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Dr J Israel's Practice Good Also known as The Vale Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr J Israel on 21 April 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, and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly below average in 2014/2015 for several health indicators, but the practice had addressed this and made some improvements in 2015/2016.

  • 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.
  • The majority of 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.
  • 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.

The areas where the provider should make improvements are:

  • Ensure QOF performance is continuously monitored and improvements are made.

  • Ensure translation services are advertised in the waiting area, in a format patients can understand.

  • Ensure there is a policy for safeguarding adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 July 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.

  • 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 systems, processes and practices in place to keep patients safe and safeguarded from abuse, but they did not have a policy for safeguarding adults.

  • The majority of risks to patients were assessed and well managed.

Effective

Good

Updated 28 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that in 2014/2015, patient outcomes were mostly below average for several health indicators. The practice was able to demonstrate actions it had taken to make improvements to these areas in 2015/2016, and described a plan of action to make further improvements.

  • 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.

Caring

Good

Updated 28 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published on 7 January 2016 showed patients rated the practice similar to 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.

Responsive

Good

Updated 28 July 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, they participated in a pilot to offer in-house physiotherapy services to patients.

  • 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 28 July 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.

  • There were arrangements to monitor 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

  • 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 28 July 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.

  • Performance for diabetes related indicators was below average. For example, 67% of patients with diabetes had well-controlled blood sugar in the previous 12 months (national average 78%). The practice had carried out its own analysis in 2015/2016 which showed performance had increased to 84% in 2015/2016.

  • All patients with a long term condition had a named GP, a personalised care plan, and most had received a structured annual review to check their health and medicines needs were being met.

  • Performance for asthma related indicators was average; 72% of patients with asthma had an asthma review in the previous 12 months (national average 75%).

  • Performance for indicators related to chronic obstructive pulmonary disease was below average; 79% of patients with chronic obstructive pulmonary disease had a review of their care in the previous 12 months (national average 90%). The practice had carried out its own analysis in 2015/2016 which showed performance had increased to 80% in 2015/2016.

  • Longer appointments and home visits were available when needed. The practice encouraged patients with long term conditions to make use of their in-house massage service to aid their mental and physical well-being.

  • 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 28 July 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.

  • 85% of women aged between 25 and 64 years received a cervical screening test in the previous five years. This was in line with the national average of 82%

  • 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 and health visitors.

Older people

Good

Updated 28 July 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 by GPs, and the practice’s community nurse who was able to perform a variety of services including phlebotomy for these patients.

  • Home visits were scheduled to coincide with patients’ medicine reviews, but the practice also responded to home visit requests from patients.

  • Urgent appointments were available for those with enhanced needs.

  • The practice hosted regular multi-disciplinary meetings attended by social workers, district burses and palliative care nurses.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, 79% of patients with hypertension had well controlled blood pressure in the previous 12 months. This was in line with the national average of 84%.

Working age people (including those recently retired and students)

Good

Updated 28 July 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.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice offered an in-house phlebotomy service and 24 hour blood pressure monitoring to reduce the need for patients to visit local hospitals.

  • Extended hours opening and daily telephone consultations were available for patients who could not attend the practice during normal working hours.

  • There was accessible health promotion material available throughout the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 July 2016

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

  • 57% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was significantly below the national average of 84% but the practice had carried out its own analysis in 2015/2016 which showed an increase to 74% in 2015/2016.
  • 78% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records. This was below the national average of 88% but the practice had carried out its own analysis in 2015/2016 which showed an increase to 98% in 2015/2016.
  • The practice provided care for patients in local care homes for people with poor mental health and learning difficulties.

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

  • 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 28 July 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 homeless people, travellers and those with a learning disability.

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

  • The practice told us homeless people were able to register as patients to receive on-going care at the practice. They also provided care to women from a local women’s refuge home for vulnerable women and children with complex health and social needs.

  • 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.