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Inspection Summary


Overall summary & rating

Good

Updated 3 June 2016

Letter from the Chief Inspector of General Practice

On 16 January 2015 we carried out a full comprehensive inspection at Firsway Health Centre. The inspection was rated as requires improvement.

Improvements were specifically required in the following areas:

  • Regulation 10 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Assessing and monitoring the quality of service provision.

  • Regulation 11 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Safeguarding people who use services from abuse.

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Cleanliness and infection control.

  • Regulation 13 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Management of medicines.

  • Regulation 21 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Requirements relating to workers.

  • Regulation 23 of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2010, Supporting staff.

The Health and Social Care Act 2008 (Regulated Activity) regulations 2014 replaced the above regulations in April 2015.

This inspection took place on 19 April 2016 and was a focussed inspection to check improvements had been made. We inspected areas of each domain. We found all the required improvements had been made and the practice is now 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 been trained to provide 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 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 two areas of outstanding practice:

  • The practice had a system in place to monitor and review families at risk with health visitors. These meetings took place fortnightly. There was a code on the practice’s computer system so that all clinicians were aware of there was an issue with a family.

  • The practice had developed templates for use when prescriping certain medicines, for example oral contraception. Up to date NICE guidance was inbuilt into these templates as a prompt for GPs, all relevant facts could be considered.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 June 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.

  • The practice had a system in place to monitor and review families at risk with health visitors. These meetings took place weekly. There was a code on the practice’s computer system so that all clinicians were aware of there was an issue with a family.

Effective

Good

Updated 3 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were usually 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.

  • The practice had developed templates for use when prescribing certain medicines, for example oral contraception. Up to date NICE guidance was inbuilt into these templates as a prompt for GPs, all relevant facts could be considered.

Caring

Good

Updated 3 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients usually rated the practice slightly below 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 3 June 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 were able to access appointments when they were needed. We saw urgent on the day appointments were available.

  • 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 3 June 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 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.

  • Regular meetings were held for staff of all levels. Receptions staff had a short briefing twice a day and clinicians met each day at 11am for 10 minutes for a catch up.

Checks on specific services

People with long term conditions

Good

Updated 3 June 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.

  • 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. A new system was in place so that all conditions could be reviewed during the same appointment.

  • 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 3 June 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 comparable to the averages for all standard childhood immunisations.

  • Childhood immunisation appointments could be made up to 7.30pm on certain days.

  • 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.

  • 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. The practice had a system in place to monitor and review families at risk. Weekly meetings took place with health visitors so the practice was fully up to date with changes within family circumstances.

  • Uptake for the cervical screening programme was comparable to the local and national average, and appointments for cervical screening could be made up to 7.30pm on certain days.

Older people

Good

Updated 3 June 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.

  • A register of housebound patients was kept so timely visits could be made to review conditions and provide vaccinations.

  • Patients living in residential or nursing homes had individual care plans that were regularly reviewed.

Working age people (including those recently retired and students)

Good

Updated 3 June 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.

  • Patients could contact the practice by email to avoid having to telephone or call in during working hours.

  • The practice was open until 8pm two days a week to make it easier for patients who worked to access appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 June 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.

  • 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, with one being trained as a Dementia Friend.

People whose circumstances may make them vulnerable

Good

Updated 3 June 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 and 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.

  • 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.