The Over-Wyre Medical Centre

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