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Woodlands Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 22 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodlands Medical Practice on 13 October 2016. Overall the practice is rated as outstanding.

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

  • There was an effective system in place for reporting and recording significant events and learning was shared with all staff in meetings.

  • Risks to patients were assessed and well managed.

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

  • Patient survey figures were consistently above average when compared with CCG and national averages.

  • Comments about the practice and staff were wholly positive.

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

  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

  • 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. We saw this to be the case on the day of inspection.

  • 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.

  • The practice offered extended hours so that appointments could be made up from 7.15am on a Tuesday and Friday morning for patients that worked and could not attend during normal opening hours. These appointments were reserved for working patients but were released to the other patients if they had not been booked the day before.

  • Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons. The practice had a log of the alerts received which showed the title of the alert and the members of staff that it had been passed to. It also showed actions taken, for example searches on records and patients contacted were necessary.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. 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.

  • There was a comprehensive understanding of the performance of the practice and individuals within the team.

We saw areas of outstanding practice including

  • The practice took the care of vulnerable people seriously. For example, patients with learning disabilities were managed alongside the primary care liaison nurse for learning disabilities. The practice was proactive in identifying patients including those that reached the eligible age to be an adult with a learning disability. Over 90% of eligible health checks were completed which was achieved by sending pictorial leaflets to patients explaining the health check and liaison with the primary care liaison nurse regarding non attenders or non responders. Carers were supported in the practice. The practice had a carers champion and the practice had had identified 471 patients as carers (4.9% of the practice list). The practice computer system also alerted staff if patients had a carer. The practice had 371 patients that had been identified as having a carer (3.8% of the practice list). These patients would be contacted by the carers champion to see what support could be offered. The practice contacted external agencies to assist with supporting carers for example for families of palliative patients at times to arrange services such as night sitting to alleviate the pressures of carers and had received an award in 2016 from the CCG for going the extra mile.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 December 2016

The practice is rated as good for providing safe services

  • There was an effective system in place for reporting and recording significant events and learning was shared with all staff in meetings.

  • Action was taken to improve safety in the practice and new processes and policies implemented.

  • 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 22 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average and had been maintained for 12 years.

  • The practice used guidelines to positively influence and improve practice and outcomes for patients. For example, bespoke clinical templates were designed to support the clinical staff to provide more hands on care using both local, national guidelines and to reflect the practices own processes and procedures.

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvements and staff were actively engaged in monitoring and improving patient outcomes as a result. In addition batch audits were regularly maintained to missed opportunities

  • 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

Outstanding

Updated 22 December 2016

The practice is rated as outstanding for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care.

  • 90% of patients were able to get an appointment to see or speak to someone the last time they tried compared to the CCG average of 84% and the national average of 85%.

  • 94% of patients described the overall experience of this GP practice as good compared to the CCG average of 85% and the national average of 85%.

  • 95% of patients said they would recommend this GP practice to someone who has just moved to the local area compared to the CCG average of 75% and the national average of 78%.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. We saw several examples of person centred care provided from administrative staff and clinicians.

  • The practice had identified 471 patients as carers (4.9% of the practice list). The practice computer system also alerted staff if patients had a carer. The practice had 371 patients that had been identified as having a carer (3.8% of the practice list).

  • Views of external stakeholders were very positive and aligned with our findings. For example from external agencies, residential care home and multidisciplinary teams.

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

  • Patients said that staff go the extra mile and one staff member had been won an award for going the extra mile from the CCG.

  • Relationships with patients were strong, caring and supportive.

Responsive

Good

Updated 22 December 2016

The practice is rated as good for providing responsive services.

  • The practice was a designated C-Card collection point (collection of condoms for ages 13-24). This meant that patients registered for this service could call into the practice to collect condoms.

  • There were innovative approaches to providing integrated patient-centred care. The practice had services that prevented patients been referred to secondary care such as an ear care programme including an aural toilet service and audiology (hearing tests), D-Dimer near patient testing was provided at the practice. (Near patient D-dimer test is a test available for use in GP practices which saves time and money to identify deep vein thrombosis (DVT) and pulmonary embolism (PE)).

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group for example the practice had implemented flu clinics on a Saturday morning.

  • Patients could access appointments and services in a way and at a time that suits them. The practice offered extended hours so that appointments could be made from 7.15am on a Tuesday and Friday morning for patients that worked and could not attend during normal opening hours.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 22 December 2016

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

  • High standards were promoted and owned by all practice staff and teams working together across all roles.

  • There was an overarching governance framework which supported the delivery of the high-quality person-centred care. Arrangements were in place to monitor and improve quality and identify risk.

  • There was a comprehensive understanding of the performance of the practice and individuals within the team.

  • There was a proactive approach to succession planning in the practice. The practice was a training practice and part of the future planning was to ‘grow their own’ which was already evident as one of the salaried partners had originally` joined the practice as a trainee.

  • The practice proactively sought feedback from staff and patients, which it acted on. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The patient participation group was very active.

  • 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 knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • There was a strong focus on continuous learning and improvement at all levels, this was demonstrated through internal meetings held to improve the quality of service provided.
Checks on specific services

People with long term conditions

Outstanding

Updated 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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 better compared to the national and CCG average. (100% compared to 82% CCG average and 89% national average).

  • Longer appointments and home visits were available when needed.

  • All 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.

  • The practice had initiated insulin treatment in six type two diabetic patients over the past two years, this prevented referral to secondary care.

Families, children and young people

Outstanding

Updated 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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. Children that had attended A&E three times or had not attended appointments with secondary care were flagged to the safeguarding lead.

  • Immunisation rates were above CCG averages 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, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 92%, which was above the CCG average of 85% and the national average of 81%.

  • The practice was the highest performer in the CCG for cervical and breast screening as of December 2015.

  • The practice along with some female members of the PPG had hosted an event one evening in the practice in 2015 to encourage patients to attend for cervical screening. This event also gave demonstrations on how check their own breasts.

  • 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.

Older people

Outstanding

Updated 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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.

  • Each care home was linked to a named GP to enable continuity of care and to build relationships with the care home and the patients.

  • Named GP leads did weekly ward rounds of the care homes and also attended for home visits when required.

Working age people (including those recently retired and students)

Outstanding

Updated 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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.

  • Telephone consultations were available and had been increased to meet demand.

  • The practice offered extended hours so that appointments could be made from 7.15am on a Tuesday and Friday morning for patients that worked and could not attend during normal opening hours. These appointments were reserved for working patients but were released to the other patients if they had not been booked the day before.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 83% and the national average of 84%.

  • 100% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was above the CCG average of 85% and the national average of 89%.

  • The practice held registers of patients experiencing poor mental health and ensured that these patients had a review each year.

  • 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 when 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 22 December 2016

The practice was rated as outstanding for caring and well led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability ensured that these patients had a review each year.

  • The practice worked alongside the primary care liaison nurse for learning disabilities. The practice was proactive in identifying in maintaining a current register of these patients. Health checks for these patients were completed in the environment best suited for the patient which could be the patient’s home or a day centre if the practice was not suitable.

  • Vulnerable patients at risk of safeguarding were recorded on a register so that these were discussed at meetings with other health care professionals in the case management of vulnerable patients. The practice maintained a list that ensured the patients were discussed until there were no concerns.

  • 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.