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Inspection Summary


Overall summary & rating

Good

Updated 23 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Keighley Road Surgery on 16 February 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.

  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.

  • Patient Champions had been established to develop innovative services aimed at improving the health and well-being of the practice population.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they found it easy to make an appointment with a GP or nurse practitioner and that there was continuity of care, with urgent appointments available the same day.

  • The practice made good use of the facilities available to them and was 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.

    We saw the following examples of outstanding practice:

  • The practice business manager had been instrumental in setting up the local ‘Pennine GP Alliance’ which was established to facilitate collaboration between local practices in innovating and improving services to local people.

  • One of the nurse practitioners had led on setting up a local nurse practitioner forum which had implemented changes in the scope of the nurse practitioner role. These changes had been adopted by all practices in Calderdale and was being extended to the Kirklees practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 March 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 23 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • Patients’ needs were assessed and care was planned and delivered in line with current clinical guidelines and legislation. This included assessing capacity and promoting good health.

  • Clinical audits demonstrated quality improvement.

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

  • All staff had received an annual appraisal and personal development plan.

  • Staff worked with multidisciplinary teams to plan care and deliver appropriate treatment for those patients with more complex needs.

Caring

Good

Updated 23 March 2016

The practice is rated as good for providing caring services.

  • Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 23 March 2016

The practice is rated as good for providing responsive services.

  • It reviewed the needs of its local population and engaged with the NHS England Area Team and Calderdale Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example volunteer patient champions had been selected and trained to develop services to promote good health and provide health education to patients.

  • Patients said they found it easy to make an appointment with a GP or nurse practitioner and that there was continuity of care, with urgent appointments available the same day.

  • The practice made good use of their facilities, having recently made several improvements to the premises 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 23 March 2016

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

  • There was 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 this.

  • 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 staff and clinical meetings.

  • There was an overarching governance framework which supported the delivery of the strategy to provide 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 knowing about notifiable safety incidents

  • The practice proactively sought feedback from staff and patients and adapted services in response. The patient participation group was active and was involved in developing services to better meet patient need.

  • There was a strong focus on continuous learning and improvement at all levels. The practice provided training opportunities for trainee GPs, student nurses and administrative apprenticeships

  • The practice business manager had been instrumental in setting up the local ‘Pennine GP Alliance’ which was established to facilitate collaboration between local practices in innovating and improving services to local people.

  • One of the nurse practitioners had led on setting up a local nurse practitioner forum which had implemented changes in the scope of the nurse practitioner role. These changes had been adopted by all practices in Calderdale and was being extended to the Kirklees practices.

Checks on specific services

People with long term conditions

Good

Updated 23 March 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. Children with diabetes had been included in this group of patients.

  • A case finding exercise had been carried out to identify those patients at risk of developing chronic obstructive pulmonary disease (COPD), a lung condition which causes difficulty with breathing. This group of patients were offered early assessment and intervention to help manage any symptoms.

  • Patient Champions ran a series of healthy walks which started at the surgery. These walks varied in distance to suit a variety of patient needs and encouraged safe physical activity.

  • Data showed that 82% of patients on the diabetes register had a cholesterol recording within normal range compared with 81% nationally.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 23 March 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 accident and emergency ( A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and staff gave examples from practice which confirmed this.

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

  • Staff provided us with good examples where joint working with midwives, health visitors and school nurses had been effective.

Older people

Good

Updated 23 March 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.

  • It was responsive to the needs of their older patients, many of whom were housebound, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice provided us with data which showed that 61% of eligible people had received an over 75 year health check in the preceding year.

  • Before the inspection we sought feedback from a nursing home who had residents registered at the practice.They told us they were very happy with the service provided by the practice.

Working age people (including those recently retired and students)

Good

Updated 23 March 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. For example appointments were available on Saturday morning with a GP, nurse practitioner, practice nurse or health care assistant.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs of this age group.

  • Data showed that 85% of eligible women had completed a cervical screening test within the preceding five years compared with 82% nationally.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 March 2016

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

  • 95% of patients with schizophrenia and other psychoses had had a comprehensive care plan documented in the preceding 12 months.compared to the national average of 90%

  • 82% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months compared to the national average of 84%

  • The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • Patients were able to access a counselling service in-house which was provided by the local Community Mental Health Team.

  • The practice carried out advance care planning for patients with dementia.

  • The practice gave patients experiencing poor mental health information about how to access various support groups and voluntary organisations.

  • There were systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff showed they had a good understanding of how to recognise and support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 March 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 and those with a learning disability.

  • Longer appointments were offered for people with a learning disability.

  • The practice regularly worked with multidisciplinary teams in the case management of vulnerable people.

  • The practice participated in the ‘Staying Well’ project intended to help combat loneliness and social isolation.

  • The practice gave good examples of how they had been able to support vulnerable people, for example by allowing access to practice washing and toilet facilities for a homeless patient over a period of several months and by offering support for patients fleeing domestic violence.

  • Staff were aware of additional support services for vulnerable people and described how patients were signposted to these agencies.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were able to demonstrate their awareness of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.