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Inspection Summary


Overall summary & rating

Good

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brig Royd Surgery on 27 October 2015.

While overall the practice is rated as good for providing safe, effective, caring, and well led care for all the population groups it serves, we found the practice was outstanding in its responsiveness to the needs of it practice patient population.  In particular we found that it care and responsiveness to the needs of patients who had mental health problems was also outstanding.

Our key findings were as follows:

  • Patients said they found it easy to make an appointment with a preferred GP, there was continuity of care and urgent appointments were available the same day.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

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

  • Information about services and how to complain was available and easy to understand. Complaints were addressed in a timely manner and the practice endeavoured to resolve complaints to a satisfactory conclusion.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients.

  • Risks to patients were assessed and well managed.

  • The practice had a number of policies and procedures in place and held regular governance meetings.

We saw some areas of outstanding practice:

  • The practice had developed an educational website which acted as a resource for their own practice as well as other practices in the area, nationally and internationally.

  • The practice recognised that patients experiencing poor mental health may find it difficult to remember appointment times and dates, and therefore allowed this group of patients to attend as walk-in patients, regardless of the urgency of need. 

  • Patient survey results about the quality and access to the service were very positive and significantly better than other practices. 

  • The practice had an active patient reference group(PRG) and one of their initiatives had been about helping and underlining the importance of screening for patients.  The PRG provided written information to help patients understand the significance of screening tests such as bowel cancer screening. Other initiatives are planned, for example, the development of a ‘You Tube’ video explaining the significance and use of spirometry equipment. Spirometry is a test used to diagnose and monitor certain lung conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 February 2016

The practice is rated as good for providing safe services. There were enough staff to keep patients safe. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Lessons were learned and communicated to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were effective processes in place for safe medicines management.

Effective

Good

Updated 11 February 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. There was evidence of annual appraisals and staff had received training appropriate to their roles. We saw evidence of effective multidisciplinary team working

Caring

Good

Updated 11 February 2016

The practice is rated as good for providing caring services. Data showed patients rated the practice higher than others for several aspects of their care. Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. Care planning templates were being developed and their use extended for staff to use during consultation. Information to help patients understand the services was available and easy to understand. We saw staff treated patients with kindness, respect and maintained confidentiality.

Responsive

Outstanding

Updated 11 February 2016

The practice is rated as outstanding for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Calderdale Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found it easy to make an appointment with a preferred GP, there was continuity of care and urgent appointments were readily available the same day. The practice had sought advice from Calderdale Disability Partnership in planning facilities and services for the practice. Feedback was sought from patients on a daily basis by use of a complaints/comments book in the reception area as well as a comments box.  A separate list of appointments was made available each day for both morning and afternoon sessions to deal with urgent cases. Every day a GP and practice nurse acted as ‘on call’ to deal with urgent cases. Patients who were experiencing mental health difficulties were able to access non-urgent appointments on the day as it was recognised that this group of patients may find it difficult to remember appointment times and dates. Patients who had been identified as at a higher likelihood of failing to attend their appointment were given appointments at the end of the session to make more effective use of clinician’s time. The practice told us they would endeavour to see any patient who arrived at the wrong time for their appointment, particularly if they were felt to be vulnerable.  Information about how to complain was available both in the practice and on the website. Learning from complaints was shared with staff. The practice had responded to several issues raised by the patient reference group (PRG) and other patient feedback.

Well-led

Good

Updated 11 February 2016

The practice is rated as good for being well-led. It had a vision and strategy and staff  were clear about their roles and responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures in place and held regular practice meetings. There were systems in place to monitor and improve quality and identify risk. Staff received induction, regular performance reviews and attended staff meetings. The practice proactively sought feedback from patients and staff which it acted upon. There was an active patient reference group (PRG).

Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

The practice is rated as good for the care of people with long term conditions. The practice had a nurse led approach to long term conditions, supported by the GPs. There were structured annual reviews in place to check the health and medication needs of patients were being met. Longer appointments and home visits were available when needed. Staff worked with relevant health and social care professionals to deliver a multidisciplinary package of care. For example patients could be referred to a single point of contact service where provision of aids and adaptations or assessment for social support was provided.

Families, children and young people

Good

Updated 11 February 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 who were subject to a safeguarding plan. The practice provided sexual health support and contraception, maternity services and childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. A private room for breastfeeding mothers and baby changing facilities were provided.

Older people

Good

Updated 11 February 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. All patients over 75 years of age had a named GP and were offered an annual health check. The practice was responsive to the needs of older people, offering home visits and longer appointments. The practice worked closely with other health care professionals, such as the district nursing team and community matron to ensure housebound patients received the care they needed. Before we visited we sought feedback from the nursing home which had strong links with the practice  and they told us they were very happy with the service provided by the practice to their residents

Working age people (including those recently retired and students)

Good

Updated 11 February 2016

The practice is rated as good for the care of working age people (including those recently retired and students). The practice had extended hours, including pre-bookable late night appointments one day a week. The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. For example, smoking cessation services and cervical screening was provided.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 11 February 2016

The practice is rated as outstanding for the care of people experiencing poor mental health, including people with dementia. Dementia screening tools were routinely used and referrals made to appropriate services as necessary. The practice offered annual health reviews, longer appointments and home visits as needed for patients experiencing poor mental health or dementia. The practice recognised that patients with certain mental health conditions might find it difficult to remember appointment times and dates and therefore allowed this group of patients to walk in and request an appointment when needed, on the day, regardless of the urgency of medical need. Quality Outcomes Framework ( QOF) data showed performance for mental health indicators was 100% which was higher than CCG and national averages which were 96.3% and 92.8% respectively.

People whose circumstances may make them vulnerable

Good

Updated 11 February 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 those with a learning disability. It carried out annual health checks and offered longer appointments for people with a learning disability.

Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.