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Inspection Summary


Overall summary & rating

Good

Updated 19 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Creffield Medical Centre on 02 February 2016. Overall the practice is rated as Good.

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

  • Staff knew how to raise concerns and report safety incidents. Safety information was recorded, monitored, and reviewed to identify trends or recurrent themes. When safety events occurred they were investigated and any issues identified were shared with all staff members.

  • Risks to patients were well managed. The system for assessing risks included those associated with; premises, equipment, medicines, and infection control.

  • Patient care was planned and provided to reflect best practice and recommended current clinical guidance.

  • Staff had received appropriate training for their roles and further training had been encouraged, recognised and planned.

  • Information regarding how to complain was available at the practice and on the practice website.

  • The practice staff members had received training regarding the safeguarding of children and vulnerable adults, and knew who to contact with any concerns.

  • The practice was suitably equipped to treat patients and meet their requirements. The equipment had been checked and maintained to ensure it was safe to use.

  • Patient comments were positive when we spoke with them during the inspection. Members of the virtual practice patient participation group were proactive and keen to be involved with practice development.

  • The clinical staff met daily to ensure comprehensive quality peer support for the team.

  • The leadership structure at the practice was well-established and all the staff members we spoke with said they felt supported in their working roles by both the practice manager and the GPs.

However we found an area where the practice should improve;

  • Continue to implement an effective system to identify patients who are carers and provide them with support.

We also saw an area of outstanding practice:

The practice provided space within their reception area for exercise classes aimed at their more active elderly patients. This weekly exercise class that was organised by the Patient Participation Group (PPG) was aimed to improve people’s balance and help reduce falls. The practice also supported the PPG to organise and arrange tea parties for patients identified as alone. From single people within the older people’s population, to single mothers within the families, children and young people population group to meet and talk with others in similar circumstances for support, company and conversation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 May 2016

The practice is rated as good for providing safe services.

  • Safety incidents were documented and shared with the staff members to ensure practice safety lessons were learnt from the actions that were taken. Patients involved in incidents received an explanation or an apology when appropriate.

  • Infection control procedures were completed to a satisfactory standard and well documented. The practice had developed processes to keep people safe and safeguarded from abuse.

  • Risks to patients were assessed on a daily basis and were well managed.

  • The practice had appropriate premises and equipment to keep patients and staff safe.

  • Medicines and repeat prescriptions were managed safely.

Effective

Good

Updated 19 May 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were comparable with local and national practices rates.

  • Patient care was planned and provided in a way that reflected best practice and followed recommended current clinical guidance.

  • Clinical audits undertaken at the practice showed the GPs used auditing to improve the practice service quality.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was a system in place to ensure that staff received supervision and appraisal.

  • Staff communicated with multidisciplinary teams to understand and meet the range and complexities of people’s needs.

Caring

Good

Updated 19 May 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.

  • Patients told us they often received information about their treatment; this was in a way that was easy to understand and involved patients in decisions about their care and treatment.

The practice recognised the needs of patients who were carers and provided support and information about the range of agencies and organisations available to support them.

Responsive

Good

Updated 19 May 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.

  • Appointment times and availability were flexible to meet the needs of patients. Same and next day appointments were available. Home visits and telephone consultations were provided as needed. The practice offered its patients access to book online appointments with a GP via the internet.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. Accessible toilets and baby changing facilities were available.

  • 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.

Well-led

Good

Updated 19 May 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 with a responsive service for all its patients.

  • Information about the practice was available to staff and patients. There was a clear leadership structure and staff felt supported by management.

  • 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 and the practice had systems in place to monitor notifiable safety incidents and ensure this information was shared appropriately with actions taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. There was a strong focus on continuous learning evidenced in the training records, and developments seen at all levels.

Checks on specific services

People with long term conditions

Good

Updated 19 May 2016

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

Performance for the management of long term conditions was comparable with other GP practices locally and nationally. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice responded to the needs of people with long-term conditions providing:

  • Longer appointments and home visits were available when needed.

  • The long term condition patients had a named GP and a structured annual review to check that their health and medication needs were being met. The practice long term condition management system provided appointments giving sufficient time to review all the chronic conditions that the patient had. This approach identified the clinician most qualified to review all their conditions reducing the need for multiple attendances.

  • GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. Shared care with the local Hospital was delivered for the monitoring of various disease-modifying medications where the practice arranged and reviewed blood results.

  • Patients with diabetes, asthma, and COPD were recalled for review by a GP and nurse to ensure consistent care. Patients were seen and monitored according to their clinical need and sent a reminder when their review was due.

  • The percentage of patients with diabetes, on the practice register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was comparable to other practices nationally.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was also comparable to other practices nationally.

Families, children and young people

Good

Updated 19 May 2016

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

The practice responded to the needs of families, children and young people by providing:

  • Children living in disadvantaged circumstances and those who were at risk, for example, children and young people who had a high number of A&E attendances were monitored by the practice.

  • Consistently higher Immunisation rates for all standard childhood immunisations in comparison to national rates.

  • Routine child health surveillance for children at eight weeks and three and a half years were provided.

  • The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 70% which was comparable with the national average of 75%.

  • Parents told us that children and young people were treated in an age-appropriate way and were recognised as individuals when seen.

  • Females aged between 25-64 years, attending cervical screening within the target period (3.5 or 5.5 year coverage) was 77% in comparison with 77% for the CCG average and 74% for the national average.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • Antenatal care for patients not able to see the community midwife was provided at the practice and postnatal reviews were performed alongside the baby check.

  • Positive joint working with midwives, and liaison with the local safeguarding team (with parental consent) as appropriate.

  • Attendance as appropriate was made by GPs at child protection conferences.

    Liaison with local schools, and health visitors.

  • Safeguarding information coded onto patients’ computer medical records.

  • The use of ‘Gillick’ competency testing for children over 16 years of age.

  • Staff members were familiar with and had access to local advice/safeguarding/support services to families and health promotion services to young people and families (e.g. weight management).

  • Baby changing facilities were available and a private room could be offered for breastfeeding mothers.

  • Family planning clinics included contraceptive implant fitting were offered

Older people

Good

Updated 19 May 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 over 75 years were informed by letter of their named GP and could change this GP if they wished. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice was responsive to the needs of older people including:

  • Home visits with GPs and nurses.

  • Hospital admissions avoidance was discussed at regular multidisciplinary team meetings to reduce unplanned hospital admissions for the frail elderly, and patients who were receiving palliative care. There were personalised care plans for patients at high risk of hospital admission to support the reduction of emergency referrals.

  • Each emergency admission was reviewed on discharge to ensure patients and their carers had the clinical input and medicine they needed. Following admissions for a fall patients were referred to specialists who were experienced in falls prevention.

  • Senior health checks and unplanned admission avoidance care plans.

  • High rates of seasonal flu/shingles vaccinations. Transport was arranged through the local community voluntary sector to improve access for patients.

  • Dementia screening was provided opportunistically and also on request. The practice was proactive and focused on primary prevention wherever possible.

  • For the more active elderly patients exercise classes are held at the practice. The patient participation group also arranged tea parties for patients from this population group that the practice had identified may be lonely.

  • Patients were coded as carer’s on the practice computer records system. Carer’s were provided details of local and voluntary agencies to provide support.

Working age people (including those recently retired and students)

Good

Updated 19 May 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

The needs of working age people, those recently retired and students had been recognised and the practice had adjusted their services to ensure they were accessible, adaptable, and could offer continuity of care. For example:

  • Offering online services to book appointments, and order repeat prescriptions.

  • Telephone consultations were available on a daily basis with both doctors and nurses. They aimed to accommodate requests for call-back to patients for specific time periods such as lunch breaks to fit in with work timetables for patients.

  • Extended hours services above local requirements, were provided by GPs, nurses, and healthcare assistants from 8.15am to 11.15am on Saturdays.

  • A full range of health promotional services such as smoking cessation, weight management and health checks, flu vaccination clinics on Saturdays.

  • Family planning services, post-natal and baby checks were available as were appointments to monitor the development of babies and the health of new mothers.

  • The practice tried to be as flexible and accommodating with regards to appointments where possible for this population group. Telephone consultations were available every day and were provided for patients who needed advice but were unable to get to the surgery.

  • The practice had an automated surgery pod available which enabled patients to measure their blood pressure, weight, smoking status and more. The data generated by the automated pod was recorded directly into patient’s electronic medical record.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had adapted their services to meet the needs of people within this population group for example:

  • 68%

  • 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 provided people experiencing poor mental health information about how to access support groups and voluntary organisations.

  • The practice followed up patients who had attended accident and emergency from this population group.

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

  • The practice had flexibility regarding missed appointments and tried to make their services as easy to access as possible.

Patients within this population group were referred for counselling or specialist mental health input when required.

People whose circumstances may make them vulnerable

Good

Updated 19 May 2016

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

The practice had modified their services to meet the needs of people within this population group for example:

  • The practice had a register of patients living in vulnerable circumstances this included travellers and those living with a learning disability (LD). There were 32 people on the practice learning disability register.

  • Longer and flexible appointments, scheduled at the start of surgery sessions to reduce waiting time were available for patients with a LD. Also specific clinics with information being given in pictorial format to aid LD patients understanding were held. Annual learning disability checks were provided.

  • The practice actively includes mental health and dementia reviews within patients long term condition management program and worked with multi-disciplinary teams to case manage vulnerable people.

  • Vulnerable patients were told how to access various support groups and voluntary organisations with comprehensive information available within the practice and on their website.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children, they were also aware of their responsibilities. This included information sharing, documentation of safeguarding concerns and who to contact. Practice staff knew they could ask the safeguarding lead at the practice for advice should they have any concerns.

  • Home visits were offered to those patients unable to attend for routine or emergency care, including their vaccinations. The practice undertake a weekly visit to two nursing homes this is to provide an extended service to vulnerable patients who are in a care setting.

  • Notifications were attached to the medical records of vulnerable patients. These ensured staff members were aware when patients rang to be seen for an appointment or a home visit that they were offered flexibility regarding time and appointment length.

  • The practice had flexibility regarding missed appointments and tried to provide easy to access services for patients with poor mental health that frequently book appointments and then fail to turn up. Staff realised this population group’s problems and accommodated them by seeing them.

  • The practice patient group are undertaking a project to set up “tea parties” for patients who may be lonely. In addition they host a weekly session for “my social prescription” which encourages patients to pledge time to provide a service. This could range from befriending to gardening or teaching someone to knit. In return volunteers bank the time that they spend to be given back to them when they are in need of help.