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Dr Rahman & Staples Outstanding Also known as Ellison View Surgery

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rahman & Staples on 30 September 2016. Overall, the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
  • 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. They commented positively about the clinical staff at the practice, words used include very good, caring and excellent and understanding.
  • Information about services and how to complain was available and easy to understand.
  • Most 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.
  • Outcomes were above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 99.6% of the points available in 2014/2015. This was 5.2% above the local average and 4.9% above the national average.
  • 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 regulation.

We saw several areas of outstanding practice:

  • Results for the National GP Survey, published in July 2016, were above local and national averages for consultations with clinical staff. Of those who responded 100% said they had confidence and trust in both the last GP, and nurse, they saw or spoke to. We also saw that, for those who responded, 86% would recommend this surgery to someone new to the area (CCG average 79%, national average 78%).
  • The practice was aware of the wider issues that faced some of their patients and that affected their health. They had participated in a pilot project to help reduce social isolation in older patients. Led by the practice, but closely involving a national charity for older people. A nurse or GP saw each patient, care plans were put in place if needed and medications were reviewed, with new medications available on the day. The practice arranged for support services for older people to attend the sessions so that non-clinical issues could also be addressed. The sessions were held over three afternoons at the practice and 22 patients took part. The national charity had evaluated the project and is considering extending the project.
  • The practice had been one of two practices nationally that had taken part in an accessible information pilot. As part of this, the practice had reviewed the communication needs of all patients with a learning, hearing or visual disability (67 patients). Where appropriate, each patient met a patient liaison officer to discuss their communication needs. Following this the practice had updated their new patient registration and NHS health check forms to make sure that information about patients’ communication needs was collected regularly and produced a large print patient information leaflet. All patients identified with any communication difficulties are now offered longer appointments if required.
  • The practice had carried out work with young people to improve their awareness of what general practice can offer and their rights regarding access and consent. This involved giving a lesson to year eight pupils at a local secondary school. This was delivered by a group of GPs, nurses and NHS staff. The practice manager was involved from this practice. Following this work the practice now writes to all patients over the age of 14 with information on patient confidentiality for young people.

There was one area of practice where the provider needs to make improvements.

The provider should:

  • Provide all staff with infection control training, which is relevant to their roles and responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 November 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 and 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. For example, there was an effective safety alert system and safeguarding leads were in place.
  • Good infection control arrangements were in place and the practice was clean and hygienic. Disclosure and Barring Service (DBS) checks had been completed for all staff that required them.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 November 2016

The practice is rated as good for providing effective services.

  • We found that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Data showed patient outcomes were above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 99.6% of the points available in 2014/2015. This was 5.2% above the local average and 4.9% above the national average. For 18 of the 19 clinical domains within QOF, the practice had achieved 100% of the points available.
  • Quality improvement work was taking place, including clinical audit.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of people’s needs.

Caring

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for providing caring services.

  • Data showed that patients rated the practice significantly better than other practices for several aspects of care, for example, for consultations with clinical staff. Of those who responded 100% said they had confidence and trust in both the last GP, and nurse, they saw or spoke to. We also saw that, of those who responded, 97% say the last GP they saw or spoke to was good at involving them in decisions about their care (CCG average 85%, national average 82%).
  • Feedback from patients and carers we spoke to was continually positive about the way that staff treated people. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw a strong patient-centred culture. On the day of the inspection we heard of many examples were staff had gone the extra mile, for example delivering prescriptions when patients were unable to collect prescriptions or responding to vulnerable patients who required support and intervention.
  • The practice was aware of the wider issues that faced some of their patients and that affected their health, they had focused on pilots and projects that focused on these wider needs, for example, they had led a local project that focused on social inclusion.
  • The practice supported a CCG project on patient centred care that focused on supporting patients to help themselves improve their own health. A quality marker, ‘better u’ for patient centred care, had been developed from this project and the practice was involved in testing the quality marker to find out if the award is obtainable without additional support.
  • People who use services were active partners in their care. Staff were fully committed to working in partnership with people, on the day of the inspection we saw that the practice was committed to empowering patients.
  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Information for patients about the services offered by the practice was available. For example, they provided this information on the practice’s website and patient leaflet.
  • The practice had close links to local and national support organisations and referred patients when appropriate.
  • All of the administrative staff had completed carers’ awareness training to ensure they were aware of their needs. The practice had recently reviewed their carers register to ensure it was up to date.

Responsive

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. They were involved in supporting innovative approaches to providing integrated patient-centred care. We saw that the practice had a proactive approach to understating the needs of different groups of people and to delivering care in a way that met these needs and promoted equality. For example, the practice had been the pilot practice for the clinical commissioning group’s (CCG) integrated care team project. This project has since been implemented by the CCG. They had also been part of a local ‘talk to us’ project to let young patients know of their right to confidential advice at the GP practice.
  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way the met these needs and promoted equality. This included people who are in vulnerable circumstances and have complex needs. For example, the practice had been one of two practices nationally that had taken part in an accessible information pilot.
  • People could access appointments and services in a way and at a time that suited them. Most 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.
  • Data from the National GP Patient Survey, published in July 2016, showed that how patients rated the practice was in line with others for access to care and treatment. For example, of those that responded 77% feel they don’t normally have to wait too long to be seen (CCG average 37%, national average 58%).
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Specialist clinics and support services were available for patients.
  • Information about how to complain was available on the practice website and in the practice leaflet.

Well-led

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for being well-led.

  • The practice had a clear vision with quality and safety as their top priority. Staff were clear about the vision and their responsibilities in relation to this. The practice told us that they aimed to provide services for patients based on the whole range of their patient’s needs. On the day of the inspection, we saw that staff were committed to this aim.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour regulation. 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.
  • 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 practice proactively sought feedback from staff and patients, which it acted on.
  • There was an active patient participation group (PPG) and the practice had acted on feedback from the group.
  • The leadership drove continuous improvement. There was a clear proactive approach to seeking and embedding new ways of providing care and treatment.
Checks on specific services

People with long term conditions

Outstanding

Updated 24 November 2016

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

  • The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority for support by the practice, comprehensive care plans were in place and regularly reviewed. The practice completed reviews of long-term conditions at home when patients could not visit the practice.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in this population group were generally above national averages. For example, the practice had achieved 99% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 9.1% above the local CCG average and 9.8% above the national average. At 9.1%, their clinical exception-reporting rate was 0.4% below the local CCG average and 0.1% below the national average.
  • Home visits were available when needed. Longer appointments were available if requested.
  • All patients with a long-term condition had a named GP and were offered 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 held regular clinics for long-term conditions, for example for patients with diabetes.

Families, children and young people

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for the care of families, children and young people.

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given were generally comparable to CCG averages apart from for one immunisation. Immunisation rates for the vaccinations given to under two year olds ranged from 28.3% to 100% (CCG average 24.8% to 98.9%) and for five year olds ranged from 95.7% to 100% (CCG average 96.2% to 99.1%). Urgent appointments for children were available on the same day.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
  • Nationally reported data showed that outcomes for patients with asthma were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 2.6% above the local CCG and national averages.
  • The practice had carried out work with young people to improve their awareness of what general practice can offer and their rights regarding access and consent. This involved giving a lesson to year eight pupils at a local secondary school. This was delivered by a group of GPs, nurses and NHS staff. The practice manager was involved from this practice. Following this work the practice now writes to all patients over the age of 14 with information on patient confidentiality for young people.
  • The practice provided contraceptive and sexual health advice.

Older people

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in their population. All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check. The practice worked to reduce the unplanned hospital admissions for patients over the age of 75.
  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs. The health care assistant visited the local linked care home to complete patient health checks for patients newly registered at the practice.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were generally in line with local clinical commissioning group (CCG) and national averages. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 1.1% above the local CCG average and 2.1% above the national average.
  • The practice maintained a palliative care register and offered immunisations for shingles and pneumonia to older people.

Working age people (including those recently retired and students)

Outstanding

Updated 24 November 2016

The practice is rated as outstanding 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.

  • Patients could order repeat prescriptions and routine healthcare appointments online.

  • Telephone appointments were available.
  • A text message reminder service was available.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • The practice’s uptake for cervical screening was 75.4%, compared to the CCG average of 81.9% and the national average of 81.8%.
  • Additional services such as new patient health checks, travel vaccinations and joint injections were provided.
  • The practice website provided a good range of health promotion advice and information.
  • The practice participated in an enhanced service that allowed out of area patients to register with the practice.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 November 2016

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

  • The practice had identified 1% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services. Forty-seven patients were on this register, 64% of those has had an annual review, 47% had an influenza vaccination (2015/2016 data, which is yet to be verified or published).
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 6.8% above the local CCG average and 7.2% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.8% above the local CCG average and 5.5% above the national average. 79% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was below the national average of 84%.
  • 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations. They 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. The practice actively screened patients with long-term condition for dementia. Staff and members of the PPG had undertaken dementia friends training. The practice played an active part in a local initiative to help make Hebburn a dementia friendly area. The practice’s healthcare assistant visited patients with dementia at home to carry out any heath checks they required.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 November 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

  • The practice had a vulnerable adult’s policy that was regularly reviewed. The practice held a register of patients living in vulnerable circumstances including patients with a learning disability; patients with learning disabilities had been invited to the practice for an annual health check. Thirty-one patients were on this register, 84% had an annual review and 48% had an influenza vaccination (2015/2016 data, which had not yet been verified or published).
  • The practice had reviewed the communication needs of all patients with learning, hearing or visual disability. They had updated their new patient registration form and NHS health check forms to make sure that they collected this information needs on a regular basis. A large print patient information leaflet was produced and is available for patients. All patients identified with any communication difficulties are offered longer appointments if required.
  • The practice used easy read letters to communicate with patients with learning disabilities, pictures of the doctors and nurse at the practice are displayed on room doors to help patients who cannot read.
  • Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average. The practice used locally produced easy read letters when they invited patients with learning disabilities for cervical screening tests.
  • The practice offered longer appointments for patients with a learning disability if requested.
  • The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people. 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.
  • Good arrangements were in place to support patients who were carers.