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Inspection Summary


Overall summary & rating

Good

Updated 12 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elmham Medical Practice on 12 April 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • There was scope to strengthen the management of some risks, including infection control, and risks associated with legionella.
  • 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 a named 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.
  • 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 and complied with the requirements of the duty of candour.
  • There had been recent change of partnership at the practice that required the new management structure to adapt in a short timeframe. We found they had done this and the evolving management structure was progressing well.

However there were areas of practice where the provider must make improvements:

  • Undertake infection control audits in order to protect patients and staff.
  • Ensure that Patient Group Directions are reviewed and in date and ensure that Patient Specific Directions are in place to protect both staff and patients.

There were also areas of practice where the provider should improve:

  • Action previously identified issues around the risks associated with legionella.
  • Complete clinical audit cycles in order to deliver and monitor improved outcomes for patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 May 2017

We found the practice had taken appropriate improvement action.

  • The practice had implemented infection control audits to ensure that safe infection control measures were in place and were being followed by staff. Although action plans were developed following the audits, these did not include details to enable progress to be monitored; for example the named person responsible for the action and the expected date of completion.
  • The Patient Group Directions (PGDs) had been reviewed and Patient Specific Directions (PSDs) developed and embedded into practice.

Effective

Good

Updated 12 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • There was scope to better demonstrate quality improvement through clinical audits by closing audit cycles.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals (although some were overdue) and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 July 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.

Responsive

Good

Updated 12 July 2016

The practice is rated as good for providing responsive services.

  • Access by telephone was very good with almost all patients who responded to the National Survey stating that they could get through with ease.
  • Patients said they found it easy to make an appointment with a 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.
  • 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 and other stakeholders.

Well-led

Good

Updated 12 July 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The patient participation group was active.
  • There had been recent change of partnership at the practice that required the new management structure to adapt in a short timeframe. We found they had done this and the evolving management structure was showing good progress.
Checks on specific services

People with long term conditions

Good

Updated 12 July 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. Practice nurses were appropriately trained and their responsibilities included asthma management, diabetic control, heart disease management and COPD (chronic obstructive pulmonary disease) management.
  • QOF(Quality and Outcomes Framework: a system intended to improve the quality of general practice and reward good practice) performance for diabetic patients was good. 83.97% of diabetic patients had managed their blood sugar within ideal parameters in 2014/15 (outperforming the CCG average of 77.4% and the national average of 77.54 %.)
  • The practice offered in-house diagnostics to support patients with long-term conditions,, such as 24 hour ambulatory blood pressure machines, electrocardiogram tests and ankle brachial index tests to read the severity of peripheral arterial disease.
  • 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. For example, the practice engaged with care pathways such as the psychology service and the respiratory service to further support patients with long term conditions.

Families, children and young people

Good

Updated 12 July 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 in line with national and CCG averages for all standard childhood immunisations.
  • The practice held monthly meetings to discuss vulnerable or at risk children and health visitors and other relevant professionals were invited to attend. Minutes from these meetings were shared as appropriate and patient records were updated.
  • 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.
  • The cervical screening rate for this practice (80 %) was in line with the national average (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, health visitors and school nurses.
  • The practice offered the fitting and removal of long term contraception.

Older people

Good

Updated 12 July 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided care for around 150 people living in local care homes and regular visits were undertaken by either GPs or nurse practitioners to offer proactive support and advice.
  • The practice operated a free delivery and collection service at local Post Office sites for medicines.

Working age people (including those recently retired and students)

Good

Updated 12 July 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.
  • 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 12 July 2016

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

  • The percentage of patients with a new diagnosis of depression who were reviewed in a timely way was 100% (compared with the CCG average (86%) and national average (85%). The exception reporting rate was in line with the CCG and national average.
  • 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.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 12 July 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and proactively supported these patients to attend an annual health review.
  • 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 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.