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Inspection Summary


Overall summary & rating

Good

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Castle Practice on 13 April 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 had effective procedures in place to ensure care and treatment was delivered in line with current evidence based guidance.
  • Staff understood and fulfilled their responsibilities to raise safety 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.
  • 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 named GP and there was continuity of care, with urgent appointments available the same day.
  • Some staff had not received updates on mandatory training, but were aware of the procedures to follow.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a system in place to identify carers, but the numbers on the register were low due to the practice not coding the information on the medical records.
  • 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 Candor. The practice encouraged a culture of openness and honesty.

The areas where the provider should make improvement are:

  • Effectively code all patients identified as carers.

  • Continue to monitor and improve access to the practice.

  • Review telephone access as results from the January GP patient survey showed 44% of patients said they could get through easily to the practice by phone (CCG average of 68%, national average of 73%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2016

  • There was an effective system in place for reporting and recording significant events and incidents and lessons were shared with staff to make sure action was taken to improve safety in the practice. When there were unintended or unexpected safety incidents, patients received support and a verbal and written apology. They 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 patients safe and safeguarded from abuse, however some staff still required an update of their training, but they were aware of the procedures to follow.
  • Staff were able to explain how safeguarding concerns were raised and dealt with and gave examples of outcomes.
  • Systems were in place to ensure the safe storage of vaccinations and evidence to demonstrate that checks were undertaken to monitor the vaccines.
  • Equipment required to manage foreseeable emergencies was available and was regularly serviced and maintained and minor surgical procedures were carried out and the practice had robust and effective infection control procedures in place.
  • Risks to patients were assessed and well managed and there were enough staff to keep patients safe.

Effective

Good

Updated 23 June 2016

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients.
  • The practice provided enhanced services which included immunisations and advanced care planning. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and patients’ needs and care were planned and delivered in line with current evidence based guidance.
  • The practice was proactive in completing clinical audits that demonstrated quality improvement. There was evidence that clinical audits were effective in improving outcomes for patients.
  • 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.
  • The practice was proactive in encouraging staff to develop their knowledge and skills, for example one of the practice nurses had recently completed the advanced nurse practitioner course.
  • Staff worked with multi-disciplinary teams in managing the needs of patients with long term conditions and complex needs and offered regular reviews of these patients.
  • The practice offered a warfarin service for their patients, this included blood tests and reviews of their medication.

Caring

Good

Updated 23 June 2016

  • Data from the national GP patient survey results published in January 2016 showed patients rated the practice higher than the local and national average 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.
  • The practice offered flexible appointment times based on individual needs and we saw evidence of how the practice had responded to the needs of vulnerable patients with compassion and empathy.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect and maintained patient and information confidentiality.

Responsive

Good

Updated 23 June 2016

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. A CCG is an NHS organisation that brings together local GPs and experienced health professionals to take review and commission local health services.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice provided an anti-coagulation service and patients could have their blood tests, medication dosage checks and reviews completed at the practice.
  • Patients said they found it easy to make an appointment with a named GP and 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. Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.
  • Learning from complaints was shared with staff at quarterly meetings.

Well-led

Good

Updated 23 June 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 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 meetings with the practice team.
  • There was an overarching governance framework which supported the delivery of the strategy and 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 and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. PPGs are a way in which patients and GP surgeries can work together to improve the quality of the service. The PPG was promoted in the waiting room and invited patients to join. Staff had received inductions and had regular performance reviews.
  • There was a strong focus on continuous learning and improvement and the practice worked closely with the local Clinical Commissioning Group.
Checks on specific services

People with long term conditions

Good

Updated 23 June 2016

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

  • The practice ran an anti-coagulation clinic service for their patients and also carried out DMARD monitoring for patients on methotrexate and other associated medicines. (DMARD monitoring involves a series of tests to check patients for adverse effects).

  • Longer appointments and home visits were available when needed.

  • All patients with a long-term condition had a named GP and a structured annual review to check their health and medicines needs were being met.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • For those patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care and the practice had a separate telephone line so that patients could access the practice urgently.

Families, children and young people

Good

Updated 23 June 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 may be at risk, for example, children and young people who had a high number of A&E attendances.

  • 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.

  • The practice’s uptake for the cervical screening programme was 86% which was higher than the national average of 82%.

  • The practice offered a full range of family planning services, including implants.

  • The practice used a rapid access system for patients who required to see a doctor the same day. Appointments were available outside of school hours.

  • The premises were suitable for children and babies.

  • The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.

  • We saw positive examples of joint working with midwives and health visitors and the midwife held an ante natal clinic twice weekly at the practice.

Older people

Good

Updated 23 June 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, this included enhanced services for dementia and care planning to avoid hospital admissions.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.

  • Patients over 75 years of age were offered an annual face to face review with a GP and all patients had a named GP.

  • The practice worked closely with multi-disciplinary teams so patients conditions could be safely managed in the community.

  • The practice reserved an appointment slot every morning for patients who were on the hospital admission avoidance list so they could access a GP immediately.

Working age people (including those recently retired and students)

Good

Updated 23 June 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 was proactive in offering on line services such as appointment booking and repeat prescriptions services, later evening appointments and telephone consultations were also available.

  • A full range of health promotion and screening that reflected the needs for this age group was also available.

  • The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.

  • The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

  • The health care assistant offered a stop smoking service with support from an external provider and the Citizens Advice Bureau held a weekly service at the practice to offer advice and support.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 June 2016

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

  • There were 96 patients on the dementia register and 89% (85 patients) had had their care reviewed in a face to face meeting in the last 12 months
  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact. We saw that there were 82 patients on the mental health register and 94% (77 patients) had had care plans agreed.
  • Patients experiencing poor mental health were signposted to various support groups and voluntary organisations and the community psychiatric nurse held twice weekly clinics at the practice.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and one of the GPs had completed training to prescribe specific medicines used in mental health to support patients in the community.
  • The practice had access to psychological support through Solihull Healthy Minds (IAPT) and regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 June 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 those with a learning disability.

  • We saw that there were 50 patients on the learning disability register, 64% (32 patients) of these patients had received an annual health check and the practice was encouraging the other patients to attend their health reviews.

  • The practice offered longer appointments for patients with a learning disability and worked with other health care professionals in the case management of vulnerable patients.

  • The practice held a register of carers and had 73 carers registered, which represented 0.6% of the practice list. This number was considered low in proportion to the number of patients at the practice, on further investigation we found that carers were being identified by the practice, but the information was not being recorded in the patient’s records effectively.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice told vulnerable patients how to access various support groups and voluntary organisations and there was a system in place to identify patients who required additional support and extra time during appointments.

  • All staff had received safeguarding training, and knew how to recognise signs of abuse in vulnerable adults and children and the procedures to follow. 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.