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Archived: The Rothbury Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 16 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Rothbury Practice on 11 February 2016. Overall the practice is 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 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.
  • Patients said they found it easy to make an appointment with a named GP and that 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 they acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw some areas of outstanding practice:

  • The practice responded quickly to provide care to approximately 450 extra patients from a nearby practice, which was closed down at short notice last autumn. This represented an 8% increase in the patient list size of the practice. Both clinical and administration staff worked extra hours to ensure that all of these patients were registered quickly and that nobody was overlooked. Extra staff were recruited to ensure medical records and prescriptions were transferred correctly. The practice has managed this task without negatively impacting on the 450 patients or their existing patient population.

  • The practice provided end-of-life care, in conjunction with the local palliative care team, which had a strong, visible, person-centred approach. Patients were assigned to a named GP who oversaw their care, while another GP was assigned to offer support to family members. The practice had also developed a template to improve communication between services involved in managing the end-of-life care of their patients. We saw evidence and received feedback from patients to show that this end-of-life service was greatly appreciated.

The areas where the provider should make improvement are:

  • Provide appropriate training to staff who act as chaperones to assist them to perform this role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 May 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 16 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.
  • The practice was the lowest prescriber of antibiotics in the county in quarter two of 2015/16. They also achieved the highest uptake of influenza vaccinations among learning disability patients in the county.
  • 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 ongoing appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 May 2016

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 observed a strong patient-centred culture. We were given multiple examples by staff and patients of occasions when staff had gone out of their way to help patients in need.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • A former GP from the surgery had formed a local bereavement visiting service which was run jointly by the practice and local churches.

Responsive

Outstanding

Updated 16 May 2016

The practice is rated as good for providing responsive services.

  • The practice had responded quickly to successfully register approximately 450 patients (an 8% increase on their list size) from another surgery which had closed down at short notice. This required additional staff to be employed, as well as requiring existing staff to work extra hours to ensure patients were registered and reviewed.
  • Practice staff reviewed the needs of their local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • 100% found it easy to get through to this surgery by phone compared to a CCG average of 76.8% and a national average of 73.3%.
  • 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.
  • Services were tailored to particularly suit the rural population served by the practice. For example they offered a “complex care” clinic to remove the need for patients with long-term conditions to book multiple appointments, reducing their need to travel to the practice.
  • 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 16 May 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 this.
  • 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 knowing about 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.
Checks on specific services

People with long term conditions

Good

Updated 16 May 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.
  • Performance for diabetes related indicators was better than the CCG and national average. For example, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (1 April 2014 to 31 March 2015) was 90.2%, compared to the national average of 77.5%. IFCC-HbA1c is a test to measure blood glucose levels.
  • The practice ran a “complex clinic” to review patients with more than one diagnosis at one appointment, to save them having to visit the practice multiple times.
  • 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. 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 16 May 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 relatively high 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.
  • 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

Good

Updated 16 May 2016

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

  • 79% of the practice population is over 65 years old, with almost double the number of patients between the ages of 60 and 69 than the national average. The practice offered proactive, personalised care to meet the needs of this group.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • In the 30 months prior to March 2015 the practice had screened 69% of patients aged 60-69 for bowel cancer, (clinical commissioning group average 64.3%, national average 58.3%).
  • The practice provided their own end-of-life care in conjunction with the palliative care team.
  • The practice had a higher-than-average prevalence of cancer, due in part to the higher prevalence of cancer among older people. The practice had managed to achieve a rate of 54.3% of new cancers being treated following diagnosis via two week wait referrals (local average 44.4%, national average 48.8%).

Working age people (including those recently retired and students)

Good

Updated 16 May 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.
  • Cervical screening uptake was 83.1%, which was comparable to the national average of 81.9%.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was similar to the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (1 April 2014 to 31 March 2015) was 93.3%, compared to the national average of 89.6%.
  • 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.

People whose circumstances may make them vulnerable

Good

Updated 16 May 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, travellers and those with a learning disability.
  • The practice had achieved the highest uptake of influenza vaccinations in the county among patients with a learning disability.
  • The practice offered longer appointments for patients who needed them.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.