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Yorkshire Street Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 13 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yorkshire Street Medical Practice on 9 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.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • There were systems in place to assess and monitor risks to patients, though we noted there was no paediatric mask in place for emergency oxygen, some supplies were out of date and blind pulls had not been assessed to remove potential ligature points.
  • 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.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had encouraged patients to attend exercise on prescription over many years.

  • Feedback from patients about their care was consistently and strongly positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

  • 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 (PPG). For example, hand rails had been put up after a patient comment and a new ramp had been installed following feedback from the PPG.
  • The practice had a clear vision with patient care as the top priority.
  • The practice actively engaged with patient groups who may historically have been difficult to reach, for example parents of new born babies and 16 year olds.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Access to appointments was well managed. Patients said they found it easy to make an appointment and there was good continuity of care, with urgent appointments available the same day and routine pre bookable appointments always available within 48 hours.
  • 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.

The areas where the provider should make improvement are:

  • Complete actions to mitigate the risks identified including supplies and emergency equipment, blind pulls, alarm calls and prescription pads.

  • Develop infection prevention and control procedures to incorporate relevant blood spill guidance and sample handling.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2016

The practice is rated as good for providing safe services.

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

  • Lessons were shared to make sure action was taken to improve safety in the practice, we saw evidence of new templates and procedures being introduced following reflection and learning from incidents.

  • We saw examples of unintended or unexpected safety incidents, where patients 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.

  • Although risks to patients who used services were assessed, systems and processes did not cover all potential risks to patients.

  • For example, there were unsecured blind pulls in patient accessible areas which could act as ligature points, there was no emergency alarm in the disabled toilet and there was no paediatric mask available for the oxygen.

  • There were also some medical supplies which were out of date, the practice removed these and ordered replacements immediately.

  • The practice had systems in place for secure storage of blank printer prescriptions and prescriptions for controlled drugs. Blank prescription pads however, were stored in reception with no audit trail. The practice implemented a system whilst we were on-site.

  • The practice responded proactively to all areas of concern during the inspection which mitigated a number of potential risks to patients.

  • Staffing levels were good and ensured prompt access for patients to care at all times.

Effective

Good

Updated 13 April 2016

The practice is rated as good for providing effective services.

  • 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 saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients, including notifying NHS England where national directives needed updating.

  • Data showed that the practice was performing highly when compared to neighbouring practices in the Clinical Commissioning Group (CCG). For example, 99% of patients with Chronic Obstructive Pulmonary Disease (COPD, a condition of the lungs) had a full review in the previous 12 months, higher than the national average of 90%.

  • A variety of comprehensive clinical audits demonstrated quality improvement, involvement of all staff and a reflective culture.

  • 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.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

  • There was a long history of referring patients to exercise on prescription. Many patients we spoke to told us they attended the gym and other exercise groups because of the practice’s direction and encouragement.

Caring

Good

Updated 13 April 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for almost all aspects of care. For example, 93% found the receptionists helpful, higher than the CCG average of 85% and national average of 87%.

  • Feedback from patients about their care and treatment was consistently and strongly positive.

  • The culture of the practice was patient focussed throughout.

  • Staff listened to their patients and gave a very personalised service to them. Staff were motivated and inspired to offer kind and compassionate care.

  • 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.

  • The practice provided high quality information for patients, and comprehensive written information prior to minor surgery. This included a written consent form.

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

  • The practice sent sympathy cards to the next of kin when patients died which included information on support services. GPs contacted families to offer personal support.

Responsive

Good

Updated 13 April 2016

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example a variety of local enhanced services were provided to offer access closer to home, such as 24 hour electro cardiograms (ECG); d-dimer (a test which checks for blood-clotting problems) and wrist splints (for patients who had undergone operations on their hands and wrists).

  • Patients said they found it easy to make an appointment with a named GP and that 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.

  • 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 PPG. A new ramp had been installed at the front entrance to improve access for less physically able people following a PPG suggestion.
  • People could access appointments and services in a way and at a time that suited them, for example appointments could be easily booked on line, on the day appointments were always available and routine appointments were made within 2 working days.
  • Information about how to complain was available and easy to understand. However, leaflets had to be requested from staff at the time of our visit. Evidence showed that the practice responded quickly to issues raised. The practice acted immediately to place complaints leaflets in the waiting room whilst we were conducting our inspection.
  • The practice actively engaged with patients through a face-to-face and virtual PPG, there were over 90 virtual PPG members who received regular information. The PPG met quarterly and worked actively to support the practice, and had also developed the Burnley Patients Network which worked with the CCG and actively promoted health awareness and patient issues locally.
  • The practice used innovative ways to engage with different patient groups. For example sending congratulations cards to parents with new babies and birthday cards to 16 year olds which included information on relevant health care and services.

Well-led

Good

Updated 13 April 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 this.

  • There was a clear leadership structure and staff felt supported by management. The practice had comprehensive policies and procedures to govern activity and held regular governance meetings.

  • Individual staff had allocated tasks which they were enthusiastic about and made a difference to patients. For example, patient information displays were eye catching and informative. Other areas of responsibility included childhood immunisation screening; cervical screening and health checks for patients with learning disabilities. Data for all these areas showed higher performance than comparator practices. Staff understood their performance in these areas and proactively worked to consistently improve patient care.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. 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, which it acted on. For example, CCTV was introduced following a staff suggestion.

  • There was an active PPG which met quarterly as well as a virtual PPG which had over 90 members. The practice regularly circulated information via email to this group.

  • The practice gathered feedback from patients using information technology and social media, and the patient participation group influenced practice development.

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

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction with very low staff turnover. Staff were positive about the team ethos and support they received.

  • The practice currently helped train medical students and was planning to become a GP training practice.

  • The practice had comprehensive development plans which linked to practice priorities.

Checks on specific services

People with long term conditions

Good

Updated 13 April 2016

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

  • Practice nurses managed patients with chronic diseases under the guidance of GPs.

  • 100% of patients with atrial fibrillation (a heart condition) whose stroke risk was assessed as high were treated with appropriate medication to reduce the risk of stroke compared with the national average of 98%.

  • Patients with diabetes were referred to the expert patients programme and diabetic retinopathy screening.

  • 97% of patients with diabetes on the register had an influenza immunisation in the preceding flu season (national average 93%).

  • 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.

  • The practice philosophy was to help educate and inform patients about long-term conditions to empower them to manage their own conditions where possible.

  • Patients who had experienced breast cancer were invited for reviews with the practice nurses. The practice also worked closely with Lancashire cancer care network and signposted patients with cancer to various local support services.

  • All patients with mobility difficulties were highlighted on the computer system and GPs and nurses saw them on the ground floor.

Families, children and young people

Outstanding

Updated 13 April 2016

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

  • The practice provided ante natal clinics with the community midwife.

  • The practice had identified the need to improve childhood immunisation rates and some years back began sending congratulations cards to parents of new born babies with advice for parents and immunisations schedules.

  • A member of staff was responsible for coordinating childhood immunisations and took pride in achieving high immunisation rates for standard childhood immunisations. For example, rates for under 12 month olds were 90% and 95% compared to CCG figures of 72% and 84%. 24 month olds rates varied from 82% to 97% (CCG rates 75% to 86%).

  • The practice reviewed access to baby clinics following an incident and now ran pre-booked appointments. Practice staff told us parents were much happier with the new arrangements.

  • The practice invited mothers of new born babies to 40-minute post-natal checks with a GP.

  • Unwell babies and children were seen the same day.

  • The safeguarding lead met with health visitors to discuss children “of concern”. The practice had adopted a low threshold to identifying children and families who may require additional support. There were excellent 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 or missed immunisations were discussed and referrals to social services were made where appropriate.

  • 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.

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

  • The practice worked closely with health visitors and school nurses.

  • The healthcare assistant had conducted a survey of young people as part of her training. As a result of this work, the practice had begun sending birthday cards to patients who turned 16, including age appropriate information about access to health services and advice.

  • Patients were encouraged to use social networking to engage with the practice and text messaging was used for appointment reminders, health promotion information and feedback.

  • A member of staff was responsible for coordinating cervical screening for women. Data showed 83% of eligible women had attended screening in the previous 3 years compared to 73% nationally.

  • There was relevant information and signposting to domestic violence support within the practice.

  • A newly appointed nurse completed training in family planning as part of appraisal and continuous professional development planning.

  • One of the nurses identified that the nationally issued patient group directive on influenza vaccination missed out pregnant women, so contacted NHS England who revised it to include expectant mothers.

  • The practice offered family planning and sexual health screening for the wider local population.

Older people

Good

Updated 13 April 2016

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

  • The practice offered same day appointments for older patients.

  • All patients who were over 75 had a named GP and were offered an annual health check.

  • The practice had a carers register with 3% of the population recorded as carers. Patients were signposted to the local carers contact and invited to annual health checks.

  • A carers display board in the practice gave details of support available to carers.

  • The practice offered proactive, personalised care through a care plan and worked with other professionals to deliver good care to this age group.

  • Home visits were carried out by the GPs and practice nurses to housebound patients and joint working with community staff ensured these patients were supported in their own homes.

  • The practice had access to a CCG funded community geriatrician who advised in management of patients with complex conditions and contributed to care planning.

  • 83% of patients aged 65 and over had received a seasonal flu vaccination the previous flu season, higher than the national average of 73% (2013-14 data).

  • The practice worked closely with two specialist nurse practitioners who conducted ward rounds in all local care homes and liaised daily with GPs where there were concerns.

  • The GPs supported patients in intermediate care beds locally for patients who could not manage on their own but did not require full hospital care.

  • The practice sent bouquets to patients who were 100 years old (all centenarians had been female to date).

Working age people (including those recently retired and students)

Good

Updated 13 April 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 sent details to the local university for local students to promote access to health care for this population group.

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

  • Extended hours appointments were available on Monday evenings for patients who had difficulty attending during normal hours.

  • The practice offered a full range of sexual health screening and family planning services to their own patients as well as those of other local practices.

  • The practice was proactive at using social media to engage with patients and encouraged feedback through a variety of mediums.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 April 2016

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

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    92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to 89% nationally.

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

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

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

  • Counselling and wellbeing support services were offered from the practice by partner organisations.

  • The practice had comprehensive system in place to follow up patients who had attended hospital where they may have been experiencing poor mental health.

  • All staff had completed Dementia Friends training and wore Dementia Friend badges.

People whose circumstances may make them vulnerable

Good

Updated 13 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held registers of patients living in vulnerable circumstances and met bi-monthly with the integrated neighbourhood team to ensure health and social care needs were met.

  • The practice conducted thorough annual health checks for people with a learning disability and had proactively identified some patients with health concerns who were treated to avoid further significant illnesses.

  • The GP responsible for conducting annual health checks for patients with learning disabilities had built up a good relationship with many patients who had previously not engaged with health services, and ensured they regularly attended the practice and other health services as required.

  • The practice worked with a local substance misuse service to support patients with drug and alcohol problems.

  • Ex veterans were identified, offered an annual health check and signposted to local support groups.

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

  • Staff clearly recognised 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.