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Dishley Grange Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dishley Grange Medical Practice on 23 November 2016. Overall the practice is rated as good.

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

  • Staff used an established system for reporting and recording significant events and the practice demonstrated an open and transparent approach to safety reporting and management.
  • Risks to patients were assessed and well managed and the practice sought to continually improve processes.
  • 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.
  • 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.
  • The practice had invested significant resources into improving and expanding access. This included the provision of extended opening times and facilitation of digital communication options.
  • The practice had developed working relationships with an extended range of multidisciplinary professionals and teams that enabled patients to access specialist services as part of coordinated care without the need to attend hospital.
  • 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.
  • Clinical staff proactively shared decision making with patients. This meant patients had input into their condition management plans as a strategy to help empower them to improve their health.
  • There was a focus on continuous learning and improvement at all levels through ongoing processes of reflection in meetings, investigations and treatment reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2017

The practice is rated as good for providing safe services.

  • Staff used an effective system for reporting and recording significant events.
  • Lessons were shared internally and with external colleagues to make sure action was taken to improve safety and reduce the risk of a repeat incident. This included where incidents involved other providers and agencies.
  • When things went wrong patients received reasonable support, 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. This included multidisciplinary risk assessments and protocols that enabled staff to respond quickly to patients at risk.
  • Medicines management processes were in place including repeat prescription monitoring, emergency drugs checking and a safety alerts protocol.
  • Staff in the dispensary at the branch adhered to national best practice and safety guidance and monitored this through regular audits.

Effective

Good

Updated 28 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable or better than clinical commissioning group (CCG) and national averages. This included two clinical domains where exception reporting was slightly higher than CCG and national averages, 15 clinical domains with significantly lower exception reporting and three clinical domains in which reporting was comparable.
  • Staff assessed needs and delivered care in line with current evidence based guidance and used a continuous review system to ensure they were always up to date with latest standards.
  • Clinical audits and benchmarking exercises demonstrated quality monitoring and improvement. The practice had a demonstrable track record in identifying areas of good practice in patient care, opportunities for multidisciplinary working and area for improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. This was because there was a consistent, embedded culture of promoting professional development through clinical training.
  • All staff had undergone an appraisal in the previous 12 months and there was evidence of personal development plans for all staff that demonstrated the commitment of the senior team to building on the skills and interests of each individual.
  • Multidisciplinary working was used proactively to improve patient outcomes. Staff had established substantive links and relationships with a range of secondary care, community and non-profit providers to ensure patients received holistic, consistent and specialised care.

Caring

Good

Updated 28 April 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice mainly in line with local and national averages.
  • Feedback from patient surveys and CQC comment cards indicated patients were treated with compassion, dignity and respect.
  • The practice actively encouraged patients to be involved in decisions about their care and worked with families where appropriate.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw that  staff treated patients with kindness and respect, and maintained patient confidentiality.
  • Structured emotional support was in place for patients including access to counsellors and bereavement support.
  • Services and guidance were in place for carers, including a monthly carer’s clinic.

Responsive

Good

Updated 28 April 2017

The practice is rated as good for providing responsive services.

  • Practice staff readily engaged with the Clinical Commissioning Group (CCG) to provide extended and responsive services to meet people’s needs. This included through coordinated palliative care, dementia screening and annual reviews for patients with a learning disability.
  • Services were tailored to meet the needs of individuals and were delivered in a way that ensured flexibility, choice and continuity of care. This included flexible and urgent appointments and proactive work to ensure patients with complex needs had access to rapid, specialist care and support.
  • The involvement of other organisations and the local community was embedded in service planning and ensured the practice met people’s needs. This included providing access to virtual medical guidance and advice.
  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. This included people who were in vulnerable circumstances.
  • There was active review of complaints by the senior team and improvements were made as a result across the services.

Well-led

Good

Updated 28 April 2017

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

  • Leadership, governance and culture were used to drive and improve the delivery of high quality person-centred care.
  • The strategy and supporting objectives aimed to support staff and service delivery following a challenging period of change.
  • The practice prioritised reducing health inequalities in the local community and adopted a systematic approach to working with other organisations to improve care outcomes.
  • There were high levels of staff satisfaction. Staff were clearly proud of the organisation as a place to work and spoke highly of the culture. There was consistently high levels of constructive engagement with staff.
  • There was demonstrable collaboration and support across all functions and a common focus on improving quality of care and patients’ experiences, achieved through feedback, meeting events and audits.
Checks on specific services

People with long term conditions

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to people with long-term conditions.

  • Clinical staff had lead roles in chronic disease management based on their professional experience and interests and patients at risk of hospital admission were identified as a priority.
  • Staff used templates and registers to provide timely and structured care, including proactive reviews and scheduled annual reviews.
  • The practice performance was comparable with national and Clinical Commissioning Group averages in the Quality Outcomes Framework.
  • Longer appointments and home visits were provided for patients along with a range of extra services, including a online communication options to help triage patients to the most suitable appointment type.
  • Patients had an annual review from a named GP 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. This included through partnership working with a specialist neurorehabilitation unit.
  • Performance for diabetes related indicators was similar to the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 72% compared to the CCG average of 77% and the national average of 78%. The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 80% compared with the CCG average of 82% and national average of 80%. Longer appointments and home visits were available when needed.
  • The practice developed a ‘ near patient testing template’ to provide safe long-term prescribing and regular follow-ups following participation in local pilot schemes.
  • A diabetes nurse was the principal lead clinician for this condition and provided dedicated clinics, insulin initiation and condition management.

Families, children and young people

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to 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. This included children and young people who had a high number of emergency hospital attendances and those who were known to be affected by health inequalities.
  • A bi-monthly multidisciplinary meeting was used to review care for these patients and staff had implemented a specific template to share concerns and manage risks.
  • Immunisation rates were better than local and national averages.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Midwife clinics were held twice weekly at both surgeries as part of a track record of positive working with community midwives.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Services included child health surveillance, antenatal care, contraception, childhood immunisation and sexual health advice. GPs also provided intensive regular support to young people with psychological needs where there were delays to be seen by psychologists.

Older people

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people and offered home visits, urgent and extended appointments.
  • Staff provided advanced care plans and reviewed these at monthly multidisciplinary meetings.
  • The practice engaged and coordinated care with specialist community teams to provide rapid and individualised care to patients.
  • Staff worked with community partners to prevent unnecessary hospital admissions. This included through liaison with a proactive care matron and intermediate care team.
  • Staff provided a ‘social prescribing’ referral service as a strategy to reduce social isolation and improve community engagement.

Working age people (including those recently retired and students)

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to 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. This included a range of extended hours and telephone clinic access.
  • The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. This included screening minor illness and injury clinics, smoking cessation, phlebotomy and travel health and immunisation.
  • Online and remote services included electronic prescriptions, text messaging, telephone consultations and health record access.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to people experiencing poor mental health.

  • 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar to the national average of 84%. The practice offered proactive dementia screening and referrals to memory assessment services.
  • The practice had a dedicated mental health facilitator and engaged with a range of local services for the benefit of patients, including the community mental health team and crisis teams.
  • Patients were offered an annual review that included a physical assessment, medicine review, blood tests and a discussion with a GP or mental health facilitator.
  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice supported patients experiencing poor mental health to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended a hospital emergency department where they may have been experiencing poor mental health.
  • One GP had a special interest and training in teenage mental health and another had qualified in psychiatry. Both GPs offered targeted and individualised care.
  • The practice offered dementia screening and referral to memory advisors.

People whose circumstances may make them vulnerable

Good

Updated 28 April 2017

The practice is rated as good for the provision of services to people whose circumstances make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances and used advanced care planning to avoid hospital admissions. This included for patients who lived in a care home and patients who lived in a residential neurorehabilitation unit.
  • A lead GP for learning disabilities was in post and provided annual reviews, safeguarding reviews and health checks.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients, including independent advocates.
  • 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.
  • Carers were offered an annual health check and flu vaccination and the practice facilitated a monthly carer’s clinic offered by a community health and wellbeing service.