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Inspection Summary


Overall summary & rating

Good

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grove Medical Practice on 15 March 2016. Overall the practice is rated as good.

  • 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said the staff were helpful, caring, friendly, professional and treated them with dignity and respect.
  • 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.
  • 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 an area of outstanding practice:s

  • The practice regularly updated and adapted standard templates used on the electronic record system to reflect new NICE guidelines.

    The practice maintained a comprehensive practice handbook that contained a complete reference to staff of services provided by the practice, including all operational procedures, prescribing and clinical guidelines, policies, community and secondary care services, and external organisations contact details. The handbook also provided electronic links to a variety of national and local guidance for staff to expediently access.

The areas where the provider should make improvement are:

  • Review prescriptions tracking log incorporating allocated distribution.

  • Display a warning notice where the oxygen cylinder is stored.

  • Ensure all staff are appropriately trained in basic life support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 August 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 clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 15 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to national figures.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had a programme of both independent and CCG led audits including second cycle audits that demonstrated quality improvement.

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

  • There was evidence of annual 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 15 August 2016

The practice is rated as good for providing caring services.

  • Data from the most recent national GP patient survey published showed the practice was above CCG averages for its satisfaction scores on consultations with GPs and nurses, but fell below national averages in some areas.

  • Patients said the staff were helpful, caring, friendly, professional and treated them with dignity and respect.

  • 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 15 August 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, the practice engaged with local and CCG led schemes aimed to reduce avoidable hospital admission rates, including the integrated care plan programme and regular attendance at GP federation meetings.

  • 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.

Well-led

Good

Updated 15 August 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 knew and understood the values which were embedded across the practice.

  • 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 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 15 August 2016

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

  • The practice offered GP and nurse led chronic disease management for conditions including diabetes, hypertension, asthma and COPD. Patients were invited for six monthly health checks for management of their disease and medication review. Reminders were placed on patients repeat prescriptions when their review was due.

  • Quality and Outcome Framework data for long-term conditions were at or above average compared to national figures.

  • The practice engaged in local enhanced services to identify patients with long-term conditions at high risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk. The care plans included a section called ‘rescue plan’ that advised the patient when to consult with their GP or other services if required. The practice’s avoidable admissions rate was lower compared to the CCG average.

  • The practice held regular multi-disciplinary team meetings with community nurses, palliative care team and community matron to discuss older patients with complex medical needs and review and update their care plans.

  • Home visits were available for patients unable to attend the practice due to illness or immobility and alerts were placed on electronic records for patients who had difficulty using the stairs.

Families, children and young people

Good

Updated 15 August 2016

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

  • There was a named GP lead for safeguarding vulnerable children and staff had received role appropriate child protection training and were aware of their responsibilities to raise any concerns. The practice maintained a register of vulnerable children and their families and monthly meetings with health visitors took place to discuss cases on the register.

  • The practice engaged with local services to support vulnerable children and young adults. For example, they proactively referred patients to a local multi-agency team of counsellors, psychologist and family support workers who provided support for vulnerable children, their families and for young parents.

  • The practice maintained a register of young carers and offered support and signposting to local services when appropriate.

  • Uptake rates for childhood immunisations 2014/15 were at or above CCG averages.

  • The practice provided shared ante-natal care with local hospitals and GP-led post-natal checks for mothers and babies at six weeks.

  • The practice nurses were trained to offer family planning and contraceptive advice as required.

Older people

Good

Updated 15 August 2016

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

  • Patients over the age of 75 years had a named GP to promote continuity of care.

  • The practice offered daily telephone consultations and home visits for patients unable to attend the surgery due to illness or immobility.

  • Information on support groups was provided to patients who may benefit from this support.

  • The practice participated in a local transport pilot scheme that provided assisted travel to the surgery.

  • The practice aimed to provide services in house to avoid travel to distant sites. For example, the practice initiated an in-house anticoagulation monitoring service in response to feedback from patients who were having difficulties travelling to the local hospital.

  • Patients were pro-actively referred to local community services including falls prevention, occupational therapy and social services as required.

  • The practice engaged in local enhanced services and identified older patients at high risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk. The care plans were agreed with the patient and they kept a copy of their care plan at home. The practice’s avoidable admissions rate was lower compared to the CCG average.

  • The practice held regular multi-disciplinary team meetings with community nurses, palliative care team and community matron to discuss older patients with complex medical needs and review and update their care plans. The practice also took part in quarterly network multi-disciplinary meetings attended by local GP practices and consultants in care of the elderly and mental health to discuss difficult cases and share knowledge and expertise to improve management and avoid admissions.

Working age people (including those recently retired and students)

Good

Updated 15 August 2016

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

  • The practice offered extended hour appointments with two doctors and one practice nurse one evening a week for patients unable to attend the surgery during working hours. Both booked and open access telephone consultations were also available.

  • There was the facility to book appointments and request repeat prescriptions online.

  • The practice nurses had received smoking cessation training to offer support and advice for patients who wished to stop smoking with onward referral to local smoking cessation services if required.

  • Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 August 2016

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

  • Screening for dementia was offered to patients at risk or those with concerns about their memory with onward referral to local memory clinic services if indicated.

  • The practice provided primary medical services to three local supported living homes for patients with learning disabilities and people experiencing poor mental health.

  • One of the GPs was the mental health lead for the practice and had been involved in reviewing the criteria for discharge from secondary care services back to the community teams. Discussion with the patients GP was sought before discharge from secondary care mental health services and the practice was currently auditing the impact of this service.

  • The practice proactively referred patients with depression or anxiety to local Improving Access to Psychological Therapies (IPAT) services when required.

  • QOF data for 2014/2015 showed the practice was comparable to local and national averages for mental health indicators.

People whose circumstances may make them vulnerable

Good

Updated 15 August 2016

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

  • There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns. Alerts on electronic patient records were used to highlight vulnerable patients and these cases were regularly discussed at multi-disciplinary team meetings.

  • The practice maintained a register of patients with learning disabilities and they were invited for annual health checks to update care plans and review medication. Alerts placed on electronic records ensured these patients were offered first and double time slots when booking appointments.

  • Patients who did not have English as their first language could also book longer appointments to allow time for use of translation services.

  • The practice list was open for people who were homeless to register and they were encouraged to use the practice address for correspondence to reduce the rate of missed hospital appointments.