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Inspection Summary


Overall summary & rating

Good

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sheldon Practice in Solihull on 20 January 2017. 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. The practice had identified, recorded and analysed significant events in order to identify areas of learning and improvement and so mitigate the risk of further occurrence.
  • There were arrangements to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
  • 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.
  • 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 the 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.
  • Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.
  • The practice had been through a period of change with an extension to the premises during 2016. Patients told us that services had been continuous during this period and staff had worked very hard to accommodate patients.
  • The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Staff spoke positively about the team and about working at the practice
  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2017

  • There were systems to monitor safety. These included systems for reporting incidents, significant events which included positive learning events, near misses, as well as comments and complaints received from patients. The practice had monthly meetings to discuss lessons learnt and implement action plans. Risk assessments were in place. This included health and safety risk assessments.
  • There was an effective system in place to ensure all alerts were reviewed and acted on appropriately, including alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA).

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
  • When things went wrong patients received a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • We observed the premises to be clean and tidy and we saw completed cleaning specifications to demonstrate that the required cleaning had taken place for each area of the practice.

Effective

Good

Updated 17 March 2017

  • Our findings at inspection showed that there were systems 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.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice took an active approach to joint working and engaged well with other health and social care services. This included a minor surgery service for patients registered with other providers in the locality.
  • Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average. The most recent published results (2015/16) were 98.8% of the total number of points available with an exception reporting rate of 4%.

Caring

Good

Updated 17 March 2017

  • Data from the national GP patient survey showed patients rated the practice lower than 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 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 17 March 2017

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and clinical commissioning group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day.
  • There were longer appointments available at flexible times for people with a learning disability and for patients experiencing poor mental health. Same day appointments were also available for children and those who needed to see a doctor urgently.
  • There were facilities for disabled patients and translation services available. The practice had a hearing loop in place and alerts were added to patients’ records.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Results from the national GP survey in July 2016 showed 81% of patients were satisfied with the surgery’s opening hours which was comparable to the local average of 74% and the national average of 76%.
  • 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.

Well-led

Good

Updated 17 March 2017

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff spoke positively about the team and about working at the practice.
  • 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.
  • The provider was aware of the requirements of the duty of candour. The GP 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 and had recently changed from a virtual group to holding regular meetings since August 2016.
Checks on specific services

People with long term conditions

Good

Updated 17 March 2017

  • 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 (2015/16) was 97% which was above the CCG average of 91% and national average of 90%.
  • The practice provided additional diabetic services including referrals to the diabetes prevention programme and insulin initiation.
  • Longer appointments and home visits were available when needed and patients unable to attend the practice, received reviews at home.
  • One of the nurses had trained as a nurse prescriber and could prescribe a range of medicines within their role as lead for chronic disease management.
  • All 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. We saw evidence that meetings were held every three months.
  • The provider offered services to support the diagnosis and monitoring of patients with long term conditions such as ambulatory blood pressure monitoring, 24 hour echocardiograms (ECG) and spirometry. Health promotion support was also available, for example smoking cessation was offered by the health care assistant.

Families, children and young people

Good

Updated 17 March 2017

  • 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 Accident & Emergency attendances.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children. The practice held safeguarding meetings every three months with the health visiting team.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every fortnight at the practice.
  • Childhood immunisation rates for under two year olds was comparable to the national average. The practice had achieved 90% which was comparable to the national target of 90%. Immunisation rates for five year olds ranged from 94% to 100% compared to the national average of 88% to 94%.
  • The practice had implemented a text messaging service commissioned by the clinical commissioning group (CCG) to remind patients of health checks and vaccination reminders.
  • The practice’s uptake for the cervical screening programme was 85% which was higher than the national average of 82%.

Older people

Good

Updated 17 March 2017

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • Data supplied by the practice showed nine patients were on the palliative care register and all had received a recent medication review.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were unable to attend the practice.
  • The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
  • The practice worked closely with multidisciplinary teams so patients’ conditions could be safely managed in the community.

Working age people (including those recently retired and students)

Good

Updated 17 March 2017

  • 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 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. This included smoking cessation advice by the health care assistant.
  • The practice offered extended opening hours on Monday evenings that would benefit patients of a working age.
  • The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2017

  • The latest published data from the Quality and Outcomes Framework (QOF) of 2015/16 showed 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The latest published data from the Quality and Outcomes Framework (QOF) of 2015/16 showed 100% of patients with mental health problems had had an agreed care plan. agreed between them and their Staff had a good understanding of how to support patients with mental health needs and dementia and a counselling service was held every fortnight to support patients.

People whose circumstances may make them vulnerable

Good

Updated 17 March 2017

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that of the 11 patients who were on the learning disability register, four had received their annual health checks and all patients had been issued with a hospital passport. (Hospital passports are designed to give hospital staff helpful information about illness and health).The practice sent regular appointments to patients and encouraged patients to attend their health review.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and held meetings with the district nurses and community teams every three months.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • A substance misuse support worker held sessions at the practice every two weeks.
  • 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.
  • The practice’s computer system alerted GPs if a patient was also a carer. There were 62 patients on the practice’s register for carers; this was 3% of the practice list. There was supportive information in place for carers to take away as well as information available through the practice website. The practice offered annual reviews and influenza vaccinations for anyone who was a carer.