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The Over-Wyre Medical Centre Outstanding

Reports


Inspection carried out on 18th January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as outstanding overall. (Previous inspection 11/12/2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those retired and students) – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at The Over-Wyre Medical Practice on 12th January 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

  • There were well established and comprehensive systems in place to manage and monitor risks to patients, staff and visitors. This included risks to the building, environment, medicines management, staffing, equipment and a range of emergencies that might affect operation of the practice. A comprehensive health and safety assessment had been done with actions completed to ensure full compliance.

  • The practice routinely reviewed the quality, effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.We saw that a wide range of clinical audit was carried out.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • Patients were supported by staff to use the online system to book routine appointments which had improved telephone access for others.

  • The practice reviewed the needs of their local population and had initiated positive service improvements for patients. They implemented suggestions for improvements as a consequence of feedback from the patient participation group.

  • Staff said they felt fully engaged, valued and listened to within the practice team.

  • There was evidence that innovation and service improvement was a priority among staff and leaders. High standards were promoted and owned by all practice staff with evidence of strong team working and commitment to personal and professional development.

We saw several areas of outstanding practice :-

  • There were six nursing homes in the locality which were served by the practice. Each care home had an allocated GP who maintained regular telephone contact at their respective homes on a weekly or fortnightly basis and undertook monthly ward rounds when required. Additionally the Wyre Integrated Neighbourhood (WIN) Care Home Team was piloted and led by one of the practice GPs which offered clinical triage within two days, holistic assessment, advanced care planning, monthly “ward rounds” and medication reviews. We saw evidence that both hospital admissions and attendance at A&E had been reduced since this team was established.

  • Staff understood their role in safeguarding vulnerable patients. They were fully aware they should go to the lead GP for safeguarding for further guidance who had attained a wide range of safeguarding training. The GP held monthly meetings with health visitors, school nurses and practice staff. The lead safeguarding administrator reviewed all correspondence and sent any concerns to the lead GP for review and any further action. A safeguarding folder was used to store all minutes of meetings and referrals in relation to vulnerable adults and children. A regularly updated spreadsheet of all children known to social services was kept. A practice safeguarding self- assessment audit tool was in use to monitor that all aspects of the safeguarding process were managed according to legislative guidelines. The last audit carried out indicated full compliance with recommendations.

  • Practice staff had undertaken a project called “Falling for the GP”. The purpose was to identify the causes of patient falls, through a risk assessment process and implement actions to reduce these risks. The outcomes from the initiative included increase in patient confidence to self-manage because the risk of future falls had been reduced. The audit and model providing analysis and education had been shared with the clinical team leading to improved physical wellbeing status of frail elderly patients who fell.A protocol had been developed utilising this work and had been shared with the CCG for use by all local teams.

  • A virtual ward for patients who required or might require unplanned admissions had been created. This comprised of a wall mounted system to monitor all patients who had been admitted to hospital or were at risk of doing so. Detailed care plans were produced with the multidisciplinary team to facilitate a safe discharge and avoid readmission and individual progress was monitored.

  • Staff had increased their resilience by attending a number of leadership development opportunities. For example the Improving Leaders programme, the Productive GP programme and the GP Forward View Time for Care programme. This had led to reviews of a number of processes which improved care and effectiveness of the service provided. For example ordering and administration of repeat prescriptions, communicating test results and managing frequent attenders.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 11 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of The Over Wyre Medical Centre.

We carried out a comprehensive inspection on 11 December 2014. We spoke with patients, members of the patient participation group and staff, including the management team.

The practice was rated as good overall. A safe, caring, effective, responsive and well-led service was provided that met the needs of the population it served.

Our key findings were as follows:

  • All staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents were maximised to support improvement.
  • The practice was proactive in using methods to improve patient outcomes. Best practice guidelines were referenced and used routinely. Patients’ needs were assessed and care planned and delivered in line with current legislation.
  • Feedback from patients was positive. We observed a patient centred culture and found strong evidence that staff were motivated and inspired to provide kind and compassionate care.
  • The practice reviewed the needs of their local population and had initiated positive service improvements for patients that were over and above their contractual obligations. They implemented suggestions for improvements as a consequence of feedback from the patient participation group.
  • The practice had a clear vision which had quality and safety as top priorities. High standards were promoted and owned by all practice staff with evidence of team working across all roles. There was a strong governance structure in place. The leadership culture was open and transparent. The practice had a clear understanding and commitment to the needs of staff. We found high levels of staff satisfaction.

We saw several areas of outstanding practice including:

  • The practice had completed an extensive programme of clinical audits over the last 12 months. Audits reviewed were comprehensive and had resulted in changes to improve patient outcomes. We saw an example of an audit where the practice had obtained and taken into account patient feedback in evaluation of the results.
  • Patients were able to view a copy of their personal NHS summary care record through a secure on line facility on the practice website.
  • The practice offered a total of 23 enhanced services to improve patient outcomes. A good skill mix amongst the staff enabled the practice to respond to changing priorities and demands. The practice manager regularly reviewed the non-clinical staff resource available to ensure it was used to optimum effect in delivering service.
  • There were robust and comprehensive systems in place to manage and monitor risks to patients, staff and visitors. This included risks to the building, environment, medicines management, staffing equipment and a range of emergencies that might affect operation of the practice.
  • We were given eight examples of the practice responding to feedback from their Patient Participation Group and taking action to improve the service including amendments to the appointment system.
  • There were six nursing homes in the locality which were served by the practice. Each home had an allocated GP who carried out routine ward rounds at their respective homes on a weekly or fortnightly basis as required.

In addition the provider should:

  •  Ensure all changes to patients’ medicines when delegated are checked by the GP for accuracy.
  • Ensure medicines awaiting collection are locked in the dispensary when the surgery is closed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.