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Hedingham Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 7 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilton House Surgery on 27 January 2016. The overall rating for the practice was requires improvement and the practice was rated as requires improvement for providing safe, effective, responsive and well-led services and good for caring. We issued the provider with a requirement notice for improvement. The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Hilton House Surgery on our website at www.cqc.org.uk.

We then carried out a further comprehensive inspection on 11 May 2017. This inspection was undertaken to re-rate the practice and to ensure that the improvements identified at the January 2016 inspection had been actioned. Overall, the practice is now rated as good.

Our key findings were as follows;

  • The practice had improved their system of governance and made considerable improvements since our last inspection in January 2016.

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Learning was being cascaded to staff.
  • The practice had undertaken risk assessments across a range of areas that protected patients and staff.
  • Medicine management was effective, including the monitoring of patients prescribed high-risk medicines.
  • Medicine and patient safety alerts were managed effectively and changes of treatment made where required.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • A staff induction system was now in place. Staff received adequate supervision and appraisal.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Data had generally improved since July 2016 although there was improvement still required in relation to patient satisfaction over telephone access and the opening hours of the surgery.
  • The practice had identified a high number of carers and provided them with support and guidance and an assessment of their needs.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice responded to the needs of their patient population and provided services accordingly.
  • 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 governance at the practice had improved and the practice performance in the Quality and Outcomes Framework remained consistently high.

The areas where the provider should make improvement are:

  • Continue to improve patient satisfaction in relation to access to the practice by phone and the opening hours of the surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 September 2017

The practice is rated as good for providing safe services.

  • The practice had an effective system to identify, report and analyse significant and safety events. There was evidence of investigation and shared learning with staff working at the practice. Patients affected received an explanation and apology when required.

  • Patient safety and medicine alerts were managed effectively and changes made to patient’s medicines when required.

  • The practice followed guidance in relation to medicine management and prescribing. Patients of high-risk medicines received reviews in line with published guidance.

  • Staff had received training in basic life support and there were emergency medicines, a defibrillator and oxygen readily available for use. All equipment was in date.

  • The number of staff working at the practice met the needs of patients and they had been appropriately trained.

  • Risks to patients were well managed and mitigated. Those staff acting as chaperones had received a disclosure and barring service check and had been trained for the role.

  • Practice staff were all trained to an appropriate level in safeguarding children and vulnerable adults. There were two GPs responsible for managing safeguarding issues.

Effective

Good

Updated 7 September 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average. This had been consistently high for the last four years

  • Clinical audits demonstrated quality improvement and where improvements had been identified these had been maintained.

  • Staff had the skills and knowledge to deliver effective care and treatment. There was an induction process for new staff to follow. Staff received an appraisal and regular supervision.

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

  • End of life care was coordinated with other services involved. The practice was pro-active in supporting patients with their preferred place of care when nearing the end of their lives

Caring

Good

Updated 7 September 2017

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.

  • The practice had identified 3.2% of their patients as carers and offered them support and guidance.

  • Survey information we reviewed showed that 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 accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Comment cards we received were very positive about the practice and the staff working there.

Responsive

Requires improvement

Updated 7 September 2017

The practice is rated as requires improvement for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.

  • The practice routinely provided longer appointments for patients with a learning disability or suffering with dementia.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • The national GP patient survey published in July 2016 and 2017 reflected that patients were generally satisfied with the services provided, although improvements were still required in relation to access to the surgery by phone and the opening hours of the surgery.

  • The practice responded to the national GP patient survey results by making changes to improve satisfaction rates.

  • The practice had two GPs on call on a daily basis to deal with emergency appointments and other urgent issues.

  • The practice had a palliative care register, which included patients in care homes who were considered as frail and vulnerable. These were regularly reviewed and care and treatment changed when required.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available. Complaints we viewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 September 2017

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

  • The practice had made some considerable improvements since our inspection in January 2016.

  • 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. Governance had improved and risks to patients and staff were now well managed.

  • There were regular clinical and staff meetings where the learning from complaints and significant events were discussed.

  • The practice responded to feedback from the national GP patient survey and had made improvements to the services provided.

  • Staff felt supported by the leadership and had received appraisals including personal development plans. There was an induction process in place for staff new to the practice.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour. We saw evidence the practice complied with these requirements and patients received an explanation and an apology when appropriate.
Checks on specific services

People with long term conditions

Good

Updated 7 September 2017

The practice is rated as good for the care of people with long-term conditions.

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

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health. These patients were on a register and a multi-disciplinary package of care was provided. This included patients who were resident in care homes.

  • Patients with long-term conditions received regular health reviews. Data from the Quality and Outcomes Framework (QOF) reflected that the practice performed consistently well for these patients.

Families, children and young people

Good

Updated 7 September 2017

The practice is rated as good for the care of families, children and young people.

  • Staff had received training in safeguarding children and two GPs were identified as leads in this area. We found there were effective systems to identify and follow up children who were at risk.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with midwives, health visitors and school nurses to support this population group.

  • The practice had emergency processes for acutely ill children and young people through the provision of an ‘on call’ GP duty system provided by GPs at the practice during opening hours.

Older people

Good

Updated 7 September 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns. Patients who were frail or vulnerable were monitored and reviewed regularly.

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

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

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They were pro-active in providing these patients with their preferred place of care. Multi-disciplinary meetings were held with a range of other healthcare professionals in attendance.

  • Staff had received safeguarding training for vulnerable adults.

Working age people (including those recently retired and students)

Good

Updated 7 September 2017

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

  • The needs of these populations 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 7 September 2017

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

  • The practice carried out advance care planning for patients living with dementia and offered longer appointments.

  • The practice had an effective system for monitoring repeat prescribing for patients receiving medicines for mental health needs and followed published guidance.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

  • Most of the clinical staff had received training in the Mental Capacity Act 2005.

People whose circumstances may make them vulnerable

Good

Updated 7 September 2017

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.

  • Longer appointments were routinely provided for this population group to ensure consultations were thorough.

  • End of life care was delivered in a coordinated way, which took into account the needs of those whose circumstances may make them vulnerable. A register was in place that identified patients nearing the end of their lives and those who were frail and vulnerable.

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

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. The practice had identified 3.2% of patients who were carers and provided them with support.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.