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Archived: Railway Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 20 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Waterloo Medical Group on 9 February 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 a highly effective system for reporting and recording significant events. The staff team took the opportunity to learn from all internal and external incidents.

  • Risks to patients and staff were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

  • Outcomes for patients were consistently good. The Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in obtaining 99.9% of the total points available to them for providing recommended care and treatment.

  • The practice worked closely with other organisations when planning how services were provided, to ensure patients’ needs were met.

  • Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment.

  • The main practice and its branches had good facilities and they were well equipped to treat patients and meet their needs.

  • Services were tailored to meet the needs of individual patients and were delivered in a way that ensured flexibility, choice and continuity of care. All staff were actively engaged in monitoring and improving quality and patient outcomes.

  • The leadership, governance and management of the practice assured the delivery of high-quality person-centred care, supported learning, and promoted an open and fair culture.

    We also saw areas of outstanding practice:

  • The practice has demonstrated leadership within the region through their proactive and lead role in developing the Blyth Acute Service (BAS) which provides patients with urgent same-day care. The service commenced in February 2015, and at the time of the inspection, 10,347 patients had used the service at least once. (This also includes patients from the adjacent practice.) A high proportion of these patients have used the service numerous times. Healthwatch Northumberland recently carried out a service of patients about the BAS. Most patients who responded were very positive about the service, and they said they received a better quality of care and treatment than they did before. This is outstanding because staff have worked hard to develop a new way of delivering urgent, same-day care which has improved patient access and outcomes.

However, there were also areas where the provider needs to make improvements. The provider should:

  • Continue to review and improve telephone access to the practice and their appointment system.

  • Ensure they have documentary or electronic evidence which confirms that NHS Property Services have completed the health and safety checks they are contracted to carry out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 May 2016

The practice is rated as good for providing safe services.

There was an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned when things went wrong and shared with staff to support improvement. There was an effective system for dealing with safety alerts and sharing these with staff. The practice had clearly defined systems and processes that kept patients safe. However, the provider did not have access to documentary evidence to enable them to confirm that all of the required health and safety checks, carried out by NHS Property Services, had been completed. Individual risks to patients had been assessed and were well managed. Good medicines management systems and processes were in place. The premises were clean and hygienic. Required pre-employment checks had been carried out for staff recently appointed by the practice.

Effective

Good

Updated 20 May 2016

The practice is rated as good for providing effective services.

Outcomes for patients were very good. The QOF data, for 2014/15, showed the practice had performed very well in obtaining 99.9% of the total points available to them for providing recommended care and treatment. This was 2% above the local CCG average and 4.9% above the England average. Patients’ needs were assessed, and care was planned and delivered, in line with current evidence based guidance. Clinical audits demonstrated staff’s commitment to quality improvement. Staff were consistent in supporting patients to live healthier lives, through a targeted and proactive approach to health promotion. This included promoting good health, and providing advice and support to patients, to help them manage their health and wellbeing. Staff worked effectively with other health and social care professionals to help ensure the range and complexity of patients’ needs were met. Staff had the skills, knowledge and experience to deliver effective care and treatment.

Caring

Good

Updated 20 May 2016

The practice is rated as good for providing caring services.

Patients were supported, treated with dignity and respect, and were involved as partners in their care. Data from the NHS National GP Patient Survey of the practice, published in January 2016, showed patient satisfaction with the quality of GP and nurse consultations was either above, or broadly in line with, the local CCG and national averages. Patients’ emotional and social needs were seen as being as important as their physical needs, and there was a strong, visible, person-centred culture. Patients told us they were treated with compassion, dignity and respect, and they felt well looked after. Information for patients, about the range of services provided by the practice, was available and easy to understand. Staff had made good arrangements to help patients and their carers cope emotionally with their care and treatment.

Responsive

Good

Updated 20 May 2016

The practice is rated as good for providing responsive services.

Staff had taken on a lead role in planning and developing services within their locality. They were actively contributing to the development and delivery of an innovative way of providing urgent, same-day care to patients.

Staff worked closely with other organisations and with the local community to plan how services were provided, to ensure they met patients’ needs and offered flexibility, choice and continuity of care. Patients we spoke with, and most of those who completed Care Quality Commission (CQC) comment cards, were satisfied with access to appointments, and they said they were able to obtain an appointment in an emergency. Results from the NHS GP Patient Survey of the practice, showed that patient satisfaction levels with the convenience of appointments was better than the national average and, in relation to appointment waiting times, were higher than both the local CCG and national averages. However, patient satisfaction regarding telephone access and appointment availability, were lower. Staff had been proactive in addressing these concerns. They had closely monitored patient feedback, and used this to help further improve the care and treatment they provided, such as developing the Blyth Acute Service to offer patients access to same-day urgent care.

T

he 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. Evidence showed that the practice responded quickly to any issues raised.

Well-led

Good

Updated 20 May 2016

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

The practice’s leadership and governance arrangements actively encouraged and supported a culture, which consistently focussed on how high quality, person centred care, could be delivered and improved. The practice showed leadership across the local region by developing new ways of providing same-day urgent care. All of the staff we spoke to were proud to work for the practice, and had a clear understanding of their roles and responsibilities. The practice had good governance and performance management arrangements, and had clearly defined and embedded systems and processes, that kept patients safe. There was a clear leadership structure and staff felt well supported by the GPs and the practice manager. Regular clinical management, nursing and multi-disciplinary team meetings took place which helped to ensure patients received effective and safe clinical care. The practice actively sought feedback from patients via their Friends and Family Test survey and patient participation group. There was a strong focus on, and commitment to continuous learning and improvement, at all levels within the practice.

Checks on specific services

People with long term conditions

Good

Updated 20 May 2016

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

Nationally reported QOF data, for 2014/15, showed the practice had performed well, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients who had diabetes. This was 5% above the local CCG average and 10.8% above the England average. Nursing staff held lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients with long-term conditions were offered a structured annual review, to check their health needs were being met and that they were receiving the right medication. A good call and recall system was in place, which helped ensure that all patients requiring an annual review received one. Clinical staff were very good at working with other professionals, to deliver a multi-disciplinary package of care to patients with complex needs.

Families, children and young people

Good

Updated 20 May 2016

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

There were systems to identify and monitor children who were at risk. Alerts had been added to the records of at-risk children, or those subject to child protection procedures, to help ensure staff were aware of who they were, so this could be taken into account during any consultations. Regular ‘Supporting Families’ meetings took place, to help ensure information about vulnerable children and families was shared with the relevant health and social professionals, and to identify and manage potential risks. Appointments were available outside of school hours and the main practice and branch surgery premises were suitable for children and babies. The practice offered a range of contraceptive services as well as sexual health advice.  Staff had targeted younger patients through a poster campaign, and a member of staff acted as the Young Person’s Champion, to help raise their profile within the practice. The practice had performed well in delivering childhood immunisations. Publicly available information showed that all of their immunisation rates were above 90%. Nationally reported data showed the practice’s performance in relation to the delivery of their cervical screening programme was comparable with other practices.

Older people

Good

Updated 20 May 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed well, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients who had heart failure. This was 1.1% above the local clinical commissioning group (CCG) average and 2.1% above the England average. The practice offered proactive, personalised care which met the needs of their older patients. All patients over 75 years of age had a named GP who was responsible for their care. Staff were participating in a local care homes project to look at better ways of supporting the high-risk patients who lived in them. Staff worked closely with other healthcare professionals to meet the needs of patients requiring palliative and end of life care, and to help prevent acute unplanned admissions into hospital.

Working age people (including those recently retired and students)

Good

Updated 20 May 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them for providing care and treatment to patients who had hypertension. This was 0.3% above the local CCG average and 2.2% above the England average. Staff had assessed the needs of this group of patients and developed their services, to help ensure they received a service which was accessible, flexible and provided continuity of care. The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 May 2016

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

There were good arrangements for meeting the needs of patients with specific mental health needs, including depression. Nationally reported QOF data, for 2014/15, showed the practice had performed well in obtaining 100% of the total points available to them, for providing recommended care and treatment to this group of patients. The data showed that 77.4% of these patients had a documented care plan, which had been agreed with their carers during the preceding 12 months. This was 3.1% above the local CCG average and 0.2% above the England average. Patients experiencing poor mental health were provided with advice about how to access various support groups and voluntary organisations. Staff kept a register of patients who had mental health needs, to make sure they received the support they required. The practice’s clinical IT system clearly identified these patients to ensure staff were aware of their specific needs.

The arrangements for meeting the needs of patients who had dementia were also good. Nationally reported QOF data, for 2014/15, showed the practice had performed well in obtaining 100% of the total points available to them, for providing recommended care and treatment to this group of patients. This was 0.9% above the local CCG average and 5.5% above the England average. Staff kept a register of patients who had dementia, and the practice’s clinical IT system clearly identified them, to help make sure clinical staff were aware of their specific needs. Clinical staff, including the practice’s healthcare assistant, actively carried out opportunistic dementia screening, to help ensure their patients were receiving the care and support they needed to stay healthy and safe. All staff had become Dementia Friends to help raise the profile of dementia patients registered at the practice.

People whose circumstances may make them vulnerable

Good

Updated 20 May 2016

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

There were good arrangements for meeting the needs of vulnerable patients, including those who had learning disabilities. The QOF data, for 2014/15, showed the practice had obtained 100% of the points available to them, for providing recommended care and treatment to patients who had learning disabilities. This was in line with the local CCG average and 0.2% above the England average. Staff maintained a register of patients with learning disabilities, which they used to ensure they received an annual healthcare review, provided by a dedicated clinician. Staff offered extended appointments for these reviews and they could take place at the patient’s home if needed. Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. A chaperone service was available to help safeguard patients. The practice kept a register of patients who were also carers and was using this to help provide them with appropriate services.