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Inspection Summary


Overall summary & rating

Good

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chapelthorpe Medical Centre on 21 June 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 been trained to provide them with 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.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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 areas of outstanding practice:

  • The practice offered online services such as online bookings and prescription ordering. It had recently begun to offer “AskmyGP”, a portal which allowed the patient to contact the practice online outlining their condition. Patients then received contact from the practice such as signposting advice or a request that they come into the surgery for an appointment.

  • The practice operated a diabetic clinic delivered in conjunction with a local secondary care provider. The practice also offered specialist care management and enhanced services such as insulin initiation in-house.

There where two areas where the provider should make improvements:

  • The practice needed to ensure that all actions identified as a result of a significant event report had been completed and that this had been recorded, and that lessons learned from such events were shared with all relevant staff.

  • The practice needed to ensure that appropriate action was taken by staff following patient safety and other alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 August 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting, recording and analysing significant events. However it was not completely clear during the inspection that all learning points from incidents had been fully actioned or that lessons learned were shared. The practice told us that they would review this.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • Alerts and other information was cascaded to staff via the practice IT system and had the practice had recently moved to a new system for monitoring that alerts had been received. During the inspection we identified that in some cases there was limited evidence to show that all alerts were being opened and acted upon following their dissemination. The practice said it would examine this further.

  • Via their participation in one of the local Vanguard programmes the practice received the support of pharmacists who worked directly within the practice. Pharmacists supported medicines optimisation work (medicines optimisation seeks to maximise the beneficial clinical outcomes for patients from medicines with an emphasis on safety, governance, professional collaboration and patient engagement), and carried out other activities which included medication reviews and dealing with medication queries.

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

  • Risks to patients were assessed and well managed.

  • The practice had developed a locum induction pack which gave key information to locum GPs who may be new to the practice and the procedures which operated within it.
  • There were effective arrangements in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs.

Effective

Good

Updated 9 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

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

  • Clinical audits demonstrated quality improvement.

  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The practice had trained staff to act as care navigators to signpost patients that may be in need of assistance in the community to services that could help. They were also able to explain to patients in more depth the range of services and options available to them.

  • The practice supported the Chapelthorpe Medical Centre Health Champions, these were a group of 19 patients from the practice who, having received training and additional support, voluntarily offered their services to meet the needs of the practice population. Activities have included supporting and interacting with patients in the waiting room, signposting and the establishment of a walk and talk group and a practice carers group.

Caring

Good

Updated 9 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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. For example, patients could use an IT resource in the waiting room which contained a community services directory, which provided up to date information about local community resources. In addition they could access face-to-face support and signposting from the practice care navigators and Health Champions.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The IT system used coding and icons to alert staff to patients who may be vulnerable or have specific needs which allowed clinicians to tailor consultations more effectively.

Responsive

Good

Updated 9 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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 the practice,

    • Offered a range of appointments which included pre-bookable appointments, on the day/urgent appointments, telephone consultations and online services via a portal

    • Worked within local Vanguard programmes and delivered enhanced health and care signposting and information for patients (using care navigators and improved IT access), extended hours access to services, and offered in-house services such as physiotherapy. The practice also worked closely with other health and care professionals to integrate and link services for patients.

    • Supported the Chapelthorpe Medical Centre Health Champions, a group of trained volunteers who delivered a range of health and wellbeing initiatives including carers support and health walks.

    • The practice operated a diabetic clinic delivered in conjunction with a local secondary care provider. The practice also offered specialist care management and enhanced services such as insulin initiation in-house.

    • The practice also hosted renal (kidney disease) outreach clinics twice a month for both registered and non registered patients and twice yearly screening clinics for abdominal aortic aneurysm (this is a dangerous swelling affecting the main blood vessel that runs from the heart). In 2015/2016 an average of 20 patients attended each renal clinic, and in the same year 68 practice patients attended abdominal aortic aneurysm (AAA) screening (An abdominal aortic aneurysm is a swelling of the aorta, the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body).

    • Patients told us 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 and other stakeholders.

Well-led

Good

Updated 9 August 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 it.

  • 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 governance meetings.

  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

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

Checks on specific services

People with long term conditions

Good

Updated 9 August 2016

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

  • GPs and nursing staff had lead roles in chronic disease management such as diabetes, Chronic Obstructive Pulmonary Disease (COPD) and asthma.The practice kept registers of patients with long term conditions and used these to effectively manage treatment packages which included structured examinations, the development of care plans and regular reviews. Whenever possible the practice made every effort to carry out multi-condition appointments for those with more than one long term condition.

  • Patients at risk of avoidable hospital admission had an identified named GP and care coordinator in place as well as a personalised care package and review programme.

  • The practice operated a diabetic clinic delivered in conjunction with a local secondary care provider. The practice also offered specialist care management and enhanced services such as insulin initiation in-house.

    • In 2015/2016 nine patients received insulin initiation and four received GLP-1(a medication used to treat diabetes) initiation.

    • Performance for diabetes related indicators was either comparable with or better than the national average. For example, 93% of patients on the diabetes register had a record of a foot examination and risk classification being carried out in the preceding 12 months compared to the national average of 88%.

  • Longer appointments and home visits were available when needed.

  • The practice hosted renal (kidney disease) outreach clinics twice a month for both registered and non registered patients and twice yearly screening clinics for abdominal aortic aneurysm.

Families, children and young people

Good

Updated 9 August 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.

  • Childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94% to 97% (CCG figures ranged from 95% to 98%) and five year olds from 96% to 100% (CCG figures ranged from 92% to 97%).

  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 83% and the national average of 82%. The practice had an effective recall system in place and offered reminders for patients who did not attend for their cervical screening test.

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

  • The practice carried out eight week mother and baby checks.

  • The practice was a c-card distribution centre which gave improved access to contraceptives to young people, chlamydia forms and testing kits were also available from the reception (chlamydia is a common sexually transmitted disease which may not show obvious symptoms).

Older people

Good

Updated 9 August 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. For example, t

    he practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. Once a patient was identified the practice carried out advanced care planning and three monthly reviews, which involved multi-disciplinary working across health and social care providers. At the time of inspection the practice had 199 patients on their avoiding unplanned admissions register.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Staff received regular safeguarding training to assist them to identify and action concerns related to vulnerable older patients.

  • The practice delivered weekly clinical sessions to practice patients within three local care homes.

Working age people (including those recently retired and students)

Good

Updated 9 August 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, the practice participated in the catch up programme for students aged 17 and over for measles, mumps and rubella and meningitis C vaccinations.

  • There was the provision for telephone consultations during the day for patients who may not have been able to attend the surgery during the day.

  • The practice had extended evening appointments from 6pm to 8.30pm on Monday and Wednesday. In addition it worked with other local GPs and offered appointments from 6.30pm to 8pm Monday to Friday and from 9am to 3pm on Saturday and Sunday. These latter sessions were delivered from a nearby practice.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group which included healthy living advice and referral to other services such as community mental health.

  • The practice offered online services such as online bookings and prescription ordering. It had recently begun to offer “AskmyGP” a portal which allowed the patient to contact the practice online outlining their condition. Patients then received contact from the practice such as signposting advice or requesting that they come into the surgery for an appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 August 2016

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

  • Patients were able to access a local psychological therapies service either via practice referral or self-referral.

  • As part of long term condition reviews patients were routinely screened for dementia and asked if they had memory issues. Patients who said they had begun to experience problems were referred within the practice for further investigation and support.

  • 99% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG and national averages of 84%. In addition all newly diagnosed dementia patients were offered a first review within six months rather than wait for a first annual review.

  • 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive and agreed care plan documented in the patient record which was comparable to the CCG average of 89% and the national average of 88%. The annual review of those patients on the mental health register also included a physical health check.

  • The practice was working toward the achievement of dementia friendly status.

People whose circumstances may make them vulnerable

Good

Updated 9 August 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 such as those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability or the frail elderly with complex needs.

  • Patients with a learning disability were offered a health check and annual review.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and held regular multi-disciplinary team meetings to discuss these patients and their ongoing needs.

  • The practice had trained staff to act as care navigators to signpost patients that may be in need of assistance in the community to services that could help and assist them.

  • The practice had an electronic information point in the waiting room for patients to utilise to access a range of services which included a directory of local services.

  • 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 normal working hours and out of hours.