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The Springs Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr DJ Collins (The Springs Health Centre) on 28 September 2016. Overall, the practice is rated as good.

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

  • There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.

  • Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
  • Patients told us they were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
  • The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly meetings took place to discuss and review patients’ needs.
  • The practice directly employed two community matrons and a part-time care co-ordinator to deliver and co-ordinate care and support to vulnerable patients in their own homes.
  • The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
  • Arrangements were in place to assess and manage risk effectively.
  • Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had good access to GP appointments.
  • The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
  • The practice provided care to residents across three local care homes for older people. Regular planned visits to the home by both the community matron and by a GP ensured continuity of care and a reduction in the number of acute visits.
  • There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
  • The practice management team consisted of the GP partners, the practice manager and the nurse manager. All decisions were agreed collectively as a team rather than solely as a partnership, demonstrating a more inclusive approach to decision making within the practice.
  • The partnership had a vision for the future. They were proactively engaged with their Clinical Commissioning Group (CCG) in order to provide joined-up care closer to people’s homes via an integrated care model.
  • The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
  • The practice had a patient participation group (PPG) which met bi-monthly. The practice consulted with their PPG, although we did not see evidence of the PPG driving change within the practice.

We saw the following areas of outstanding practice:

  • Two community matrons worked a total of 47 hours per week. The practice directly funded half of these hours. The two matrons proactively engaged with the wider multi-disciplinary teams to deliver responsive care to support patients and their families, and provided bereavement support following a patient death. One of the matrons had worked with the CCG’s lead medicines management technician on a deprescribing project (deprescribingrefers to reducing or stopping the prescribing of medicines that may be causing harm, may no longer be providing benefit, or may be considered inappropriate). The outcome of the project resulted in cost savings of almost £14,000 with 18% of prescribed medicines being stopped. Other medicines were reduced, changed or new medicines initiated after the review.
  • The practice had significantly higher rates of screening for cervical and breast cancer in relation to local and national averages. For example, uptake for the breast screening programme for 50-70 year olds within six months of invitation was 84.3%, which was above the CCG average of 79.6% and the national average of 73.2%. The practice also had higher bowel screening rates than the national average and had achieved good performance in the uptake of NHS health checks. This was due to a proactive approach taken by the practice team including opportunistic reminders to patients, and motivating patients to receive screening if it was observed that they had refused the test.

The areas where the provider should make improvement are:

  • Improve the uptake of annual health checks for patients with a learning disability.
  • Review immunisation training updates for nurses in line with recognised standards.
  • Consider a review of infection control management within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 November 2016

  • Staff were supported to report significant events in a supportive environment. Learning was applied from incidents to improve safety in the practice.
  • The practice had effective systems in place to ensure they safeguarded vulnerable children and adults from abuse.
  • The practice worked to written recruitment procedures to ensure all staff had the skills and qualifications to perform their roles, and had received appropriate pre-employment checks.
  • Systems were mostly in place to manage medicines on site appropriately, although the system for monitoring the distribution of prescriptions within the practice required strengthening. The practice also needed to ensure that their written procedures were reflected in every day practice.
  • Patients on high-risk medicines were monitored on a regular basis.
  • Actions were taken to review any medicines alerts received by the practice, to ensure patients were kept safe.
  • The practice had systems in place to deal with medical emergencies within the surgery.
  • Risks to patients and the public were generally well-managed. The oversight of infection control management required strengthening, supported by evidence of up to date training undertaken by the designated lead.
  • The practice had developed contingency planning arrangements supported by a written plan that was regularly updated. 

Effective

Good

Updated 4 November 2016

  • The practice delivered care in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
  • Regular clinical meetings took place to discuss issues such as new guidance. Clinical education sessions provided an environment of learning within the practice.
  • The practice had achieved 96% of the available points in respect of the Quality and Outcomes Framework (QOF) 2014-15. This was marginally below the CCG average of 98.1%, and above the national average of 94.7%.
  • The practice kept their staffing skill mix under review to meet the demands of patients and to provide good access to the care that patients needed.
  • The practice worked collaboratively with the wider health and social community to plan and co-ordinate care to meet their patients’ needs at regular multi-disciplinary team meetings.
  • Staff had the skills and experience to deliver effective care and treatment. New employees received inductions, and all members of the practice team had received an appraisal in the last year, which included a review of their training needs.
  • We saw examples of how clinical audit was being used to improve quality and enhance safe patient care and treatment. 

Caring

Good

Updated 4 November 2016

  • We observed a patient-centred culture and approach within the practice. Staff treated patients respectfully and with kindness.
  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated that they felt treated with compassion and dignity, and were given sufficient time during consultations. Patients said they were involved in decisions about their care and treatment.
  • Feedback received from community-based staff who worked with the practice was very positive about the high standards of care provided by the practice team.
  • The practice team knew their patients well due to the practice being long-established with a low turnover of staff. This aided them in providing personalised care and ensured greater continuity for patients.
  • We were provided with examples of individual patient stories which reflected the caring approach of the practice team. 

Responsive

Good

Updated 4 November 2016

  • Comment cards and patients we spoke with during the inspection provided mainly positive experiences regarding obtaining an appointment with a GP. The latest GP survey showed that patient satisfaction was above, or in line with, local and national averages regarding access to GP appointments.
  • Patients could book appointments and order repeat prescriptions on line. The practice participated in the electronic prescription scheme, so that patients could collect their medicines from their preferred pharmacy without having to collect the prescription from the practice.
  • The practice hosted some services on site including counselling, and twice weekly ante-natal and post-natal clinic provided by the midwife. This made it easier for their patients to access services locally.
  • The practice implemented improvements and made changes to the way it delivered services as a consequence of feedback from patients.
  • The premises were tidy and clean and well-equipped to treat patients and meet their needs. The practice accommodated the needs of patients with a disability, including access to the building through automatic doors.
  • The practice reviewed any complaints they received and dealt with these in a sensitive and timely manner. Information about how to make a complaint was available for patients. Learning from complaints was used to improve the quality of service.
  • If patients at reception wished to talk confidentially, or became distressed, they could be moved into a private room to ensure their privacy. 

Well-led

Outstanding

Updated 4 November 2016

  • The partners were committed to the delivery of high quality care and promoting good outcomes for their patients.
  • The practice management team consisted of the GP partners, the practice manager and the nurse manager. The team made decisions collectively rather than solely as a partnership, demonstrating a more inclusive managerial approach within the practice.
  • GPs and nurses had lead roles providing expert advice to patients and acting as a resource for their colleagues.
  • The practice had developed a range of policies and procedures to govern activity.
  • The partners worked collaboratively with other GP practices in their locality, and with their CCG. This approach was supportive of the local CCG strategy for 21st century model of care to deliver treatment and support closer to patients’ homes. For example, they developed collaborative models of integrated working with community-based teams to optimise the care of patients.
  • The practice was innovative in being a pilot site for new initiatives. They were early adopters of new schemes, which helped place them at the forefront of developments within primary care. This included early investment in community matron posts and a practice based care co-ordinator to support vulnerable patients, as an early adopter of the care planning process
  • The partners reviewed comparative data provided by their CCG (such as referral rates) and ensured actions were implemented to address any areas of outlying performance.
  • Staff felt well supported and valued by the management team. The practice held regular staff meetings to ensure good communication.
  • The practice had sought feedback from patients, and acted on this to improve service delivery. There was a Patient Participation Group (PPG) which met every two months.
Checks on specific services

People with long term conditions

Good

Updated 4 November 2016

  • The practice undertook annual reviews for patients on their long-term conditions registers, including a review of their prescribed medicines. Practice data showed that 87.3% of patients with chronic obstructive airways disease and 79% of patients with asthma had attended for an annual review during 2014-15.
  • QOF achievements for clinical indicators were generally in line with CCG averages, and above national averages, although outcomes for diabetes were slightly lower. The practice achieved 84.3% for diabetes related indicators, in comparison to local and national averages of 96.7% and 89.2% respectively in 2014-15.
  • Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice.
  • The recall system was co-ordinated by the administration team. A protocol was in place to ensure that patients received one of 16 specific letters for their condition(s). This meant that each patient was booked into see the right person for the correct amount of time. It also accounted for follow up tests, for example after a patient had received spirometry (a test to assess breathing) or a blood test.
  • There was a lead designated GP or nurse for the clinical domains within QOF.

Families, children and young people

Good

Updated 4 November 2016

  • The midwife held ante-natal clinics and saw new mothers for a post-natal review at the practice each week. The health visitor held fortnightly well-baby clinics in the practice.
  • Childhood immunisation rates were high and were either in line with, or marginally above, local averages. Overall rates for the vaccinations schedule given to children up to five years of age ranged from 94.7% to 100% (local averages 95.2% to 99.1%).
  • Same day appointments were provided for babies or children who were unwell.
  • The practice had an identified lead GP for child safeguarding. The health visitor and midwife attended a meeting approximately every four to six weeks with the lead GP to review and discuss any child safeguarding concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
  • A full range of family planning services were accessible throughout the week. The practice had pioneered a system with the local school so that the person could present different coloured cards denoting either a request for emergency or routine contraception, without having to discuss this.
  • The practice had baby changing facilities, and a small play area was available for children. The practice welcomed mothers who wished to breastfeed on site, and offered a private room to facilitate this if requested.

Older people

Good

Updated 4 November 2016

  • The practice offered proactive and personalised care to meet the needs of older people. Care plans were in place for older people with complex needs, and the practice worked collaboratively with other providers to deliver tailored care packages to patients. Fortnightly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.
  • The practice directly employed two community matrons and their own care co-ordinator to facilitate the planning of care for patients being discharged from hospital, or to provide support to help vulnerable patients remain in their own home. Specific groups had been targeted for assessment and appropriate follow-up support including patients aged over 80, and older patients prescribed multiple medicines.
  • The community matron had worked with the CCG’s lead medicines management technician on a deprescribing project focussing on older patients. The outcome of the project resulted in 18% of prescribed medicines being stopped, as they were no longer needed. Other medicines were reduced, changed or new medicines initiated after the review. This impacted on care for older patients due to the potentially adverse effects associated with taking multiple medicines, such as the increased risk of falls.
  • The practice provided care to residents across three local care homes for older people. Regular planned visits to the home by both the community matron and by a GP ensured continuity of care and a reduction in the number of acute visits. We spoke with managers of the homes who were very satisfied with the care provided by the practice, and described the relationship with the practice as being extremely positive and responsive to their residents’ needs.
  • Longer appointment times could be arranged for patients with complex care needs. Home visits were provided for those unable to attend the surgery.
  • Uptake of the flu vaccination for patients aged over 65 was 71%, which was in line with local (73.9%) and national (70.5%) averages.
  • The practice had actively participated with commissioners in the re-structuring of care programmes for older people to deliver joined-up services closer to patients’ homes.

Working age people (including those recently retired and students)

Good

Updated 4 November 2016

  • Extended hours consultations were available with a GP, nurse, and health care assistant until 8pm every Tuesday evening to enable improved access for working patients.
  • Telephone consultations and advice were offered each day when this was appropriate, so that patients did not always have to attend the practice for a face-to-face consultation.
  • The practice offered on-line booking for appointments and requests for repeat prescriptions. Participation in the electronic prescription scheme meant that patients on repeat medicines could collect them directly from their preferred pharmacy.
  • Health reviews were available for new patients, and for those aged between 40-75 as part of the NHS health check programme. Services such as smoking cessation, and input from a health trainer from the ‘Live Life Better Derbyshire’ scheme promoted healthier lifestyles.
  • The practice actively promoted health screening programmes to keep patients safe. The practice’s uptake for the cervical screening programme was 86.3%, which was above the CCG average of 84.1% and the national average of 81.8%. Uptake of bowel and breast cancer screening was also higher than local and national averages.
  • The practice offered out of area registrations for patients, which allowed them to access the service closer to their place of work. 

People experiencing poor mental health (including people with dementia)

Good

Updated 4 November 2016

  • The practice achieved 96.5% for mental health related indicators in QOF, which was 1.6% below the CCG and 3.7% above the national averages. This was achieved with lower exception reporting rates at 7% compared against local (14.5%) and national rates (11.1%).
  • 84% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2014-15 QOF data. This was below the CCG average of 93.2% and the national average of 88.5%, but with much lower levels of exception reporting at 7.4% (CCG 17.4%; England 12.6%)
  • The practice worked closely with local community mental health teams and representatives regularly attended the multi-disciplinary team meetings.
  • The practice told patients experiencing poor mental health and patients with dementia about how to access local services, support groups and voluntary organisations. Information was available for patients in the waiting area.
  • There was access to counselling and associated talking therapies’ services on site. Patients could self-refer to this service.
  • 87.2% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was above local and national averages by 3% with lower exception reporting rates at 6%, compared to local and national averages of 8.3%.
  • Staff had received dementia awareness training from the Alzheimer’s Society at a team meeting. The practice planned to achieve ‘Dementia Friendly’ status before the end of 2016.  

People whose circumstances may make them vulnerable

Good

Updated 4 November 2016

  • Patients with end-of-life care needs were reviewed at a monthly multi-disciplinary team meeting including a lead GP, district nurses, a Macmillan nurse, and a matron from a local care home. Some of these patients were also reviewed at the fortnightly multi-disciplinary meetings if their care package needed closer monitoring, with input from the wider care team.
  • The community matron developed care plans for the most vulnerable patients including those at end of life. A specific template was used to ensure key information was available to the ambulance service, the out of hours’ provider, and social services to ensure continuity of care for the patient. This included the patient’s preferred place of care and whether a Do Not Attempt Resuscitation order was in place.
  • The practice had identified 2.4% of their registered patients as carers. The community matrons and care co-ordinator identified carers as part of their work with vulnerable patients, and new patients were identified as part of the registration process. Information on various support agencies and groups was available.
  • Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding.
  • The practice had undertaken an annual health review for 20% of their patients with a learning disability in 2014-15. The practice recognised this needed improvement and the team had discussed ways to address this. Figures for the first six months of 2016-7 showed that 12% of patients had been seen for an annual review at the time of our inspection.
  • The practice had signed up to be a safe haven for vulnerable people. Any person in need could enter the practice as a point of refuge until they could be safely collected by relatives or carers.
  • The practice had low number of patients whose first language was not English. These patients were able to access interpreter services in person or by telephone if required.