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The Elizabeth Courtauld Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Elizabeth Courtauld Partnership on 20 October 2015.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive, and well led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, and people experiencing poor mental health (including people with dementia).

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

  • Staff knew and carried out their duty to raise concerns, and to report safety incidents. Information about safety was recorded, monitored, and appropriately reviewed to identify trends or recurring themes.

  • Risks to patients were also assessed, well managed and reviewed to identify any trends or recurring themes.

  • Patients’ needs were considered and care was planned and provided in a way that reflected both best practice and recommended current clinical guidance.

  • Staff had received the necessary training appropriate for their roles and further training had been encouraged, recognised and planned for through the practice appraisal system.

  • Patients told us they were treated well with consideration, dignity and respect and they were involved in their care and decisions about their treatment. Some patients we spoke with on the day did tell us they had problems getting through on the phone.

  • Information regarding how to complain about the practice was available to patients and easy to understand.

  • The practice staff members had received training regarding safeguarding children and vulnerable adults and knew who to contact with any concerns.

  • The practice was adequately equipped to treat patients and meet their requirements.

  • The practice had a well-established Patient Participation Group (PPG) that supported the practice with their opinions regarding suggestions for practice changes.

  • There was a well-defined leadership structure and all the staff members we spoke with told us they felt supported in their working roles.

We saw two areas of outstanding practice:

  • The practice healthcare assistant (HCA) provided a free GP referred nail clipping service for patients. The practice had investigated the need and the alternative local service was expensive for many older people.

  • One of the GPs at the practice has undertaken further training in substance misuse, and provided a service for patients with this need in the practice. Patients were assessed and stabilised on treatment by the substance misuse teams at secondary care (hospital), then care was transferred to the practice. The GP with further training continued to monitor, screen urine and prescribe for these patients. This avoided them having to undertake the long journeys by public transport to secondary care services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their duty to raise concerns, and to report safety incidents. Information about safety was recorded, monitored and considered. Lessons learnt from safety incidents were communicated to staff during practice meetings to support improvement. Patients and staff told us they thought there was enough staff working at the practice to help keep people safe.

Medicine management checks and safety risks assessments were performed to ensure patients and staff were safe. These checks and assessments were also reviewed to identify any trends or recurrent themes. Infection control procedures were completed to a satisfactory standard and documented.  Staff had received infection control update training and the policy for staff guidance was up to date, followed current local, and national guidelines and legislations. The practice fire equipment was appropriate and fire drills were carried out regularly to ensure staff knew how to act and keep people safe in the event of a fire.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were above average in most cases and/or comparable with those in their local area. Staff referred to guidance from the National Institute for Health and Care Excellence and showed they used it routinely when interviewed. Patients’ health and psychological needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity to understand and manage their treatment and to promote good health. Both clinical and non-clinical audit was used to identify areas for clinical improvement.

Staff had received appropriate training to carry out their roles. Training was identified, planned and evidenced in staff records with their appraisal documentation and personal development documents.

We found staff worked with multidisciplinary teams.

Caring

Good

Updated 21 January 2016

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for most aspects of care. Patients told us they were treated with compassion, dignity and respect and involved with their care and treatment. Information about the services available for patients was easy to understand and accessible in the waiting room.

We also saw that staff treated patients with kindness and respect, and maintained their confidentiality within the reception area. This was achieved by asking patients to queue and not approach the reception desk until they were called forward by the receptionists. Patient reviews about the practice, on the NHS choices website,

were positive in regards to the caring aspects of patient care.

Responsive

Good

Updated 21 January 2016

The practice is rated as good for responsive services. Patients from the practice patient participation group (PPG) told us improvements in the appointments system over the last two years had improved access to an appointment with a named GP, this enabled continuity of care. Urgent appointments were also available on the same day they were requested. The practice had adequate facilities and was suitably equipped to treat patients and could meet their needs.

Information about how to complain was available, and the practice responded in line with the timescales quoted in their policy when issues were raised. Learning from complaints was shared with staff during practice meetings.

The practice reviewed the needs of its local population and engaged with the Clinical Commissioning Group (CCG) monthly to secure improvements to services when these were identified. One of the senior partners at the practice was the CCG clinical lead. A CCG is a group of General Practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Well-led

Good

Updated 21 January 2016

The practice is rated as good for being well-led. It had a clear vision and strategy and staff knew their duties in regard to it. There was a clear leadership structure and staff told us they felt supported both by management and the GPs. The practice had a number of policies and procedures to govern activities at the practice. We found these had been regularly reviewed and were in line with local and national guidance and legislation.

There were assessment systems in place to monitor and identify patients’ and staff members’ potential risks. The practice sought feedback from staff members during appraisals and meetings, which it acted on. Staff had received inductions, regular performance reviews during their appraisals, had attended staff meetings, and training.

Checks on specific services

People with long term conditions

Good

Updated 21 January 2016

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

Patients with a long-term condition and those at risk of a hospital admission were identified and provided with longer appointments or home visits when needed. The practice employed two nurses with additional skills in the management of long term conditions (LTC) for asthma, chronic obstructive pulmonary disease (COPD), and diabetes. The two practice nurse practitioners provided minor illness clinics which allowed the GPs to devote more time and appointments to the review and management of long term conditions. Each GP had an individual responsibility for a different LTC. All patients with a long term condition had a named GP and a structured annual review to check their health and medicine requirements were met. The practice nurses and healthcare assistants also hold clinics for this population group to address on-going monitoring of their condition(s) and lifestyle advice.

For those people with more complex needs, the named GP worked with relevant health and care professionals for example community and hospital care to deliver a multidisciplinary care package.

The practice provided patient education as a fundamental part of LTC management and hosted events which were well attended by patients.

Those patients on the palliative care register in need of care were discussed at the monthly multidisciplinary team meetings.

Families, children and young people

Good

Updated 21 January 2016

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

Immunisation rates were high for the standard childhood immunisations and HPV vaccine for teenage girls in comparison with other practices in the local area. Children at risk, for example, children and young people who had a high number of A&E attendances were followed up. On a monthly basis at the GP partnership meetings, they discussed families with safeguarding issues. The GP who knew the child/ family best would attend safeguarding meetings when possible and always provided reports where necessary for other agencies.

GPs work closely with the ‘families and schools together’ (FAST) team based in local primary schools who accept referrals from the practice. The practice also referred young people to a counselling service for teenagers aged 12 to18. Reception staff members were aware of the practice policy in respect of children who attended the surgery alone. They were provided with an appointment in a timely manner. The GP would assess the patient using ‘Gillick’ competence, before carrying out any consultation or treatment. Gillick competency test is used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

Appointments were available outside school hours for families with school age children and young people. Family Planning and sexual health requirements were led by a specialist nurse who provided for a full range of contraceptive services, including coil fitting, nexplanon fitting and other common long acting forms of contraception and emergency contraception. The practice told us their policy for confidentiality and discretion was delivered in a non-judgemental approach to make the younger population feel comfortable to use our services. This provision of care was particularly beneficial for the large student population that accessed the service.

The practice worked closely with midwives, and health visitors. They provided antenatal checks and support for mothers during pregnancy, with baby checks and post-natal checks after confinement. The practice also provided family planning services, sign-posted young people towards sexual health clinics, chlamydia, and sexually transmitted disease (STD) screening.

Older people

Good

Updated 21 January 2016

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

Nationally reported data showed that outcomes for patients were above those nationally for conditions commonly found in older people.

The practice offered proactive, personalised care to meet the needs of the older people in the practice population. They provided a range of services, for example; senior health checks, bespoke care plans as part of the admission avoidance enhanced service for people at risk of an unplanned hospital admission. Once a month the practice held a multi-disciplinary meeting (MDT) meeting with GPs, district nurses and the local social work team to discuss patients who had been identified to be at high risk of hospital admission. Weekly MDT meetings with GPs and district nurses were held to discuss older people’s caring needs. The GPs at the practice told us this collaborative work reduced hospital admissions and home visits, although keeping them informed and able to continue monitoring care and treatment.

The practice had made structural changes to provide easy accessibility for people from this population group for example, additional parking spaces, a lift, wheelchair access, hearing loops, and accessible doors and toilets.

The practice had provided a named GP for all patients in this population group, and the healthcare assistant (HCA) provided a free GP referred nail clipping service for patients. The practice had investigated the need and found the alternative local was expensive for many older people. They offered older people home visits, and urgent appointments to meet their needs. The maintenance of a frailty register and use of the template available on the computer medical records system alerted clinicians at the practice to the needs of frail patients.

The practice nurse practitioners regularly visited patients at home and in the four care homes looked after by the practice, to deal with day to day issues in a timely fashion before they developed into more serious problems. The GPs at the practice visited the local Community Hospital twice a day to treat and prescribe for the in-patients referred to the ward staying in the community led beds. They visited and treated all the patients in the community led beds including those registered at other GP practices.

Working age people (including those recently retired and students)

Good

Updated 21 January 2016

The practice is rated as good for providing services to 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 offered. Extended hours appointments were provided by GPs on Monday’s, along with minor ailment clinics held by Nurse practitioners and various long term condition clinics for example; Asthma, COPD, and Diabetes that followed normal surgery opening hours from 6.30 pm through to 8.30 pm.

Telephone appointments were available to allow easy access to and avoid unnecessary waiting. The practice offered online appointments and prescriptions as well as a full range of health promotion, screening, and health checks that reflected this population group’s needs. The practice also had online ‘Twitter feed’, an ‘eForum’ and ‘SystmOnline’ to cater for patients who preferred to access information online or outside of working hours.

Patients over 40 years of age are invited to a free health check, to prevent the risk of undetected hypertension, ischemic heart disease and diabetes. We were told during these checks clinicians gave advice on healthy eating and exercise related topics.

Lifestyle changes, such as smoking cessation clinics, and healthy living clinics provided patients advice regarding cholesterol level and weight management

People experiencing poor mental health (including people with dementia)

Good

Updated 21 January 2016

The practice is rated as good for providing services to people experiencing poor mental health (including people with dementia).

Analysis of data we held showed the percentage of patients experiencing poor mental health at the practice had received a comprehensive agreed care plan; this was 12% higher than the local and national averages within the 2013-2014 data we held. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice sign-posted patients experiencing poor mental health to access various support groups and voluntary organisations which included cognitive behaviour therapy, crisis intervention, a be-friending service and the drug and alcohol team. Patients were directed to local charities, including ‘MIND’ and ‘CRUSE’, to provide more support.

One of the GP’s at the practice has undertaken further training in substance misuse, and provided a service for patients with this need in the practice. Patients were assessed and stabilised on treatment by the substance misuse teams at secondary care (hospital), then care was transferred to the practice. The GP with further training continued to monitor, screen urine and prescribe for these patients. This avoided them having to undertake the long journeys by public transport to secondary care services.

The practice told us they had above average number of older patients which resulted in them having an above average number of patients with dementia. They screened patients for dementia using recognised clinical tools, and used a template on their surgery computer system for consistency. Patients with suspected dementia had screening blood tests and an electrocardiogram before being referred to the memory clinic at the hospital to confirm the diagnosis.

The practice looked after four residential care homes and one nursing home, with a total population of 229 patients. The majority of the residents had a diagnosis of dementia. Each home was allocated an individual practice GP, who visited regularly to provide continuity of care. A full review of these patients was carried out every six months.

The practice hosted ‘Alzheimers.org’ who provided one to one support to carers of dementia patients. They recognised that caring for people with dementia could be very demanding, and was often undertaken by people who were elderly and not in the best health. The practice understood that these carers required support from the practice and other organisations.

Patients in this population group who had attended accident and emergency (A&E) where they may have been experiencing poor mental health were followed up.

People whose circumstances may make them vulnerable

Good

Updated 21 January 2016

The practice is rated as good for providing services to people whose circumstances may make them vulnerable.

The practice held registers of patients living in vulnerable circumstances including those living with a learning disability (LD), and living in residential care. They carried out annual health reviews for patients with a learning disability and all of these patients had received a follow-up when we checked the 2013-2014 data available to us. They also provided day to day medical care with longer appointments, and liaised appropriately with LD specialist services.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. Signposting to third sector groups and organisations to access various support as element of their care.

All staff had received training in and knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff knew who the safeguarding lead was at the practice and who to contact with any concerns.