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Inspection Summary


Overall summary & rating

Good

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ballater Surgery on 19 January 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 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 and was available in five non-English local languages relevant to the practice population.
  • Patients said they found it easy to make an appointment with a named GP and that 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.
  • 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.

We saw several areas of outstanding practice:

  • The practice had trained a member of staff to become Patient Liaison Officer (PLO) who assisted in care planning for older patients for example with dementia. The PLO usually contacted the patient after their initial care plan had been set up. Patients were given access to the PLO by phone, to contact if they have any non-clinical queries for example about hospital appointments (booking and chasing), transport and signposted to services available locally. They had shared this initiative with other practices in the Clinical Commissioning Group (CCG) area and had helped train fifteen administrative staff for the PLO role from GP practices across the CCG.

  • The practice had access to medical advice for children by the use of e-mail consultations for example the parents could send photos to help identify childhood rashes.

  • The practice placed a strong emphasis on supporting carers of patients with long-term conditions. The practice hosted its own carers support group and had also run carers workshops on subjects such as emotional wellbeing.

  • The practice ran a memory assessment clinic which was led by the healthcare assistant specifically trained to perform this assessment. This had increased the dementia diagnosis rate in the practice. The practice found that many patients did not want a diagnosis of dementia and the patients with possible/likely diagnosis of dementia were identified and were coded to alert staff of their possible increased needs.

The areas where the provider should make improvement are:

  • Ensure there is a supply of hot water in all the areas of the practice including consulting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 March 2016

The practice is rated as good for providing safe services.

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

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 the practice did not have a supply of hot water to one of the consultation rooms for over ten years.

Effective

Good

Updated 16 March 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 March 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.

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

  • The practice placed a strong emphasis on supporting carers of patients with long-term conditions. The practice hosted its own carers support group and had also organised carers workshops on subjects such as emotional wellbeing.

Responsive

Outstanding

Updated 16 March 2016

The practice is rated as outstanding 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.

  • The practice had trained a member of staff to become patient liaison officer (PLO) who assisted in care planning for older patients for example with dementia. The PLO usually contacted the patient after their initial care plan had been set up. Patients were given access to the PLO by phone, to contact if they have any non-clinical queries for example about hospital appointments (booking and chasing), transport and signposted to services available locally.

  • The practice had access to medical advice for elderly patients who are less mobile by facilitating the use of telephone triage system for urgent issues and e-mail consultations. Many older people also used online services via Patient Access.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. The practice had access to complaints leaflets in five non-English local languages relevant to the practice population. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 16 March 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 this.

  • 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 had systems in place for knowing about 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 strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 16 March 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.

  • The national Quality and Outcomes Framework (QOF) data showed that 77% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 84% which was similar to the national average of 88%.

  • Longer appointments and home visits were available for people with complex long term conditions when needed.

  • All these patients 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.

  • The practice placed a strong emphasis on supporting carers of patients with long term conditions. The practice hosted its own carers support group and had also run carers workshops on subjects such as emotional wellbeing.

Families, children and young people

Good

Updated 16 March 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.

  • The national Quality and Outcomes Framework (QOF) data showed that 76% of patients with asthma in the register had an annual review, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 74%.

  • 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.

  • The practice’s uptake for the cervical screening programme was 86%, which was comparable to the CCG average of 84% and the national average of 82%.

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

  • The practice had participated in a local pilot scheme; a health visitor walking group for expectant mothers and for parents of children under five years who were socially isolated in the area. The pilot ran for two months and the practice was planning to restart this group in spring 2016.

  • The practice had access to medical advice for children by the use of e-mail consultations for example the parents could send photos to help identify childhood rashes.

Older people

Good

Updated 16 March 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.

  • Regular home visits were available for older/housebound patients. The named GP would initially assess the patient, and if appropriate, follow-up visits would be delegated to the nurse or healthcare assistant, usually on a three to six monthly basis.

  • The practice had trained a member of staff to become patient liaison officer (PLO) who assisted in care planning for older patients for example with dementia. The PLO usually contacted the patient after their initial care plan had been set up. Patients were given access to the PLO by phone, to contact if they have any non-clinical queries for example about hospital appointments (booking and chasing), transport and signposted to services available locally.

  • The practice used risk profiling to identify older adults who were at highest risk of emergency admission and provided personalised care plans with a named doctor. Patients were contacted within three days of receiving a notification of an emergency admission and care plans were modified as necessary.

  • The GPs visited two care homes on a weekly basis, supporting the needs of the residents.

Working age people (including those recently retired and students)

Good

Updated 16 March 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 including e-mail consultations as well as a full range of health promotion and screening that reflects the needs for this age group.

  • One of the practice GPs who had training in musculoskeletal medicine had developed exercise leaflets to give to patients to aid self-help and reduce unnecessary musculoskeletal referrals.

  • The practice offered Saturday morning GP clinics and monthly Saturday morning nurse clinics.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 March 2016

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

  • The number of patients with dementia who had received annual reviews was 76% which was below the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.

  • 92% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months.

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

  • The practice carried out advance care planning for patients with dementia. The practice had trained a member of staff to become Patient Liaison Officer (PLO) who assisted in care planning for older patients for example with dementia. The practice was also part of local Dementia Action Alliance and was a dementia friendly practice and all staff had had dementia training.

  • To reach the local community the practice held a dementia awareness session in the local church.

  • The practice ran a memory assessment clinic which was led by the healthcare assistant specifically trained to perform this assessment. This had increased the dementia diagnosis rate in the practice. The practice found that many patients did not want a diagnosis of dementia and the patients with possible/likely diagnosis of dementia were identified and was coded to alert staff of their possible increased needs.

  • The practice had access to a counsellor who provided weekly sessions at the surgery where necessary.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 16 March 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, carers, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability and had access to a named nurse for health checks.

  • The practice nurse previously visited patients who needed learning disability health checks at their home in order to improve their confidence; however these patients are now invited into the surgery for the health checks.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice hosted its own carers support group and had also run carers workshops on subjects such as emotional wellbeing.

  • 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 staff had access to safeguarding protocol on their computers through a specific desktop icon which provided step by step instructions which also signposted staff to relevant support in case the safeguarding leads were not available.