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Homestead Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Homestead Medical Centre on 9 August 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a 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.
  • 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.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 October 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and these were discussed at clinical meetings as well as being subject to an annual review.

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

  • When things went wrong patients received reasonable support, truthful information, and a 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. The safeguarding lead reviewed the records of all children when a family moved out of the practice to ensure adequate handover was affected in relation to care and safeguarding.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • The practice offered online-consultations with secondary care specialist consultants.

  • As a result of participation in a local Vanguard programme, the practice had the support of pharmacists and physiotherapists in-house. We saw evidence to show that the input of these specific health professionals had increased clinical capacity. (Vanguards seek to develop new care models which support the improvement and integration of services. Within the Wakefield and surrounding areas there are two programmes - enhanced health in care homes; and the improved provision of specialist integrated services into the community).

  • 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. For example, a member of the nursing team had received advanced diabetes training which allowed them to deliver level four diabetic services which included insulin initiation.

  • There was evidence of appraisals and personal and career development for staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 7 October 2016

The practice is rated as good for providing caring services.

  • The practice sent SMS text reminders to patients and reception staff also made personal calls to patients who had identified memory problems to remind them of their appointment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Two of the GPs had undergone additional diploma training in palliative care to improve care and support for patients and their families.

  • Information for patients about the services available was easy to understand and accessible. For example, patients could access face-to-face support and signposting from the practice care navigators.

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

Responsive

Good

Updated 7 October 2016

The practice is rated as good 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 to secure improvements to services where these were identified. For example:

    • The practice participated in two local Vanguard programmes, via which the practice delivered enhanced health and care signposting, referral and information for patients (using care navigators and improved IT access), and offered in-house services such as physiotherapy. The practice also worked closely with other health and care professionals to integrate and link services for patients, and delivered clinical sessions to care home patients.

    • The practice operated specialist diabetic clinics delivered in conjunction with a local secondary care provider. The practice also offered enhanced care management and services such as insulin initiation in-house.

  • 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.

  • A young person’s leaflet had been developed which gave key practice information as well as details of local support services such as those dealing with contraception/sexual health and mental health issues as well as some seldom considered issues such as young person’s bereavement support. These leaflets were available in the waiting room and were also distributed to young patients directly by clinicians.

  • 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. Learning from complaints was shared with staff and other stakeholders.

  • Staff from the practice had recently worked closely with the local ambulance service with regard to patients who made frequent, often unnecessary calls for ambulance services. They sought to identify ways to reduce these calls whilst ensuring patients’ needs were met and they received appropriate care.

  • The practice offered electronic prescribing, which involved sending prescriptions direct to the patient’s pharmacy of choice. and dispensing process more efficient and convenient for patients.

Well-led

Good

Updated 7 October 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 it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity.

  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • A comprehensive understanding of the performance of the practice was maintained and leads had been allocated to key areas of work such as QOF and medicines management.

  • 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 7 October 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. At the time of inspection 1,105 patients were on the practice long term condition management register.

  • Patients were offered annual reviews based on their birthday month although if required reviews could be carried out on a more regular basis.

  • Patients with long term conditions were offered longer appointments and were screened for depression during contact with the practice.

  • Performance for diabetes related indicators was above the local and national averages. For example, 93% of patients on the diabetes register had a record of a foot examination and risk classification being carried out in the previous 12 months compared to the CCG average of 89% and the national average of 88%

  • 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.

Families, children and young people

Good

Updated 7 October 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.

  • We were told that children and young people were treated in an age-appropriate way and were recognised as individuals. The practice was also working toward achieving “Young Person Friendly” accreditation to better serve the needs of young patients.

  • A young person’s leaflet had recently been developed which gave key practice information as well as details of local support services such as those dealing with contraception/sexual health and mental health issues as well as some seldom considered issues such as young person’s bereavement support. These leaflets were available in the waiting room and were also distributed to young patients directly by clinicians.

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

  • There was a dedicated clinic for six to eight week baby and mum checks. Non-attenders were followed up by the practice and the health visitors were informed that the appointment at the clinic had been missed.

  • Midwife-led ante-natal clinics were hosted by the practice on a weekly basis.

Older people

Good

Updated 7 October 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.

  • All patients aged over 65 years were contacted annually for flu immunisation. The invitation was made via letter and non-responders were followed up with a telephone call to encourage attendance. Flu sessions were organised to maximise uptake and were held at various times, which included Saturday mornings.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. At the time of inspection the practice had 105 patients on their avoiding unplanned admissions register.

  • All patients aged over 75 years were offered an annual health check.

  • The waiting room provided raised high back chairs which were suitable for the elderly and those with mobility problems.

Working age people (including those recently retired and students)

Good

Updated 7 October 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. For example, the practice offered 7am to 8am appointments twice a week and telephone triage/consultations were available for patients who could not get to the practice for a regular appointment.

  • The practice was proactive in offering online services such as booking and cancellation of appointments and ordering repeat prescriptions.

  • The practice offered a full range of health promotion and screening that reflected the needs for this age group, such as cervical screening and NHS health checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 2016

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

  • Performance for mental health related indicators was above the local and national averages. For example, 95% of patients diagnosed with dementia had had their care reviewed at a face-to-face meeting in the previous 12 months compared to CCG and national averages of 84%

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 7 October 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 those with a learning disability, the frail elderly with complex care needs and those coming to the end of life.

  • The practice offered longer appointments and health checks for patients with a learning disability.

  • The practice was registered under the Wakefield Safer Places Scheme. This voluntary scheme seeks to assist vulnerable people to feel safer when travelling independently. Registered sites have agreed to offer support to the individual and would contact a named relative, carer or friend if the person was in distress.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • 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.

  • The practice had made a number of changes to better meet the needs of patients with a physical disability or sensory impairment. These included the provision of more appropriate seating and improvements to signage.