You are here

Windrush Medical Practice, Windrush Health Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 17 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Windrush Medical Practice on 5 May 2016. Overall the practice is rated as outstanding. Specifically it is rated outstanding for the provision of safe, effective and well led services and good for the provision of caring and responsive services.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, using e-mails and photographs to communicate with specialists at the local hospital to reduce the need for patients to travel to outpatient clinics.

  • Feedback from patients about their care was consistently positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example by providing a floor within the practice for visiting services such as audiology and orthopaedic clinics. They also hosted the ‘hub’ which provided an overflow facility for urgent GP and nurse appointments when practices in West Oxfordshire had filled their appointments.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example a new telephone system had been installed and staff rosters amended to make more staff available to answer patient calls at peak times.
  • The practice had modern and well maintained facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as top priorities. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

  • Provision of a wide range of additional visiting services including sexual health clinics, podiatry, orthopaedic clinics, audiology clinics and counselling. This assisted patients to access services locally and avoid time consuming trips to the general hospital or other health services. An urgent care hub was also located on the premises for patients who needed to see a GP or nurse when appointments were not available at their own practice.

  • The practice recognised the importance of providing services closer to the patient. When designing the medical centre additional space was provided to accommodate a growing population and additional local services.

  • An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

  • Prompt and effective response to patient feedback. When feedback from the national patient survey identified difficulty in accessing the practice by phone the practice purchased a new telephone system, revised staff rosters to provide more staff to answer the phone and monitored call response time. Feedback from patients during inspection identified improvement in accessing the practice by phone.

We saw several areas of outstanding practice including:

  • Operation of enhanced recall systems to ensure patients did not miss important tests or treatments. For example, GPs and nurses used information from hospital departments to remind patients who required a repeat test or scan at infrequent intervals. The risk of patients missing an important test was reduced.

  • An improved and expanded prompt system to remind patients when they required tests and treatment. This was used to support patients with complex medical needs and long term medical conditions. For example, GPs were prompted to review whether a patient diagnosed with dementia required another person to act on their behalf in making decisions about care and treatment.

  • Robust arrangements for use of technology to exchange information with hospital departments. Use of both e-mail and telemedicine with a range of hospital departments in a secure transfer system. This reduced the need for some patients to visit hospital outpatients and information returned from the hospital enabled prompt follow up for the patient with their named GP.

  • Provision of a health information zone managed by the PPG. This included a computer terminal for patients to access information on local services and health promotion literature. The PPG members assessed useful information, often influenced by their discussions with other patients, to hold. They agreed what could be displayed with the practice. This information zone was for patients run by patients.Provision of services to 10 Syrian refugees and two local traveller communities. Feedback from these groups was positive. Particularly from members of the travelling community who benefitted from seeing their named GP for continuity of care. The practice record system alerted staff to book 30 minute appointments for members of the Syrian community and to book a translator who spoke the appropriate dialect.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for providing safe services.

  • Patients were protected by a comprehensive safety system and a focus on learning from others, and sharing learning, when something goes wrong. Learning from significant events was shared with other local practices and learning from the other practices was shared with the practice team.

  • All staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • The practice led a project to improve incident reporting related to receipt of hospital letters. This resulted in more prompt receipt of hospital information and enabled GPs to deliver care more safely.

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation. Staff were encouraged to participate in learning to improve safety

  • Information about safety was highly valued and was used to promote learning and improvement. All staff were encouraged to be open and transparent and fully committed to reporting incidents. Incident reporting was thorough and analysis of incidents gave a robust picture of safety.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.

  • There was a proactive approach to anticipating and managing risks to service users. For example, the safety of dispensing of medicines was regularly reviewed and safety checks of the premises were timetabled and carried out in a robust manner.

  • Systems for managing medicines were robust and when prescribing errors occurred they were investigated thoroughly and learnt from.

  • 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. There was a strong focus on openness and transparency when something went wrong.

  • The practice had comprehensive systems in place to keep patients safe and safeguarded from abuse. All staff were appropriately trained to identify abuse and knew who to report any concerns to.

  • Risks to patients were assessed and well managed. Safety of premises and equipment was a top priority and the practice had robust planned maintenance programmes in place.

Effective

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for providing effective services.

  • Our findings at inspection showed that systems were in place 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.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices nationally. For example, they had achieved 100% of the indicators for supporting patients with long term conditions.

  • The staff team demonstrated a collaborative approach to deliver high quality care to patients with complex needs. For example, by seeking advice and support for these patients from visiting professionals.

  • Staff were consistent in supporting patients to live healthier lives. For example, by promoting health checks for patients aged between 40 and 70.

  • The practice had an enhanced system of recalling patients for tests and treatments. For example, if a patient was required to attend for a hospital test the recall system logged this and the GP reminded the patient.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. For example, by using telemedicine and e-mails to communicate with hospital specialists. This assisted patients who found it difficult to attend the general hospital which often involved a two hour round trip.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff. The practice encouraged and supported staff to expand their skills and obtain additional qualifications. For example, GPs and nursing staff were trained to initiate insulin for patients diagnosed with diabetes.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher 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.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 17 June 2016

The practice is rated as good 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 met patients’ needs. For example by providing an area where other providers could offer clinics and services.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, by implementing revised staff rosters and a new telephone system to improve access to the practice when booking appointments.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

  • Translation services were easily accessed and some frequently used instructions and phrases were translated into the two languages frequently used by patients.

  • 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.

Well-led

Outstanding

Updated 17 June 2016

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

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • The practice had a very engaged patient participation group (PPG) which influenced practice development. For example, PPG members had been involved in the planning and design of the practice premises. This had resulted in additional design features such as turning circles in corridors to assist patients in wheelchairs and those using mobility scooters.

  • There was a strong culture of risk management that 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

  • There was a strong focus on continuous learning and improvement at all levels.

  • There was a high level of staff satisfaction and staff were proud to work at the practice. Staff were encouraged, and given opportunities, to contribute to the future development of the practice.

  • The leadership drive a culture of continuous improvement. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. This included a focus on bringing services closer to the patient.

  • Continuity of care was valued by the practice team and patients. The personal list system was embedded in the practice and delivered personalised care for all patients.

Checks on specific services

People with long term conditions

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

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

  • Diabetes care indicators showed that 88% of patients with diabetes were meeting target cholesterol levels compared to 84% average for the CCG and 80% national average. Data also showed that 96% of patients diagnosed with diabetes had received a foot examination compared to the CCG average of 90% and national average of 88%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and 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.

  • The practice undertook additional tests and treatments for this group of patients and used a set of prompts in the patient records to enhance the care provided. For example, the system ensured new mothers who were diagnosed with diabetes received an additional blood test six weeks after giving birth.

  • The practice used an expanded recall system to reduce the risk of patients with long term conditions missing follow up tests and treatments.

Families, children and young people

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

  • 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 relatively high for all standard childhood immunisations.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 83% 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 and health visitors.

  • We saw examples of the practice making appropriate referrals to the local authority when GPs had concerns about child safety.

  • A dedicated family planning clinic was available at the practice.

Older people

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • There were close links with the podiatry service to ensure that patients received additional support from their GP if the podiatrist had any concerns about other health matters.

  • All patients aged over 75 had a named GP and were encouraged to see their named GP to facilitate continuity of care.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Care plans were in place for older patients with complex medical problems.

  • The practice worked closely with the local community hospital to support older patients who needed short term care in hospital.

  • The practice supported registered patients who moved into local care homes and wished to retain the services of their usual GP.

Working age people (including those recently retired and students)

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

  • 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.

  • Telephone appointments were available for patients who found it difficult to attend the practice and these extended beyond 6.30pm on three evenings every week.

  • There were extended hours clinics held every Friday morning from 7.30am and Friday evening between 6.30pm and 7pm.

  • The practice actively promoted smoking cessation and 189 patients had quit smoking in the last year.

  • A range of health promotion opportunities were available and encouraged when appropriate. For example GPs referred patients for exercise classes.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

  • 97% of patients diagnosed with a severe and enduring mental health problem had a care plan agreed with them compared to the CCG average of 86% and 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 and included additional checks within the care plans. For example, the GPs checked whether the patient required a person to act as lasting power of attorney for decisions about care and treatment.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling and talking therapy services were available at the practice.

  • 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.

  • All staff had received training in the Mental Capacity Act (2005) and understood the requirement to assess capacity of patients to make decisions about their care and treatment.

People whose circumstances may make them vulnerable

Outstanding

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • 81% of patients diagnosed with a learning disability had received an annual health check in the last year (58 patients out of 71).

  • Feedback about practice services from members of the travelling community was positive. Members of this community had a named GP and were identified to ensure their need for prompt appointments was met.

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

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

  • Staff knew how to recognise signs of abuse in vulnerable adults. 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. We saw records of safeguarding concerns being escalated to ensure the patient received relevant support.

  • Translation facilities were available and actively promoted. When a patient required a translator their records were annotated to enable staff to book a translator in advance of an appointment. Some frequently used instructions and phrases were translated into a Syrian dialect and Polish because the practice was aware that members of these communities required additional support when attending for appointments.