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Aylmer Lodge Cookley Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aylmer Lodge Cookley Partnership on 19 October 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. Staff had received training which provided them with the skills, knowledge and experience to deliver effective care and treatment.

  • 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.

  • 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 areas of outstanding practice including:

  • The practice were very active in identifying and caring for people whose circumstances may make them vulnerable. This included working closely with other organisations, and setting up meetings between agencies to help provide support for vulnerable patients.

  • Patient Participation Group (PPG) members attended the practice a number of times a week according to members’ availability and there was a rota in place for this. This was to support patients, for example, by helping to show patients around the building, to provide reassurance, to help signpost to local support services, and to help gather feedback to share with the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting, recording, discussing and learning from 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, clear 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.

  • Arrangements for managing medicines kept patients safe.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 20 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) 2014/15 showed patient outcomes were in line with or above regional and national averages. The most recent published results showed that the practice achieved 98% of the total number of points available, compared with the Clinical Commissioning Group (CCG) and national averages of 97% and 95% respectively.

  • 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 20 December 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published during July 2016 showed patients rated the practice higher than others for several aspects of care. For example, 94% of patients said the GP was good at listening to them compared with the Clinical Commissioning Group (CCG) average of 92% and the national average of 89%.

  • 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. The practice had worked with a local organisation to produce a wide range of information leaflets in an easy-read format.

  • The practice had helped set up meetings between local carers, mental health and hospice organisations.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 20 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of their local population and engaged with the NHS England Area Team and the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, there was an easy read version of the complaints form available in the practice premises and on the practice website.

  • 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 20 December 2016

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

  • The practice had a clear philosophy to deliver high quality care and promote good outcomes for patients. Staff were clear about the philosophy 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 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.

    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 (PPG) 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 20 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.

  • Performance for diabetes-related indicators was in line with the Clinical Commissioning Group (CCG) and national averages. For example, 97% of patients with diabetes on the register received influenza immunisation in the last 12 months compared with CCG and national averages of 96% and 94% respectively. The practice’s exception reporting rate for this indicator was 12% compared with the CCG average of 15% and the national average of 18%.

  • 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.

Families, children and young people

Good

Updated 20 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 accident and emergency attendances. Immunisation rates were 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. We saw evidence to confirm this.

  • Performance for cervical screening indicators was in line with Clinical Commissioning Group (CCG) and national averages. For example the percentage of women aged 25-64 who attended for a cervical screening test in the last five years was 83% compared with CCG and national averages of 83% and 82% respectively.

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

  • The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

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

Older people

Good

Updated 20 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 had carried out 833 medicine reviews for patients aged over 75 years within the last 12 months. This represented 62% of the practice’s eligible population of 1,352 patients.

  • The practice directed older people to appropriate support services.

Working age people (including those recently retired and students)

Good

Updated 20 December 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 reflected the needs for this age group.

  • The practice offered online appointment booking and the facility to request repeat prescriptions online.

  • Appointments were offered to accommodate those patients unable to attend during normal working hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 December 2016

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

  • Performance for mental health (including dementia) related indicators was in line with or higher than Clinical Commissioning Group (CCG) and national averages. For example the percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face meeting in the last 12 months was 95% compared with CCG and national averages of 84%. The practice’s exception reporting rate for this indicator was 9% compared with the CCG average of 10% and the national average of 8%.

  • 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

Outstanding

Updated 20 December 2016

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

  • The practice held registers of patients living in vulnerable circumstances including homeless people, travellers, asylum seekers and those patients with a learning disability.

  • The practice had 73 patients registered as having a learning disability and were very active in identifying and caring for this group. They had completed health checks for 68 of these patients in the last 12 months (93%). The practice had reviewed the five cases where checks had not been carried out, offered checks again and then documented the reasons for the checks not taking place. The practice offered longer appointments for patients with a learning disability consisting of at least 30 minutes with a nurse and 15 minutes with a GP.

  • The practice had worked closely with Speakeasy in Worcestershire, a local organisation supporting people with a learning disability, to improve services for patients. This included carrying out a joint audit during 2015 and 2016 to identify areas for improvement. The practice had implemented a range of improvements, for example, to produce a wide range of information leaflets in an easy-read format.

  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 281 patients as carers, which represented 2% of the total practice population. Staff told us they actively worked to identify carers, for example, identifying 30 new carers when delivering influenza immunisations during 2015. The practice worked closely with the Worcestershire Association for Carers, including for example, carrying out a patient survey into carers’ needs and holding carers’ events at practice premises.

  • 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.

  • The practice had set up meetings in the last year between the Worcestershire Association for Carers, a local branch of MIND (a mental health charity) and KEMP (a local palliative care hospice) to promote and embed joint working across the region for vulnerable patients. Staff told us this was to help their vulnerable patients by bringing together external agencies who could help provide support.

  • There were strong safeguarding arrangements in place and 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.