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Abbey Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbey Medical Centre on 27 October 2016. The overall rating for this service is outstanding.

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

  • There was a system to raise concerns and report significant events. Staff understood their responsibilities to raise concerns and to report significant events. These were discussed regularly at meetings and were a standing agenda item. Learning was shared with practice staff regularly and with other practices in the locality.
  • Patients’ needs were assessed and care was provided to meet those needs in line with current guidance.
  • Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
  • Risks to patients were assessed and well managed through practice meetings and discussions with the multi-disciplinary team. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Information about safety alerts was reviewed and communicated to staff in a timely way.
  • Patients told us GPs and nurses at the practice treated them 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 in the reception area and on the practice website.
  • The practice had suitable facilities and was equipped to treat patients and meet their needs. This included easy access for patients who used wheelchairs.
  • There was a clear leadership structure and staff told us they felt supported by the management team.
  • The practice had an active Patient Participation Group (PPG) and proactively sought feedback from patients, which it acted on. Staff were committed and motivated to deliver high standards of care and there was evidence of team working throughout the practice.
  • GPs used their specialist skills in areas such as minor surgery and dermoscopy (to assess all skin lesions) which resulted in the practice being low referrers to secondary care. Referral figures from 2013 to 2016 showed a reduction in dermatology referrals of 20%. The referral figures to secondary care for the same period showed an overall 40% reduction.
  • Five nurses at the practice were trained to provide appropriate diabetes management clinics. They provided an annual total of 3280 appointments with 450 home visits to patients to ensure treatment was monitored.
  • Age UK carried out assessments for housebound patients who were at risk of social isolation and loneliness either by telephone or through home visits. An administrator was employed by the practice to liaise with both patients and Age UK. The practice had made 116 over 75 assessments in the last 6 months and referred 35 of these patients to Age UK for further support.
  • The practice had engaged with patients, the PPG and patient volunteers to assess available transport options to and from the practice and parking facilities. A travel plan was devised which also encouraged patients to walk, cycle or consider car sharing when accessing the practice, encouraging patients to increase their exercise and consider a healthier and greener way of living.
  • Patients with a newly diagnosed long term condition were referred for educational meetings and clinics to help them manage their condition.
  • The practice offered combined appointments to enable first baby checks, initial immunisations and postnatal assessments for mothers to be carried out in one visit.
  • The practice had a comprehensive audit programme in place which demonstrated a quality monitoring and improvement process for all services they provided which included clinical and non-clinical areas.

We saw several areas of outstanding practice including:

  • The practice had extended the building to provide four new consulting rooms, a large administration area and an enlarged and improved waiting room to cater for the future rise in the local population. The practice had managed the build and maintained service provision while ensuring the continued safety of patients and staff.
  • The interior decoration for the building extension and the waiting room was decided after consultation with patients, staff and assistance from the Alzheimer’s Society. There were plans to refurbish the rest of the building by redecorating and re-flooring throughout to bring the entire building up to the same standards as the new extension.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting and recording significant events. Staff were encouraged to report all incidents and events as part of their everyday role and responsibilities.
  • The practice carried out a thorough analysis of significant events and shared learning from these with all staff. Where patients were affected they received a written apology and steps were taken to prevent the same thing happening again. The incident recording form supported the recording of notifiable incidents under the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
  • The practice had clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse. Staff had received training relevant to their role.
  • Risks to patients were assessed and well managed. There were systems to manage patient safety alerts, including medicines alerts which were acted upon.
  • Simulation exercises were carried out during staff team meetings to ensure staff were clear about roles and responsibilities when responding to emergency situations. Minutes of meetings showed that responding to anaphylaxis (an allergic reaction) had been carried out during 2016.
  • Appropriate recruitment procedures were followed to ensure that only suitably qualified staff were employed to work at the practice.

Effective

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for providing effective services.

  • 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 received appraisals and had personal development plans.
  • The practice had a comprehensive audit programme in place which demonstrated a quality monitoring and improvement process for all services they provided which included clinical and non-clinical areas. This ensured that continual improvements were made to enhance patient care.
  • The most recent published data for 2015/2016 showed that the practice achieved 100% of the total number of points available compared with the local average of 99% and the national average of 95%. Evidence showed that the practice had consistently achieved this level for the past five years.
  • Staff worked with other health care teams and there were systems to ensure appropriate information was shared.
  • GPs used their specialist skills in areas such as minor surgery and dermoscopy (to assess all skin lesions) which resulted in the practice being low referrers to secondary care. Referral figures from 2013 to 2016 showed a reduction in dermatology referrals of 20%. The referral figures to secondary care for the same period showed an overall 40% reduction.
  • Five nurses at the practice were trained to provide appropriate diabetes management clinics. They provided an annual total of 3280 appointments with 450 home visits to patients to ensure treatment was monitored.
  • The practice had a planned recall system for patients with chronic diseases which targeted specific patient groups at different times of the year so that reviews of patient care could be managed effectively.
  • The practice’s uptake for the cervical screening programme at 81% was in line with the local average of 83% and the national average of 82%.
  • The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening, with results which were above local and national averages.
  • Patients were encouraged to take responsibility for monitoring their healthcare with access to a self-service monitor in the practice to measure their height, weight and blood pressure. Clinical staff followed up with patients where any concerns were noted from the information recorded.
  • Patients with a newly diagnosed long term condition were referred for educational meetings and clinics to help them manage their condition.

Caring

Good

Updated 28 April 2017

The practice is rated as good for providing caring services.

  • Staff were friendly, polite and helpful to patients both attending at the reception desk and on the telephone. We saw that patients were treated with dignity and respect.
  • Patients we spoke with and feedback we received in the comment cards were complimentary about the practice and commented that they received excellent care from the GPs and the nurses.
  • Results from the National GP Patient Survey results published in July 2016 showed the practice scored results that were mainly higher than local and national rates in relation to patients’ experience of the practice and the satisfaction scores on consultations with GPs and nurses.
  • There were many positive patient comments about the practice on the NHS Choices website. For example, patients commented that they always found the practice to be excellent with supportive and patient GPs.
  • Information to help patients understand and access the local services was available.
  • There was a register of those patients who were also carers and at the time of the inspection there were 120 carers registered with the practice (1% of the practice population). The practice had taken action to identify carers who were not yet included on their register.

Responsive

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and the local community in planning how services were provided to meet patients’ needs.
  • The practice was located in purpose-built premises and had suitable facilities. It was well equipped to treat patients and meet their needs. The open plan reception desk had a lowered counter for use by patients who used wheelchairs. Wheelchairs were made available for patients to use to access the building.
  • Patients were able to access links to information on the practice website in alternative languages.
  • Information about how to complain was available and easy to understand and evidence showed that the practice had responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders accordingly.
  • On-site services such as dermoscopy (technique for examining skin lesions) and phlebotomy (taking blood samples) were provided to reduce inconvenience to patients so they were not required to travel to secondary care providers for these services.
  • The Staff development and training was well supported by the practice and covered a wide range of topics to ensure that staff were trained to support and provide services for patients. The training and development included dementia awareness, domestic violence awareness, childhood development assessments and dementia assessments.
  • Age UK carried out assessments for housebound patients who were at risk of social isolation and loneliness either by telephone or through home visits. An administrator was employed by the practice to liaise with both patients and Age UK. The practice had made 116 over 75 assessments in the last 6 months and referred 35 of these patients to Age UK for further support.
  • The practice had extended the building to provide four new consulting rooms, a large administration area and an enlarged and improved waiting room to cater for the future rise in the local population. The practice had managed the build and maintained service provision while ensuring the continued safety of patients and staff.
  • The practice had become Dementia Friendly in response to suggestions from the PPG. Staff and PPG members had attended a presentation given by Alzheimer’s UK and training for staff was arranged.
  • The interior decoration for the building extension and the waiting room was decided after consultation with patients, staff and assistance from the Alzheimer’s Society. There were plans to refurbish the rest of the building by redecorating and re-flooring throughout to bring the entire building up to the same standards as the new extension.
  • The practice had engaged with patients, the PPG and patient volunteers to assess available transport options to and from the practice and parking facilities. A travel plan was devised which also encouraged patients to walk, cycle or consider car sharing when accessing the practice, encouraging patients to increase their exercise and consider a healthier and greener way of living.
  • The patient information leaflet gave details of GPs working days to help patients should they wish to make an appointment with a preferred GP.
  • Results from the National GP Patient Survey results published in July 2016 showed that patients’ satisfaction with how they could access care and treatment was higher than local and national averages.

Well-led

Good

Updated 28 April 2017

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

  • There was a clear leadership structure and staff felt supported by management.
  • There was an overarching governance framework which included arrangements to monitor and improve quality and identify risk.
  • There was a clear vision and strategy to provide quality care. Staff shared this vision and told us they worked hard to deliver quality care for all patients.
  • Staff morale was high with a high level of staff satisfaction and evidence of teamwork.
  • The practice encouraged a culture of openness and honesty.
  • Staff told us they were confident they would be supported if they needed to raise any issues or concerns. They said they felt respected, valued and supported by everyone and that they loved working at the practice.
  • Staff had received inductions, appraisals and attended regular staff meetings and events.
  • There was a focus on continuous learning and improvement at all levels within the practice. The practice had been a training practice for many years and were committed to the training of doctors. There were plans to host and mentor student nurses from a nearby university.
Checks on specific services

People with long term conditions

Outstanding

Updated 28 April 2017

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

  • There were systems to monitor patients with chronic diseases. The practice nurses had lead roles in chronic disease management.
  • The practice ensured continuity of care in order to achieve the best outcomes for individual patients. Patients diagnosed with a long term condition had a named GP and a structured regular review to check that their health and medicine needs were being met. Reviews were carried out at least annually if not more often.
  • Patients with a newly diagnosed long term condition were referred for educational meetings and clinics to help them manage their condition.
  • The GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care for those patients with the most complex needs.
  • GPs used their specialist skills in areas such as minor surgery and dermoscopy (to assess all skin lesions) which resulted in the practice being low referrers to secondary care.
  • The practice had a planned recall system for patients with chronic diseases which targeted specific patient groups at different times of the year so that reviews of patient care could be managed effectively.
  • Five nurses at the practice were trained to provide appropriate diabetes management clinics. They provided an annual total of 3280 appointments with 450 home visits to patients to ensure treatment was monitored.
  • The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening, with results which were above local and national averages. For example, the percentage of patients aged 50-70, screened for breast cancer in the last 36 months was 78% which was comparable to the local average of 76% and the national average of 72%. The percentage of patients aged 60-69, screened for bowel cancer in the last 30 months was 66% which was above the local average of 64% and the national average of 58%.
  • Patients were encouraged to take responsibility for monitoring their healthcare with access to a self-service monitor in the practice to measure their height, weight and blood pressure. Clinical staff followed up with patients where any concerns were noted from the information recorded.
  • There was a register of those patients who were also carers and at the time of the inspection there were 120 carers registered with the practice (1% of the practice population). The practice had taken action to identify carers who were not yet included on their register.

Families, children and young people

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for the care of families, children and young patients.

  • There were systems to identify and follow up children who were at risk of abuse. Staff had been trained to recognise signs of abuse in vulnerable children and the action they should take if they had concerns.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.
  • Appointments were available outside of school hours and the premises were suitable and accessible for children.
  • Childhood immunisation rates for the vaccinations given were comparable to local and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 98% to 100% which were slightly higher than the CCG rates of 97% to 99%, and for five year olds from 92% to 99% which were comparable with the CCG rates of 95% to 99%.
  • There was a children’s area, baby changing and breast feeding rooms available to those who needed it.
  • The practice offered combined appointments to enable first baby checks, initial immunisations and postnatal assessments for mothers to be carried out in one visit.
  • We saw examples of joint working with health visitors and district nurses.
  • A number of online services including booking appointments and requesting repeat medicines were also available.
  • The practice’s uptake for the cervical screening programme at 81% was in line with the local average of 83% and the national average of 82%.
  • The practice nurses had oversight for the management of a number of clinical areas, including immunisations and cervical cytology.
  • We saw examples of joint working with midwives, health visitors, and district nurses and a midwife led clinic was provided at Abbey Medical Centre.

Older people

Outstanding

Updated 28 April 2017

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

  • There was a higher than average number of older patients registered with the practice. The practice offered personalised care to meet the needs of this population group.
  • Health checks were carried out for all patients over the age of 75 years.
  • Age UK carried out assessments for housebound patients who were at risk of social isolation and loneliness either by telephone or through home visits. An administrator was employed to liaise with both patients and Age UK. The practice had made 116 over 75 assessments in the last 6 months and referred 35 of these patients to Age UK for further support.
  • The practice offered a range of enhanced services, for example, in dementia and end of life care. Home visits and rapid access appointments were offered for those patients with enhanced needs.
  • Nationally reported data showed that outcomes for patients were above local and national standards for conditions commonly found in older patients.
  • Telephone consultations were provided which was particularly helpful for those patients with poor mobility.
  • GPs or the practice nurses visited those patients who were housebound to provide a range of service, including ensuring that patients received their flu vaccination.

Working age people (including those recently retired and students)

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for the care of working-age patients (including those recently retired and students).

  • The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
  • The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
  • The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Repeat prescriptions could be requested online at any time, which was more convenient for patients.
  • Telephone consultations were provided which was particularly helpful for those patients who worked during appointment times.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 28 April 2017

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

  • The practice held a register of patients with poor mental health including those patients with dementia. Staff had received training on how to care for patients with mental health needs and dementia.
  • The interior decoration for the building extension and the waiting room was decided after consultation with patients, staff and assistance from the Alzheimer’s Society. There were plans to refurbish the rest of the building by redecorating and re-flooring throughout to bring the entire building up to the same standards as the new extension.
  • Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health.
  • Patients were given information about how to access various support groups and voluntary organisations.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those patients with dementia.
  • The GPs and practice nurses understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
  • The practice supported families in their bereavement and signposted them to support services.
  • Data for 2015/2016 showed the practice achieved results that were comparable with local and national rates for support for patients with poor mental health. The practice recognised they had a low dementia prevalence which suggested their registers may be incomplete and had taken action to address this. They had identified patients for assessment during 2015 and carried out 781 patient assessments but recognised the recorded prevalence was still low for their patient list. They increased the number of initial assessments to 1001 patients during 2016, 535 of whom had an impairment test carried out.
  • Two Improving Access to Psychological Therapies (IAPT) counsellors attended the practice weekly.

People whose circumstances may make them vulnerable

Outstanding

Updated 28 April 2017

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

  • The practice treated patients of all ages and provided a range of medical services.
  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. They had completed annual health checks for 67% of the 61patients on their register in the current year. Longer appointments were available for patients with a learning disability when required.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They had advised patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff would know that patients may need to be prioritised for appointments or offered longer appointments.
  • The practice offered additional services to carers such as annual health checks.
  • Staff had received training and knew how to recognise signs of abuse in vulnerable adults who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.
  • The practice offered flu and shingles vaccinations at home to vulnerable patients who were unable to attend the surgery.