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Kennet and Avon Medical Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marlborough Medical Practice on 12 December 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was a clear leadership structure and staff felt supported by the partners and the management team. The practice proactively looked for improvements and acted on staff recommendations. We saw a high level of staff satisfaction and very good staff retention rate. Staff told us they were proud of the practice as a place to work. The practice also had an active patient participation group who were very engaged in the practice and supporting improvements for patients.

  • There was an open positive learning culture in the practice and a transparent approach to safety with an effective system in place for reporting and recording significant events. The practice valued opportunities to learn from any events, near misses or suggestions.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice staff we spoke to recognised that patient care was central to the ethos of the practice and told us the practice treated patients as individuals and was proactive in considering their needs and expectations.
  • The practice had taken a number of measures to engage with the local community and had been liaising with the local town council, local members of parliament and local patient representatives to promote their services explain their challenges and help meet the patient expectation and use the information sharing to help tailor and improve services.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Ensure that the governance around Controlled Drugs is improved in order to accurately record running balances; record patient returned medicines and improve the security of the key to the CD cupboard.

  • Review the location of the defibrilator.

  • Ensure that all prescriptions for repeat medicines are signed by a prescriber before the medicines are supplied to a patient.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 January 2017

The practice is rated as good for providing safe services.

  • There was an open positive learning culture in the practice and a transparent approach to safety with an effective system in place for reporting and recording significant events. The practice valued opportunities to learn from any events, near misses or suggestions.

  • 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 to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed. The practice held regular walk rounds to ensure health and safety was regular reviewed and monitored.

Effective

Good

Updated 17 January 2017

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 the national average.

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

  • Staff also used opportunities within their teams to share and cascade learning from any external courses, for example the nursing team shared updates on dressings and wound care and the GPs had access to external speakers and training and development days which they shared across the GPs.

  • Clinical audits demonstrated quality improvement.

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

  • The practice was proactive about identifying the learning needs of staff and conducted yearly appraisals supported by interim mini appraisals to support the development needs of the staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than 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 17 January 2017

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 had access to a scheme where emergency admission beds were available to older patients in local care homes supported by GPs to help reduce avoidable hospital admissions.

  • The practice made some reasonable adjustments for patients who struggled to manage their own medicines, for example, the dispensary staff were able to offer medicine compliance aides for patients who needed this type of support to take their medicines and we saw that the process for packing and checking these was safe.

  • 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 17 January 2017

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

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients.

  • The practice staff we spoke to recognised that patient care was central to the ethos of the practice and told us the practice treated patients as individuals and was proactive in considering their needs and expectations.

  • The practice had taken a number of measures to engage with the local community and had been liaising with the local town council, local members of parliament and local patient representatives to promote their services explain their challenges and help meet the patient expectation and use the information sharing to help tailor and improve services.

  • The practice proactively looked for improvements and acted on departmental recommendations. Regular meetings were held across the staff teams. We saw a high level of staff satisfaction and very good staff retention rate. Staff told us they were proud of the practice as a place to work. The practice also had an active patient participation group who were very engaged in the practice and supporting improvements for patients.

  • 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 for managing notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • There was a focus on continuous learning and improvement.

Checks on specific services

People with long term conditions

Good

Updated 17 January 2017

The practice is rated as good for the care of patients 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 were in line with the local and national averages, for example:

  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading was in the target range in the preceding 12 months (2015/16) was 94% which was better than the clinical commissioning group (CCG) average of 93% and the national average of 91%.

  • Longer appointments and home visits were available when needed.

  • The practice reviewed patients with multiple conditions and before recalling them for any review ensured their appointment was the correct length to ensure all their needs could be reviewed.

  • All patients over the age of 65 with seven or more medications on their repeat medication list are identified and included on a register. These patients are offered an extended appointment with the GP in order that their care and treatment for all conditions is reviewed and adjusted at one appointment.

  • 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 17 January 2017

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

  • 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 patients who had a high number of Accident and Emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • The practice had engaged with a local secondary school and provided information about support available, information about support groups, help for carers and emergency key rings.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice’s uptake for the cervical screening programme was 81%, which was below the CCG average of 86% and the same as the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Children could access online booking from the age of 14.

  • The community Midwife ran a weekly clinic in the practice. Six week baby checks and post-natal checks were carried out with the midwife and a GP.

  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 17 January 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice had access to a scheme where emergency admission beds were available to older patients in local care homes supported by GPs to help reduce avoidable hospital admissions. The practice team also held an annual review meeting to discuss issues and how they could support the care homes.

  • The GP held a weekly ward round for their patients in the local care homes to assess and review care needs, on occasion accompanied by a specialist in the care of the elderly.

  • The practice arranged medicine compliance aides, assisted in the completion of repeat prescription requests and offered large print labels for older patients

  • All patients in care homes and those patients outside of care homes who were identified as being at high risk of admission were included on the admissions avoidance register and had their End of Life care plan regularly reviewed with the aim to reduce the number of admissions to hospital. On receipt of a discharge notice from hospital these patients were followed up by the local care coordinator.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 17 January 2017

The practice is rated as good for the care of working-age patients (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 offered extended hours appointments from 7.30am - 8am Tuesday to Friday and 6.30pm - 7pm Monday to Thursday. Telephone consultations were also available.

  • The practice offered online appointments including repeat prescription requests, 22% of patients had signed up for this service.

  • Patients who had registered a mobile number or email address with the practice received a reminder of their appointment.

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

People experiencing poor mental health (including people with dementia)

Good

Updated 17 January 2017

The practice is rated as good for the care of patients experiencing poor mental health (including patients living 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The percentage of patients with dementia who had their care plan reviewed in the last 12 months was 87% which was in line with the local average of 88% and the national average of 84%.
  • Performance for mental health related indicators were similar or above the local and national averages, for example:
  • The percentage of patients with a serious mental health condition who had their care plan reviewed in the last 12 months (2015/16) was 95% compared to the CCG average of 92% and the national average of 88%.
  • The practice had access to local support systems for patients experiencing poor mental health and referred for support where possible. The practice worked with the community nurses and the drug and alcohol advisors and gave them priority phone access to the GPs, and held joint consultations where appropriate.
  • The practice encouraged the dispensary and reception teams to highlight any concerns to the GPs where patients may be experiencing poor mental health and had systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 17 January 2017

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

  • The patient registration policy was an inclusive policy enabling patients living in vulnerable circumstances and homeless patients of no fixed abode to register at the practice.

  • The practice offered regular health checks and 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.