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Eve Hill Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eve Hill Medical Practice on 15 March 2016. Overall the practice is rated as outstanding.

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

  • Throughout our inspection we noticed a strong theme of positive feedback from staff, patients and other organisations who worked with the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • There were consistently high levels of constructive staff engagement. The management team worked closely together to motivate and encourage staff to succeed.
  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and improvements to patient care and treatment. Staff were actively engaged in activities to monitor and improve quality and patient outcomes
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet 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 a clear vision which had quality and safety as its top priority. We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality.
  • The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.
  • We observed the premises to be visibly clean and tidy. The practice had good facilities and was well equipped to treat patients and meet their needs

We saw some areas of outstanding practice:

  • The practice took a proactive approach to understanding the needs of their patients who were carers. Due to ongoing work to identify and support carers, the practices carers register had increased by 9% in a three month period. Practice data highlighted that there were 265 carers on the practices register and 4% of the practices list had been identified as carers. There was a dedicated carer’s lead in place and carers were offered support and regularly reviewed by the practice.
  • The practice had identified that 21% of their carer population were also experiencing other conditions such as depression. Therefore the practice offered opportunistic depression screening for carers.
  • The practice sent birthday letters to patients on their 75th birthdays to inform them of their named GP and to offer them an annual health check; 67% of the practices patients who were aged 75 and above had attended for a health check within the previous 12 months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 May 2016

The practice is rated as good for providing safe services.

  • There were robust systems in place to monitor safety. These included systems for reporting incidents, near misses, positive events and national patient safety alerts, as well as comments and complaints received from patients.

  • The practice was proactive in identifying and managing significant events. There was a strong learning culture throughout the practice and used significant events, incidents and complaints as opportunities to drive improvements.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
  • We observed the premises to be visibly clean and tidy. The practice had adequate arrangements in place to respond to emergencies and major incidents.

Effective

Outstanding

Updated 17 May 2016

The practice is rated as outstanding for providing effective services.

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

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes. In addition to audits, clinical reviews were completed across a number of areas at the practice.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff members throughout the practice had lead roles across a range of areas. Staff, teams and services were committed to working collaboratively.
  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. The practice was focusing on improving antibiotic prescribing by exploring near-patient testing methods and through local GP engagement to effectively reduce unnecessary antibiotic prescribing in general practice.

Caring

Outstanding

Updated 17 May 2016

The practice is rated as outstanding for providing caring services.

  • We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect. There was a strong theme of positive feedback from patients we spoke with on the day of our inspection; this was also evident in completed comment cards, positive survey results and positive feedback on the practices NHS Choices web page.

  • The practice took a proactive approach to understanding the needs of their patients who were also carers. There was a dedicated carer’s lead and due to improvements made in the practice on identifying carers, the carers register had increased by 9% in a three month period and therefore 4% of the practices list had been identified as carers.

  • Carers were offered further support and were opportunistically screened for depression.
  • The practice also supported patients by referring them to a number of support groups, onsite counselling services and further support organisations. 

Responsive

Good

Updated 17 May 2016

The practice is rated as good for providing responsive services.

  • Patients could access appointments and services in a way and at a time that suited them.
  • There were longer appointments available for vulnerable patients, for patients with a learning disability, for carers and for patients experiencing poor mental health. Urgent access appointments were available for children and those with serious medical conditions.
  • The practice was proactive in identifying patients with complex health conditions. There was an efficient referral process, with referrals often completed with the patient and the GP during consultation.
  • Clinical staff carried out home visits for older patients and patients who would benefit from these. Immunisations such as flu and shingles vaccines were also offered to vulnerable patients at home, who could not attend the surgery.

Well-led

Outstanding

Updated 17 May 2016

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

  • The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice. The practice recognised and celebrated staff innovation and hard work.

  • The management team worked closely together to motivate and encourage staff to succeed. They also encouraged a culture of openness and honesty. The practice proactively sought feedback from staff and patients, which it acted on. The practice had very active patient participation group which influenced practice development.

  • Throughout our inspection we noticed a strong theme of positive feedback from staff, patients and other organisations who worked with the practice. Staff spoken with demonstrated a commitment to providing a high quality service to patients. They spoke highly of the culture at the practice and were proud to be a part of the practice team.
  • The practice team was forward thinking and was becoming a lead practice for clinical research projects to improve outcomes for patients in the area. One of the GPs had been nominated by the clinical commissioning group (CCG) as the local clinical research lead. For example, the practice was involved in studies regarding the early diagnosis of bowel cancer. As a result of the research study, several patients were referred to surgeons in secondary care and one new case of colon cancer was identified. In addition to research studies, the practice continued to encourage patients to take up national cancer screening programmes. 
Checks on specific services

People with long term conditions

Outstanding

Updated 17 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.

  • A GP and a practice nurse were trained to advanced levels in diabetes care and insulin initiation. The practice were working on six monthly recalls for patients with diabetes and were also conducting telephone reviews for patients who were newly diagnosed with diabetes as well as housebound patients and working age patients

  • We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.
  • One of the GPs had a lead role in prescribing and was also appointed as the local lead for clinical research by the CCG. The GP researched how the use of near-patient testing was an effective method to determine when patients should be treated with antibiotics. The practice applied for funding in order for specific testing machines to be installed across ten of the local practices. Additionally, the lead GP hosted a teaching session for local GPs regarding antibiotic prescribing where local GPs had signed up to become antibiotic guardians.

Families, children and young people

Outstanding

Updated 17 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 A&E attendances.

  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for under two year olds ranged from 82% to 100% compared to the CCG averages which ranged from 40% to 100%. Immunisation rates for five year olds ranged from 94% to 100% compared to the CCG average of 93% to 98%.

  • The practice offered urgent access appointments were available for children, as well as those with serious medical conditions. The practice also conducted a monthly review of child attendances at the local Accident and Emergency departments.
  • We saw minutes of meetings to support that the practice worked closely with the Health Visitors and Midwife.

Older people

Outstanding

Updated 17 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. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

  • The practice sent birthday letters to patients on their 75th birthdays to inform them of their named GP and to offer them an annual health check; 67% of the practices patients who were aged 75 and above had attended for a health check within the previous 12 months.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Immunisations such as flu and shingles vaccines were also offered to patients at home, who could not attend the surgery

  • The practice had systems in place to identify and assess patients who were at high risk of admission to hospital.
  • The practice completed a detailed analysis of their unplanned hospital admissions specific to elderly patients from a local residential home. In order to manage these patients more effectively the practice introduced a number of extra measures including comprehensive community medication reviews, virtual ward support and referral to other community services such as falls teams and dementia advisors. Comparable data from 2014/15 and 2015/16 highlighted a reduction in emergency hospital admissions and attendance at A&E.

Working age people (including those recently retired and students)

Outstanding

Updated 17 May 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students).

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

  • The practice’s uptake for the cervical screening programme was 81%, compared to the national average of 81%.

  • Patients could access appointments and services in a way and at a time that suited them.
  • Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked over the telephone, face to face and online.
  • The practice offered a choice of extended hours to suit their working age population, extended hours were available on Monday to Thursday between 6:30pm to 7:30pm.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 17 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 other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

  • Performance for mental health related indicators was 100%, with an exception rate of 0%.
  • There were 66 patients on the mental health register, 92% had care plans in place, 97% had received regular medication reviews and 92% had face to face reviews. Most of these patients had care plans in place, these patients were regularly reviewed and further reviews were planned.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Data showed that diagnosis rates for patients identified with dementia were 100%, with an exception rate of 0%. There were 54 patients on the practices register for dementia, 86% had care plans in place, 100% had medication reviews and 86% had face to face reviews within a 12 month period.

People whose circumstances may make them vulnerable

Outstanding

Updated 17 May 2016

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

  • There were 38 patients on the practices learning disability register. The practice shared a report which highlighted that 95% of the practices patients with a learning disability had a care plan in place, 100% had medication reviews and 95% had face to face reviews within a 12 month period.

  • The practice regularly worked with other health and social care organisations in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

  • The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances.
  • The practice had identified 225 patients with drug and alcohol dependencies, these were included in the practice register for vulnerable patients. Practice data highlighted that 89% of these patients received face to face and medication reviews within a 12 month period.