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Giffords Partnership Good Also known as Giffords Surgery

Inspection Summary


Overall summary & rating

Good

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Giffords Partnership on 1 November 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.

  • The practice had recently introduced a new triage system for appointments which meant patients could not usually make appointments in advance. Most patients we spoke to said it was a good system and an improvement on the previous arrangements.

  • 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 one area of outstanding practice:

  • The practice had good facilities for the blind and partially sighted. Signage throughout the building was very clear and included a braille translation. The practice leaflet was available in a braille format and the practice was able to arrange the translation of any other of its documents into braille within 24 hours.

The areas where the provider should make improvement are:

  • Ensure all staff interview notes and references are recorded and retained.

  • Ensure all staff have regular appraisals.

  • Ensure that all lessons learnt from significant events incidents are shared with appropriate staff.

  • Review their appointment system to ensure it does not disadvantage working patients and other who may need to book appointments in advance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Staff told us that lessons learnt were discussed at team meetings but these discussions where not always minuted. The day after our inspection the practice sent us a new policy of learning from complaints and significant events which set out the processes to ensure that all lessons learnt are shared with all appropriate staff and recorded.

  • 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.

  • 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.

  • However, we found that there were some gaps in the recruitment records of some staff, such as interview records.

Effective

Good

Updated 9 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were  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, although not all staff had had an appraisal in the last 12 months.

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

  • The practice offered a smoking cessation support service and the

    local NHS counselling service, a midwifery service, and the Alzheimer’s Society provided services from the practice building.

Caring

Good

Updated 9 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as similar to the average  for most 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.

  • The practice leaflet was available in Standard English and Unified English braille, and the practice had made arrangements for other forms to be translated into braille within 24 hrs if requested.

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

  • The practice had been awarded a gold award for caring for carers by a local charity working in partnership with the local authority.

Responsive

Good

Updated 9 December 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 (CCG) to secure improvements to services where these were identified. For example, the practice had worked with the CCG and two other local practices to 

    establish a service to improve care for older people which had helped the practice achieve a 41% reduction in unplanned admissions of patients over 75 years of age living in a care home.

  • All patients had a named GP, who patients were encouraged to see for appointments whenever possible.

  • The practice had recently introduced a new triage system for appointments which meant patients could not usually make appointments in advance. Patients were asked to phone on the day they wanted an appointment and they would be phoned back by a GP or nurse to discuss their needs and agree an appropriate action.

    M

    ost patients we spoke to said it was a good system and an improvement on the previous arrangements.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.  

  • The practice had good facilities for the blind and partially sighted. Signage throughout the building was very clear and included a braille translation.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.

  • Staff told us that learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 9 December 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.

  • During a

    recent staffing issue caused by long-term sickness, retirements and

    difficulties in recruiting new GPs, the partners 

    had decided

    stop doing some tasks on a routine basis. 

    For example, in 2015 they decided to suspend the annual appraisal 

    process and between

    August and November 2016 they cancelled routine meetings. We were told both of these

    had now restarted.

  • 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 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 was active.

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

Checks on specific services

People with long term conditions

Good

Updated 9 December 2016

The practice is rated as good 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.

  • 98% of patients with diabetes on the register had an influenza immunisation in the period 8/2014 to 3/2015, compared to the CCG average of 96% and national average of 94%.

  • Longer appointments and home visits were available when needed.

  • All patients

    with long-term conditions had a named GP and a structured annual review to check their health and medicines needs were being met. 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. 

Families, children and young people

Good

Updated 9 December 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 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.

  • 91% of women on the register aged 25 to 64 had a cervical screening tests performed in the preceding five years compared to the clinical commissioning group average of 85% and national average of 82%.

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

  • The practice encouraged feedback from children and young people by using a feedback form specifically designed for them.

Older people

Good

Updated 9 December 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.

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

  • The practice staff made routine visits to local nursing, care and residential homes to see patients.

  • The practice had worked with the clinical commissioning group (CCG) and two other local practices under a programme called Transforming Care for Older People (TCOP) to establish a service to improve care for older people.

    One of the aims of this service was to reduce unplanned admissions and we saw data that showed the practice had achieved a 41% reduction

     in unplanned admissions of patients over 75 years of age living in a

    care home.

  • The practice worked with two other local services to provide a leg ulcer clinic and falls clinic.

Working age people (including those recently retired and students)

Good

Updated 9 December 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 online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • They had a virtual patients participation group which made it easier for this group of patients to give feedback to the practice.

  • Telephone consultations were available during working hours.

  • Travel health and vaccination appointments were available.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 9 December 2016

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

  • The quality outcome framework data for mental health showed the practice was performing below the national average.

  • 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 88% and national average of 84%.

  • 85% of patients on the register with a psychosis had a comprehensive care plan agreed in the preceding 12 months compared to the CCG average of 93% and national average of 88%.

  • 51% of patients with a psychosis on the register had their alcohol consumption recorded in the preceding 12 months, compared to the CCG average of 93% and national average of 90%.​

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 9 December 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 homeless people, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.

  • The practice had good facilities for the blind and partially sighted, including; clear signage with braille translation and the practice leaflet was available in a braille format.