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Inspection Summary


Overall summary & rating

Outstanding

Updated 3 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Collingwood Surgery on 17 November 2016. Overall the practice is rated as outstanding.

Our key findings were as follows:

  • Patients’ needs were assessed and care was planned and delivered in line with current legislation.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. Results from the National GP Patient Survey, published in July 2016, showed that patients’ satisfaction with how they could access care and treatment was much higher than local and national averages
  • The practice had a long track record of training new GPs. Feedback from trainees was very positive. The practice scored highly in the General Medical Council (GMC)’s national training scheme survey for 2015.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about services and how to complain was available and easy to understand.
  • There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
  • There was strong collaboration and support across all staff groups.

We saw several areas of outstanding practice including:

  • The practice had developed end of life care arrangements over many years and promoted the use of the palliative care register with clinicians. The practice was one of four nationally to take part in a MacMillan project to link patients on the palliative care register with a MacMillan social worker. This project had subsequently been rolled out to all practices within the CCG.
  • The practice had responded to the needs of its patients experiencing poor mental health and there were effective arrangements to provide care and support for those patients. The practice funded 50% of a mental health worker who worked full time within the surgeries; this ensured that 95% of patients with mental health problems were seen within the practice, rather than in secondary care.
  • The practice team was forward thinking and part of local and national pilot schemes to improve outcomes for patients. For example, the practice took part in the first phase of the national Health Foundation’s MAGIC programme ( ‘making good decisions in collaboration’), which looked at how to embed best practice in shared decision making.

The area where the provider should make improvements is:

  • Take steps to monitor and record the minimum and maximum temperatures for the refrigerators at the New York surgery.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 January 2017

The practice is rated as good for providing safe services.

The nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. Risks to patients were assessed and well managed.

Lessons were shared to make sure action was taken to improve safety in the practice. When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, and verbal or written apologies.

The practice was clean and hygienic and good infection control arrangements were in place. The arrangements for managing medicines, including emergency drugs and vaccinations, in the practice kept patients safe. Some medicines are required to be stored in refrigerators; records of current, minimum and maximum temperatures were held at two sites; this ensured that appropriate temperatures had always been maintained. However, only the current temperature was recorded at the New York surgery; managers told us this would be rectified.

Comprehensive staff recruitment and induction policies were in operation. Chaperones were available if required and staff who acted as chaperones had undertaken appropriate training.

Effective

Good

Updated 3 January 2017

The practice is rated as good for providing effective services.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. Arrangements had been made to support clinicians with their continuing professional development. Staff had received training appropriate to their roles. The practice had a long track record as a training practice. Four of the GPs were accredited GP trainers. Feedback from trainees was very positive.

There were systems in place to support multi-disciplinary working with other health and social care professionals in the local area. Staff had access to the information and equipment they needed to deliver effective care and treatment.

Data showed patient outcomes were above national averages. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 98.3% of the points available. This was above the local and national averages of 97.1% and 95.4% respectively.

There was evidence of clinical audit activity and improvements made to patient care and patient outcomes as a result of this. We saw a number of clinical audits had been carried out; 16 between March 2015 and October 2016.

Caring

Good

Updated 3 January 2017

The practice is rated as good for providing caring services.

Patients said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about the services available was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

The National GP Patient Survey published in July 2016 showed the practice’s scores were above local and national averages. Results showed that 98% of respondents had confidence and trust in their GP, compared to 95% nationally; 89% of respondents said the last GP they saw was good treating them with care and concern, compared to the national average of 85%. Scores for nurses were also above average; 95% said the last nurse they saw was good treating them with care and concern, which was above the national average of 91%.

The practice identified carers and ensured they were offered a flu vaccination and signposted to appropriate advice and support services; 617 patients (3.6% of the practice list) had been identified as carers. Arrangements were in place to support families who had suffered bereavement. One of the GP partners was involved in the development of a CCG strategy to ensure families are provided with appropriate care and support following the death of a child.

Responsive

Outstanding

Updated 3 January 2017

The practice is rated as outstanding for providing responsive services.

The practice scored well in relation to access in the National GP Patient Survey. The most recent results (published in July 2016) showed 91% (compared to 85% nationally) of respondents were able to get an appointment or speak to someone when necessary; 90% of respondents said they were satisfied with opening hours (compared to the national average of 76%). The practice also scored highly on the ease of getting through on the telephone to make an appointment (85% of patients said this was easy or very easy, compared to the national average of 73%).

There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality. For example, the practice engaged with a national learning disability project, “Getting it Right”, where volunteers with a learning disability

delivered workshops to staff. One of the nurses was the first point of contact for patients on the learning disability register and acted as their advocate where appropriate.

The practice had developed end of life care arrangements over many years and promoted the use of the palliative care register with clinicians. The practice was one of four nationally to take part in a MacMillan project to link patients on the palliative care register with a MacMillan social worker.

There were effective arrangements to provide care and support for patients experiencing poor mental health. The practice funded 50% of a mental health worker who worked full time within the surgeries. The funding ensured that 95% of patients with mental health problems were seen within the practice, rather than in secondary care.

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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Outstanding

Updated 3 January 2017

The practice is rated as outstanding for providing well-led services.

The leadership, management and governance of the practice assured the delivery of person-centred care which met patients’ needs. There was a clear and documented vision for the practice which had been developed with staff. Staff understood their responsibilities in relation to the practice aims and objectives.

Leaders had an inspiring shared purpose, strove to deliver person centred care and motivated staff to succeed. There was a clear leadership structure in place and staff felt supported by management. Team working within the practice between clinical and non-clinical staff was good.

There were consistently high levels of constructive staff engagement. All staff were involved in discussions about how to run and develop the practice, and the partners encouraged all members of staff to identify opportunities to improve the service delivered by the practice.

There was a clear approach to seeking out and embedding new ways of providing care and treatment. One of the GPs had a special interest in mental health. They had helped form a national network of specialist primary care clinicians; had provided advanced training and Cognitive behavioural therapy (CBT) courses for GPs throughout the CCG and had led a collaboration of seven universities to design training for mental health workers who became Improving Access to Psychological Therapies (IAPT) staff nationally.

There was a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money. One of the GPs helped to redesign a national screening and brief intervention (SBI) tool (for use when treating patients with alcohol problems). Five staff members taught about their areas of specialism at local, regional, national and international level, for example, one of the GPs was due to advise a hospital in Denmark about the implementation of shared decision making.

Checks on specific services

People with long term conditions

Good

Updated 3 January 2017

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
  • The practice scored well in the Quality and Outcomes Framework (QOF). This rewards practices for managing some of the most common long term conditions. For example, performance for asthma related indicators was better than the national average (100% compared to 97.4% nationally) and performance for heart failure related indicators was better than the national average (100% compared to 98.1% nationally). QOF exception rates were also well below average (the QOF scheme includes the concept of ‘exception reporting’ to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect).
  • Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
  • Patients had regular reviews to check health and medicines needs were being met.
  • For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 3 January 2017

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

  • The practice had identified the needs of families, children and young people, and put plans in place to meet them.
  • 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 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.
  • 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’s uptake for the cervical screening programme was 80.5%, which was slightly below the CCG average of 82.9% and the national average of 81.5%.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Older people

Outstanding

Updated 3 January 2017

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. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
  • Collingwood Surgery was the lead practice for two large nursing homes, GPs carried out a weekly ward round to review patients and had close to 100% co-ordinated care plans in place for patients.
  • The practice had developed end of life care arrangements over many years and promoted the use of the palliative care register with clinicians. The practice was one of four nationally to take part in a MacMillan project to link patients on the palliative care register with a MacMillan social worker. The pilot showed an increased rate of death in the patients’ usual place of residence in those who were on the register and had interacted with the service; and showed increased quality of care and was subsequently rolled out to all practices within the CCG.
  • Since January 2016, 172 deaths were recorded; of those 80 were on the practice’s palliative care register (47%, compared to the CCG average of 24%) and 71 died in their usual place of residence.

Working age people (including those recently retired and students)

Good

Updated 3 January 2017

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 and flexible. Extended hours surgeries were offered on Monday and Thursday evenings between 6pm and 8pm and one Saturday morning each month for working patients who could not attend during normal opening hours.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
  • Additional services were provided such as health checks for the over 40s and travel vaccinations.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 3 January 2017

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

  • Performance for mental health related indicators was above the national average (100% compared to 92.8% nationally). For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, was 94.3%, compared to the national average of 88.8%.
  • The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
  • Staff had been trained as dementia friends to help support patients and their carers and families.
  • Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
  • The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
  • The practice funded 50% of a mental health worker who worked full time within the surgeries. The funding ensured that 95% of patients with mental health problems were seen within the practice, rather than in secondary care. Staff told us that patients valued the flexibility of appointments and continuity of care.

People whose circumstances may make them vulnerable

Good

Updated 3 January 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 those with a learning disability.
  • The practice engaged with a national learning disability project, “Getting it Right”, where volunteers with a learning disability delivered workshops to staff. The practice had developed a number of ‘easy read’ leaflets and health check invitation letters for patients. Following a review of attendance rates at annual health checks for patients with learning disabilities, improvements to the recall system were implemented. The practice’s prevalence rate was 0.88%, which was above the local CCG average of 0.67% and the national average of 0.46%.
  • One of the nurses was the first point of contact for patients on the learning disability register and acted as their advocate where appropriate. The nurse liaised with secondary care health staff on behalf of patients to facilitate hospital appointments.
  • The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people.
  • 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 and out of hours.
  • Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment; 617 patients (3.6% of the practice list) had been identified as carers.