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Drs Robinson and Siddiqui Good

Inspection Summary


Overall summary & rating

Good

Updated 22 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Jones and Robinson practice (also known as Withnell Health Centre) on 15 November 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 although there was a lack of documentation of discussions and no routine review of mitigating actions taken.
  • Risks to patients were assessed and generally well managed. The building landlord’s representative had carried out premises risk assessments although the practice did not have sight of actions taken to address identified risks.

  • 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.
  • Processes were in place for handling repeat prescriptions which included the review of high risk medicines. However, the practice did not always check that patients who were taking medications that required monitoring, were being monitored appropriately when they were under the care of the hospital.
  • 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 named GP and there was continuity of care, with urgent appointments available the same day.
  • Patient feedback on the practice service overall was consistently positive.
  • 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.

We saw one area of outstanding practice:

  • The practice was proactive in developing new ways to provide care and treatment. This was demonstrated in its award-winning nursing service to visit vulnerable patients in their own homes to assess their health and social care needs. We saw evidence of a reduction in patient unplanned admissions to hospital following the start of this service.

The areas where the provider should make improvement are:

  • Review the practice significant event analysis procedure and recording form to allow for all actions taken as a result of analysis to be recorded and reviewed.

  • Establish a dialogue to ensure that actions taken to address risks identified by the building risk assessment conducted by the landlord’s representative are carried out.

  • Put systems in place to check that the appropriate monitoring is taking place for those patients under the care of the hospital when a repeat prescription is requested.

  • Arrange for Patient Group Directions (PGDs) to be signed and authorised by all relevant staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 December 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 although there was not always documentation of this or documentation of any review of actions taken.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. The practice reviewed children who did not attend for hospital appointments although this was not always documented.
  • Risks to patients were assessed and generally well managed. The building landlord’s representative had carried out risk assessments although the practice did not have sight of actions taken to address identified risks.
  • The arrangements for managing medicines generally kept people safe, however, the practice did not always check that patients, who were taking medications that required monitoring, were being monitored appropriately when they were under the care of the hospital. Patient Group Directions (PGDs) had been adopted by the practice to allow nurses to administer medicines in line with legislation, however these PGDs were not always signed by all the nurses and had not been signed by a GP as the authorising manager. The practice said that they would do this immediately following our visit.
  • The practice carried out appropriate recruitment checks prior to employment of staff and maintained comprehensive personnel files.
  • 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.

Effective

Good

Updated 22 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national average.
  • 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.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. Two of the practice nurses visited newly-identified patients in their homes to assess their health and social needs. They referred to the GPs when necessary and to any other services that were indicated. Care plans were produced for all these patients that were shared with other services.

Caring

Good

Updated 22 December 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.
  • Staff at the practice engaged with local and national charitable services and supported local health organisations including the local hospice in raising funds for them.

Responsive

Good

Updated 22 December 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.
  • 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.
  • 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 22 December 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 and held regular governance meetings.
  • The practice had arrangements to monitor and improve quality and identify risk although discussions of risks were not always documented. There was no routine review of any mitigating actions taken as a result of identified risks.
  • 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
  • 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.
  • The practice was a training practice and provided support and mentorship to medical students. They had won a Silver award from Manchester University for training medical students in the year 2014 to 2015 and a Gold award for the year 2015 to 2016.
  • The practice was proactive in developing new ways to provide care and treatment. This was demonstrated in its award-winning nursing service to visit vulnerable patients in their own homes to assess their health and social care needs.

Checks on specific services

People with long term conditions

Good

Updated 22 December 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 and patients at risk of hospital admission were identified as a priority.
  • Blood measurements for diabetic patients showed that 76% of patients had well controlled blood sugar levels compared to the national average of 78%. Also, the percentage of patients with blood pressure readings within recommended levels was 78%, the same as the national average.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and 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.
  • A podiatrist visited the practice weekly.
  • A phlebotomist visited the practice twice a week and also provided a blood-testing service for those patients who were taking blood-thinning medications for heart conditions.

Families, children and young people

Good

Updated 22 December 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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 86%, which was higher than the local average of 84% and the national average of 81%.
  • 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.

Older people

Good

Updated 22 December 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice encouraged patients to attend national cancer screening programmes. Figures showed that 73% of patients invited to attend breast screening had attended, compared to the local average of 71%, and that 64% had attended bowel screening compared to 59% locally.
  • There was a treatment room service at the practice twice a week that included a patient dressings service.

Working age people (including those recently retired and students)

Good

Updated 22 December 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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 86%, which was higher than the local average of 84% and the national average of 81%.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 December 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • 81% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is slightly lower than the national average of 84%.
  • 87% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the national average of 89%.
  • 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.
  • 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 22 December 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 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.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • A counsellor for patients suffering from post-traumatic stress disorder visited the practice when needed.
  • 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.
  • Practice nurses visited the practice’s most vulnerable patients in their homes to assess their health and social needs. They referred to the GPs when necessary and to any other services that were indicated. Care plans were produced for all these patients that were shared with other services. This nursing service had been awarded the “Delivering Quality” award by the CCG in September 2015 and had again been a finalist in the CCG award “Making an Impact” in September 2016.