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Stamford House Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 17 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stamford House Medical Centre on 1 July 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, including those relating to recruitment checks.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the impact of the work carried out by the over 75’s Champion and the success and roll out of patients access to medical records online.

  • Data showed patient outcomes were in line with or above those locally and nationally.
  • Feedback from patients about their care was consistently and strongly positive.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they found it easy to make an appointment and that 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 areas of outstanding practice, including:

The practice employed an over 75’s Champion whose role was to contact all patients over 75 years to meet where appropriate in the patients home to assess needs and provide advice and support to patients and carers, including referrals to social care and community voluntary organisations. Evidence of the impact of this work included adaptations within patients homes to reduce the risk of falls and referrals to local voluntary organisations to reduce isolation both of which helps the practice reduce unplanned hospital admissions.

The practice had introduced full patient access to their medical records. An initial roll-out with the PPG was undertaken to identify problems and errors before inviting 1% of patients to access their records. Patients were provided with one to one consultations with a GP specialisng in patient access to understand the records and navigate the system. Initial feedback from those patients using the system were positive with examples of patients accessing results prior to consultations and feeling more empowered. The practice is continuing to promote patient access and recruit more patients.

The Health care assistant (HCA) ran a weekly walking group for staff and patients. Outcomes showed both improved physical health but also emotional well-being. The HCA was looking to do two walks per week as the uptake increased.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 August 2016

The practice is rated as good for providing safe services.

  • There were systems in place for reporting and recording significant events
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and 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 people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 17 August 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 17 August 2016

The practice is rated as good for providing caring services.

  • We observed a strong patient-centred culture
  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Data showed that patients rated the practice in line with others 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.
  • Information for patients about services available was easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect and maintained confidentiality.

Responsive

Outstanding

Updated 17 August 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
  • There were innovative approaches to providing integrated patient-centred care. For example:

    • adding additional surgeries to meet needs,
    • providing a range of extended services in house and
    • providing additional support to those patients over 75 years of age.

  • The practice employed an over 75’s Champion whose role was to contact all patients over 75 years (currently 206 patients of which contact has been made with 188) to meet, where appropriate, in the patients home to assess needs and provide advice and support to patients and carers, including referrals to social care and community voluntary organisations. Patients could access appointments and services in a way and at a time that suited them. This included an open morning surgery, Monday to Friday.
  • Telephone consultations were readily available and home visits, including the phlebotomy service, were provided to house bound patients.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.
  • The practice carried out satisfaction survey of patients attending for minor surgery and results of the 20 sample surveys audited in 2015 showed100% found the consultation to be very useful and 100% felt comfortable having the procedure done at Stamford House Surgery.
  • 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 August 2016

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

  • There was a 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. 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 knowing about notifiable safety incidents
  • The practice proactively sought feedback from staff and patients, which it acted on.
Checks on specific services

People with long term conditions

Good

Updated 17 August 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.
  • Where appropriate patients with more than one long-term condition were able to access a joint review to prevent them having to make multiple appointments.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For patients with complex needs, a named GP and practice nurse worked with relevant community and healthcare professionals to deliver multidisciplinary support and care. Multidisciplinary meetings were held to review patients’ needs and to avoid hospital admissions.
  • Patients with COPD and asthma had self-management plans and access to medication at home for acute exacerbations and were directed to a structured education programme. The practice offered referral to Self-Management UK to provide in-house 6 week support courses for patients with long term conditions.

Families, children and young people

Good

Updated 17 August 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.
  • 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 good examples of joint working with midwives and health visitors. A midwife held antenatal clinics weekly.
  • A contraceptive service including the fitting of contraceptive coils and implants was available for patients.

Older people

Outstanding

Updated 17 August 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. Patients wherever possible were booked appointments with their GP to ensure continuity of care. Evidence from the practice showed continuity of care had improved as a result.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Nursing and residential homes had an allocated GP and nurse, whenever possible these staff responded to patients’ needs within the home to ensure continuity of care.
  • The practice employed an over 75’s Champion whose role was to contact all patients over 75 years (currently 206 patients of which contact has been made with 188) to meet, where appropriate, in the patients home to assess needs and provide advice and support to patients and carers, including referrals to social care and community voluntary organisations.
  • The practice embraced the Gold Standards framework for end of life care. This included supporting patients’ choice to receive end of life care at home.

Working age people (including those recently retired and students)

Good

Updated 17 August 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 were available outside of normal working hours, with two evening surgeries and two early morning surgeries.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 August 2016

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

  • 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.
  • 100% of patients with poor mental health had a comprehensive care plan documented in the record agreed between individuals, their family and/or carers as appropriate. Exception reporting was comparable to the CCG average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • It carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. The practice promoted self-referral to the local “Healthy Minds” service.
  • It had a system in place to follow up patients who may have been experiencing poor mental health and had attended accident and emergency.
  • Staff had a good understanding of how to support people with mental health needs and dementia.
  • The practice were contracted by the local CCG to provide a weekly mental health ward round at the local hospital ensuring inpatients primary care needs are being met. As part of patients discharge plans they would also attend appointments at the practice.

People whose circumstances may make them vulnerable

Good

Updated 17 August 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 nurse liaised with the local Specialist Needs Nurse to ensure the register of patients with learning disabilities was accurate and helped to signpost patients and their carers should they require additional support.
  • Vulnerable patients were identifiable with alerts noted on the secure computer system to ensure staff were alerted to needs.
  • Annual reviews were provided for patients with learning disabilities, using a nationally recognised tool. -
  • The practice was proactive in monitoring those patients identified as vulnerable or at risk. This included, monitoring A&E attendances, monitoring missed appointments from those known to be vulnerable and working with other services to ensure, where appropriate, information was shared to keep patients safe.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice provided primary care to residents of a local supported home which helped residents to tackle the issues that may prevent someone from sustaining independent living. The practice worked with support staff at the home to ensure that residents registered with the practice needs were met.
  • 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.