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Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holmside Medical Group on 8 October 2015. 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 understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
  • 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.
  • 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.
  • Both the main and branch surgeries had good facilities and were 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. For example, apologies were issued where complaints had been upheld or errors discovered.

We saw one area of outstanding practice:

  • The practice is rated as outstanding for the care of people with a long term condition. The practice had adopted the Year of Care approach to caring for its patients with long term conditions. As a result patients received one combined annual review in their birthday month and were actively involved in care planning and decision making.

There were also areas where the provider should make improvements. The practice should:

  • Consider replacing the carpet in the phlebotomy room of the main surgery with easy clean flooring

  • Review and strengthen the process for recording and monitoring computer prescriptions.

  • Review the use of patient group directions (PGDs) and understanding of patient specific directions by the healthcare assistants

  • Review the system currently in place for selecting topics for clinical audit and ensure that full two cycle audits are completed to demonstrate improvement

  • Review the decision not to have a defibrillator in the main surgery. If the outcome is that a defibrillator is not felt to be necessary a risk assessment detailing why and recording mitigating actions should be created.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned when things went wrong and shared with staff to support improvement. There was an effective system for dealing with safety alerts and sharing these with staff. Individual risks to patients had been assessed and were well managed. Good medicines management systems and processes were in place and staff recruitment was safe. The premises were clean and hygienic and there were good infection control processes. However, the practice needs to review the use of patient group directions (PGDs) or patient specific directions (PSDs) in relation to healthcare assistants delivering flu vaccinations. The practice should also consider replacing the carpet in the phlebotomy room of the main surgery with easy clean flooring and review their decision not to have a defibriallator on site.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services. Nationally reported Quality and Outcomes Framework (QOF) data showed the practice had performed well in providing recommended care and treatment to their patients. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included promoting good health, and providing advice and support to patients to help them manage their health and wellbeing. Staff worked with other health care professionals to help ensure patients’ needs were met. There was an effective staff appraisal system and, overall, staff had access to the training they needed to carry out their duties. Staff had completed a variety of clinical audits and used these to improve patient outcomes. However, these were not always full two cycle audits and the practice did not have a structured, systematic approach to selecting topics for clinical audits. Neither did the audits appear to focus on those areas where staff have identified that outcomes for patients could be improved.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. Results from the National GP Patient Survey showed patients were satisfied with the quality of the care and treatment they received from their GPs and nurses. During the inspection we saw staff treating patients with kindness and respect, and they maintained patient confidentiality.

Responsive

Good

Updated 14 January 2016

The practice is rated as good for providing responsive services. They reviewed the needs of their local population and engaged with the NHS England Area Team and local Clinical Commissioning Group to secure improvements to services where these were identified. This had resulted in the practices involvement in a number of initiatives aimed at improving patient care, including:

  • The use of the Ophelia (Optimising Health Literacy and Access) health literacy questionnaire. This helped the practice to assess its strengths and weaknesses in meeting the needs of its patient population and in planning improvements, in particular for non-English speaking patients.
  • Becoming a member of the West End Family Health social community enterprise which met weekly to share ideas and plan co-delivery of services that could not be delivered in isolation.
  • Working to the Year of Care partnership to ensure patients with long term conditions were involved in care planning and decision making and supported to self-manage their conditions
  • Becoming a Patient Online Beacon Site which encouraged patients with long term conditions to take greater control of their own health and wellbeing by offering a range of digital services.
  • Participation in the CCG ‘Ways to Wellness’ social prescribing initiative to encourage better self management of long term conditions.

The majority of patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. The main and branch surgeries had good facilities and were well equipped to treat patients and meet their needs. Although access for patients with mobility issues had been considered at the main surgery and improvements made as far as possible, facilities for this group of patients was much better at the branch surgery. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 January 2016

The practice is rated as good for providing well-led services. Staff had a clear vision about how they wanted the practice to grow and develop, and were taking steps to deliver this. The practice had good governance processes, and these were underpinned by a range of policies and procedures that were accessible to all staff. There were systems and processes in place to identify and monitor risks to patients and staff, and to monitor the quality of services provided. Regular practice and multi-disciplinary team meetings took place, which helped to ensure patients received effective and safe clinical care. This included a weekly educational breakfast meeting where clinical staff discussed new guidance, specific cases, journal articles and performance. The practice proactively sought feedback from patients who were encouraged and supported to comment on how services were delivered. The practice also had an active and committed patient participation group.

Checks on specific services

People with long term conditions

Outstanding

Updated 14 January 2016

The practice is rated as outstanding for the care of people with long-term conditions.

Effective systems were in place which ensured that patients with long-term conditions received an appropriate service which met their needs. Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.

Since 2012 the practice had implemented a single care and support planning process for patients with one or more long term conditions. They had subsequently worked to the Year of Care partnership model with staff receiving training which included the development of generic skills for nurses who had previously specialised in a particular long term condition. As a result the practice now ensured that all patients with long term conditions received a holistic patient centred annual review in their birthday month, with one combined review for patients with multiple long term conditions. Patients were encouraged to prepare for their review, be involved in discussions about their condition and contribute to a personally held care plan. These reviews comprised of an initial biometric test with a health care assistant together with the offer of a care and support planning meeting with the senior nurse. Flu vaccinations and smoking cessation sessions were available for all patients with a long term condition.

The practice had agreed to be a Patient Online Beacon Site with effect from October 2015. This NHS England initiative was aimed at encouraging patients with long term conditions to take greater control of their own health and wellbeing, supported by their GP practice, by offering a range of digital services.

The practice also participated in the CCG ‘Ways to Wellness’ social prescribing initiative which is a service designed to add to a patient’s medical support by supporting patients with a long term conditions to better manage their condition.

Families, children and young people

Good

Updated 14 January 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 are the subject of child protection plans. The practice worked with the attached health visitor to ensure contact was made with the parents/carers of children who did not attend for appointments or immunisation. Monthly multi-disciplinary child safeguarding meetings were held involving the lead GP for safeguarding, the health visitor, midwife and school nurse. Immunisation rates were broadly in line with local CCG averages for all standard childhood immunisations. Appointments were available outside of school hours and the practice ensured that same-day emergency appointments were routinely available for all pre-school children. Emergency telephone consultations with a GP were also available. Cervical screening rates for women aged 25-64 were in line with local and national averages.

Older people

Good

Updated 14 January 2016

The practice is rated as good for the care of older people. The practice had the largest population of elderly patients in the West of Newcastle and the practice had responded to this to ensure staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met. Those most at risk of unplanned admission to hospital had been identified and comprehensive care plans agreed. Arrangements had been made to meet the needs of ‘end of life’ patients. For example, staff held monthly palliative care meetings with community and Macmillan nursing staff to ensure these patients’ needs were identified and met. The practice participated in the local Clinical Commissioning Group’s (CCG) Care Homes Project and had developed an effective working relationship with a number of care homes in the local area. This made it possible to offer a greater continuity of care and more effective prevention of illness through regular visits to the homes. The practice offered home visits and longer appointment times where these were needed by older patients. Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.

Working age people (including those recently retired and students)

Good

Updated 14 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). Patients were able to book appointments at either the main or branch surgery and a flexible appointment system was in operation, including requests for emergency or pre bookable telephone consultations with GPs. Patients were sent text message reminders of upcoming appointments. The practice offered a full range of online services including booking appointments, accessing test results and ordering repeat prescriptions. Links to a range of health prevention information was also available on the practice website. The practice used the EPS(2) system to send prescriptions electronically to a local pharmacy of the patients choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

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

  • A GP lead had been identified for patients experiencing poor mental health or dementia.
  • The practice provided an annual review to patients with a history of serious mental illness and those with dementia where physical as well as mental health was reviewed and personal care plans were developed. The practice was pro-active in contacting patients who failed to attend appointments
  • The practice regularly signposted and referred patients experiencing poor mental health to various support groups and organisations, such as Newcastle Talking Therapies. Talking Therapies provides advice, support and information on coping strategies for people experiencing depression, anxiety, stress, anger, fear, bereavement and relationship difficulties
  • A close working relationship had been developed with the mental health counsellor and Primary Care Mental Health worker attached to the practice.

People whose circumstances may make them vulnerable

Good

Updated 14 January 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 with a learning disability and those with caring responsibilities.
  • They routinely offered longer appointments for people with a learning disability. Longer appointments were also offered to non-English speaking patients who required a translation service.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, such as palliative care patients and those with safeguarding concerns.
  • 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 developed effective working relationships with a local residential home for people with severe physical and learning disabilities and a Home Office approved bail hostel. Residents were registered on a temporary basis as and when required and support was provided with issues such as substance abuse.