per 1,000 population was 14, compared to the CCG average of 12 and the national average of 14.
  • 100% of patients aged 50 or over (and who have not attained the age of 75) with a fragility fracture and confirmed diagnosis of osteoporosis, were currently treated with an appropriate bone-sparing agent. This was higher when compared to the local clinical commissioning group average (61%) and national average (81%).

  • Immunisation campaigns for the elderly such as flu, shingles and pneumonia were advertised through posters, messages on prescriptions, website updates and letters, with follow up phone calls to those who have not attended.
  • The practice works closely with community matrons and care co-ordinators to promote better health.

Working age people (including those recently retired and students)

Good

Updated 11 November 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 surgery offered extended pre-bookable appointments on a Saturday.

  • 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 practice uses IT to improve access for patients. Including online appointment booking, automated 24 hour telephone booking and cancellation of appointments. Text reminders are used to encourage attendance at appointments and to remind patients of series such as flu clinics.

  • The practice’s uptake for the cervical screening programme was 81%, which was higher than the CCG average of 78% and the national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 November 2016

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

  • 86% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local average of 84% and the national average of 84%.

  • 92% of patients with a severe mental health issue who had a comprehensive, agreed care plan documented in the last 12 months, which was comparable to the local average of 90% and 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.

  • Proactive dementia screening was undertaken for at risk patients.

  • 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 administration team regularly recall patients for mental health checks and offer reminder calls on the day of appointment for those with dementia.

People whose circumstances may make them vulnerable

Good

Updated 11 November 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 patients, travellers and those with a learning disability.

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

  • The practice had completed 71% of learning disability health checks, which is above the national average of 44%.

  • The practice offers weekly visits to a learning disabilities residential unit for those unable to attend the surgery.

  • The practice had told vulnerable patients about how to access various support groups and voluntary organisations.

  • GPs worked within a multi-disciplinary team to ensure the best outcomes for vulnerable patients.

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

  • GPs were trained in drug addiction to enable them to support patients in-house. Weekly contact with drug and alcohol services is maintained to ensure prescribing is appropriate and meets the patient’s needs.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.