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Corbett Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 3 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Corbett Medical Practice on 4 February 2016. Overall the practice is rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised and shared across the team.
  • There was a strong commitment towards innovation and integrated care. The practice used innovative and proactive methods to deliver improved patient outcomes, working with other local practices.
  • Feedback from patients about their level of care and involvement in decisions about their options for treatment 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 patients’ 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was readily available and in an easy read format with pictures and large print.
  • The practice had a clear vision which had integrity, continuity of care, teamwork and trust as its core principals. There was a demonstrated commitment to continuous learning for clinical and non-clinical staff.
  • A GP had been very involved with securing funding and setting up the Droitwich Dementia Centre.
  • The practice participated in a local Social Prescribing Pilot project, which provided additional support for patients with poor mental health.
  • Research studies were being carried out which contributed to expanding knowledge and improving outcomes for patients. The practice’s contribution to research was recognised in the award of Research Practice of the Season by the University of Warwick (autumn/winter 2015).
  • The practice employed a pharmacist for 28 hours a week. This resulted in increased numbers of medicine reviews completed and greater availability of GP appointments.

We saw three areas of outstanding practice:

  • A GP had been very involved with securing funding and setting up the Droitwich Dementia Centre.
  • The practice participated in a local Social Prescribing Pilot project, which provided additional support for patients with poor mental health.
  • The practice had produced a ‘Booklet of Opportunity’ to promote the range of professional development available to GPs working at Corbett Medical Practice, in order to counteract the difficulty in recruiting GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 May 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.
  • The practice maximised opportunities to learn from internal and external incidents, to support improvement. The practice used monthly team meeting to analyse and share learning from significant events.
  • The practice valued information about safety highly and used it to promote learning and improvement.
  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
  • There was a named GP with responsibility for medicines management. The practice employed a pharmacist for 28 hours a week to enhance the safe management of medicines. The GP worked closely with the practice pharmacist.
  • The practice had clear safeguarding systems to help ensure the safety of children and adults whose circumstances might make them vulnerable and had put these into practice when necessary.

Effective

Outstanding

Updated 3 May 2016

The practice is rated as outstanding for providing effective services.

  • Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. NICE is the organisation responsible for promoting clinical excellence and cost-effectiveness.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mainly at or above average for the locality and when compared with the national average.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidelines.
  • The practice carried out regular clinical audits which they used to improve patient care.
  • 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 patients’ needs.
  • The practice pharmacist had developed a robust system for recalls for patients with chronic diseases. The pharmacist dealt with all medicines reviews and took individual patients’ circumstances and communication needs into account.
  • A GP partner was a clinical assistant in skin cancer, which enabled them to provide expert knowledge to colleagues in the practice.
  • A GP partner was a Hospital Practitioner in Paediatrics at Worcester Royal Hospital. This additional expertise was a valuable resource to the practice team.

Caring

Outstanding

Updated 3 May 2016

The practice is rated as outstanding for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice higher than others for almost all aspects of care. For example, 99% of patients said they had confidence and trust in the last GP they saw (CCG average 97%, national average 95%), 98% of patients said they had confidence and trust in the last nurse they saw (CCG average 98%, national average 97%).
  • Patients told us that they were treated with compassion, dignity and respect and that they were involved in decisions about their care and treatment. Information from patients who completed CQC comment cards reinforced the high degree of care provided and their involvement in considering their treatment options.
  • Information for patients about the services available was easy to understand and accessible. The practice leaflet and complaints leaflet were available in an easy read format with pictures and large print.
  • We saw that staff treated patients in a friendly and respectful way, and maintained patient and information confidentiality.
  • Views of external stakeholders were positive and in line with our findings. For example, the managers of the three local care homes where some of the practice’s patients lived all highly praised the practice and told us that they were very caring. Each care home had a nominated GP who visited patients each week.

Responsive

Good

Updated 3 May 2016

The practice is rated as good for providing responsive services.

  • the practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients' needs.
  • The practice had set up a social prescribing pilot project in the locality. Patients with poor mental health or those with loneliness could be referred to a counsellor and signposted to relevant external agencies if appropriate.
  • The practice made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG). This resulted in improvements to the appointment system and the availability of access to a named GP.
  • Patients could access appointments and services in a way and at a time that suited them. For example, appointments were available from 7am on a Monday and evening and this included a phlebotomy service. Extended hours up to 8.30pm were available on one day each week which rotated.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice was in purpose-built premises; it had good facilities and was well equipped to treat patients and meet their needs.
  • A GP had been involved in securing funding for and setting up the Droitwich Dementia Cafe. This was the only facility of its type in the county where dementia patients, together with their carers and families, could meet to socialise and take part in specially prepared activities.

Well-led

Outstanding

Updated 3 May 2016

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

  • The practice gave high priority to quality and safety and had a strong vision and dynamic approach to developing the practice. They had a strategy to deliver this vision and regularly reviewed and discussed their plans with staff.
  • High standards were promoted and valued by all practice staff. Practice staff worked together in a co-operative way whatever their role within the team.
  • Governance and arrangements were effective and responsibilities were delegated to encourage full involvement from team members.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • Staff received comprehensive inductions and there were monthly staff meetings. Staff told us that they felt encouraged to develop their skills and improve the standard of service delivery.
  • The practice had worked hard to provide facilities, which went beyond the core contract, and benefitted patients in the local community, as well as those registered at Corbett Medical Practice.
  • The practice gathered feedback from patients, and it had an active Patient Participation Group which influenced practice development.
  • The practice was awarded Research Practice of the Season by the University of Warwick in recognition of their contribution to expanding knowledge. Special mention was made in the citation about the practice’s contribution to a study which involved tele-monitoring or self-monitoring in patients with high blood pressure: 40 patients were recruited to this study and 23 patients from the group were selected to take part. This was the highest number in the area.
  • The practice was the first in the county to employ a Physician Associate. Physician Associates are skilled members of the healthcare team who are qualified to provide a wide range of medical services in practice with a licensed physician. The Physician Associate had played a key role in organising a national training day for future Physician Associates, as well as lecturing at undergraduate level. This illustrated the practice leadership’s commitment to encouraging learning beyond their own organisation.
Checks on specific services

People with long term conditions

Outstanding

Updated 3 May 2016

The practice is rated as outstanding 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.
  • 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. Medicines were reviewed by a clinical pharmacist, who organized the reviews and had developed a robust recall system. The pharmacist was employed by the practice for 28 hours per week. This resulted in patients with several long term conditions only having to attend one annual review instead of having a separate review for each condition. It also ensured safer prescribing. GPs held specialist interest qualifications, which enabled them to provide services closer to home for patients with chronic health conditions.
  • 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.
  • The nursing team provided lifestyle support (smoking, weight loss) and NHS Health Checks. A GP had developed a process for identification and support for patients at risk of developing diabetes, which helped delay the onset of diabetes and its complications.
  • Data from the Quality and Outcome Framework (QOF) achievement for 2014/2015 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 87%, which was 1% higher than the local average and 3% higher than the national average.
  • Data showed that 74% of patients with asthma had their care reviewed within the last 12 months which was1% below the national average.
  • The practice was shown to be top of South Worcestershire CCG in terms of chronic disease recorded prevalence, which evidenced that they were pro-active in identifying patients with chronic diseases.
  • The practice clinical team had received additional training in long term care. For example, four GPs and two nurses held diplomas in diabetes care and a GP held a diploma in geriatric medicine.

Families, children and young people

Outstanding

Updated 3 May 2016

The practice is rated as outstanding 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 we saw evidence to confirm this.
  • Cervical screening uptake was 85%, which is slightly higher than the local average of 83% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. The sit and wait clinics were popular with parents who had school age children and young adults who wanted to walk in and be seen.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Outstanding

Updated 3 May 2016

The practice is rated as outstanding 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 maintained a register for patients requiring palliative care. Home visits and rapid access appointments were provided for these patients, who often had complex needs.
  • Regular multi-disciplinary meetings were held in which patients on the palliative care register were discussed.
  • A named GP visited care homes to provide continuity and to monitor chronic diseases.
  • The practice carried out weekly visits at care homes for older people and feedback from the three care home managers to whom we spoke was very positive.
  • The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.

Working age people (including those recently retired and students)

Outstanding

Updated 3 May 2016

The practice is rated as outstanding 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.
  • Two GPs, a nurse and a phlebotomist held a clinic at 7am every Monday in order to help those who needed to see a clinician or have blood tests if they worked away during the week. The evening extended surgery time was rotated in order to maximise patient choice.
  • Bookable telephone consultations with a GP or nurse were offered to provide greater flexibility.
  • Varied types of appointments were available, including face to face or telephone consultations with a GP, practice nurse or advanced nurse practitioner.
  • The practice participated in the Clinical Contact Centre scheme, whereby people could ring the Centre for advice or an appointment at a time to suit them.
  • On-the-day sit and wait appointments were available in the late afternoon/early evening for those people who could not attend during the working day.
  • 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.
  • A wide range of contraceptive services were available at the practice (including Intrauterine devices and implants).
  • NHS Health checks were offered by nurses, who provided advice on smoking cessation, weight loss and exercise.
  • Patients who had signed up to the Electronic Prescription Service could have prescriptions sent to a pharmacy close to their place of work.
  • Online booking meant that patients could book routine appointments with a GP at a time to suit them.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 3 May 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have experienced poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • A GP partner had been instrumental in obtaining the funding and setting up the Droitwich Dementia Centre. The Centre offered a café where dementia patients, their carers and families could go to socialise and take part in specially prepared activities. The facility was available to all the local community, not just patients registered with Corbett Medical Practice.
  • A GP had been involved with setting up the Social Prescribing Pilot Project in the locality. The project, which had just started, provided advice and support for patients with social needs or for those who had poor mental health. For example, patients who were isolated or lonely could use the service. Patients could be referred into the service by their GP or self-refer. They would be given an appointment with a counsellor, who could also signpost them to external agencies like Age Concern, if appropriate. This service was open to patients from two other practices in the locality. One of the meetings was held at Corbett Medical Practice once a month.

  • Two comment cards specifically referred to the excellent care and kindness shown to patients with dementia.
  • 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 5% below the CCG average and 4% below the national average.

People whose circumstances may make them vulnerable

Outstanding

Updated 3 May 2016

The practice is rated as outstanding 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. Vulnerable patients were flagged on the practice’s index system on their computer, so that they were immediately identifiable to staff and could be offered an appropriate level of service.
  • Patients with no fixed abode were able to register at the practice using the practice’s address.
  • The practice offered longer appointments for patients with a learning disability.
  • The GPs had a buddy system for providing continuity of care for this population group.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff had received training and 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.
  • The practice was pro-active in providing confidential information about domestic abuse and sexual violence.
  • A GP had undertaken additional training in substance misuse, which was a source of additional expertise in the practice team. The GP was also a medical advisor for the local alcohol and drug recovery charity, so they provided advice to patients from Corbett Medical Practice as well as to patients in the local community.