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Frances Street Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 26 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frances Street Medical Centre on 6 April 2016. Overall the practice is rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had liaised with the local bail hostel whereby residents were supported to access health care at the practice within a safe environment.
  • Feedback from patients about their care was consistently positive.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, t

    he practice employed a pharmacist who reviewed patients' medications, provided advice and support to patients and staff and also promoted medicines optimisation.

  • The practice had identified the current premises were adequate and recognised they had used all of the available space. They were reviewing their existing accommodation and planning for future requirements. It was equipped to treat patients and meet their needs.  
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

  • The practice referred to the nurse who reviewed patient's in their own home as the  'iNurse'. They visited those patients unable to get to the surgery at home and performed joint consultations with GPs at the practice using video chat technology. This enabled the patient to see the GP and the GP to see the patient. We were told how this was particularly useful reviewing patient's with conditions that required visual assessment. For example, those with skin rashes.

  • The practice had liaised with the local bail hostel whereby residents were supported to access health care at the practice within a safe environment.
  • The practice employed a clinical pharmacist who supported staff at the practice through review of medicines prescribed, promoting best practice and providing advice for prescribing.  Patients were also able to book appointments with the clinical pharmacist for advice and support how to take their medicines and all patients taking multiple medicines were regularly reviewed and on the day following discharge from hospital.
  • The patient participation group liaised with staff to schedule regular

    a programme of patient engagement events where practice staff and external speakers facilitated educational events for patients and people from the local community. Each year the PPG would meet and arrange the programme of events for the forthcoming year. Topics included living with alzhiemer's, an introduction to yoga, living with diabetes, bowel cancer screening, dementia primary care liaison nurse, overview of the wellbeing centre, services for patients who fall and minor illness advice from the local chemist. Patients told us they enjoyed the sessions and found them very informative and people travelled from other areas to attend.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 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 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 26 May 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients. All patients diagnosed with an irregular heart beat were taking blood thinning medicines.
  • There had been 27 clinical audits completed in the last two years, 14 of these were completed audits where the improvements made were implemented and monitored.
  • Data showed that the practice was performing highly when compared to practices nationally.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.  The practice employed a clinical pharmacist who would review patients taking many medicines or those medicines highlighted through safety alerts.
  • The practice also employed a counsellor who offered patients talking therapies and support to make healthy life choices.

Caring

Good

Updated 26 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 26 May 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.  

    The practice had liaised with the local bail hostel whereby residents were supported to access health care at the practice within a safe environment.

  • There are innovative approaches to providing integrated patient-centred care. The iNurse visited those patient's unable to get to the surgery at home and performed joint consultations with GPs at the practice using video chat technology. This enabled the patient to see the GP and the GP to see the patient. We were told how this was particularly useful reviewing patient's with conditions that required visual assessment. For example, those with skin rashes.

  • 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 they had reviewed access to same day appointments and introduced a practice nurse triage system.
  • Patients can access appointments and services in a way and at a time that suits them.
  • The practice had good facilities and was 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.
  • The patient participation group liaised with staff to schedule a regular programme of patient engagement events where practice staff and external speakers facilitated educational events for patients and people from the local community. Each year the PPG would meet and arrange the programme of events for the forthcoming year. Topics included living with alzhiemer's, an introduction to yoga, living with diabetes, bowel cancer screening, dementia primary care liaison nurse, overview of the wellbeing centre, services for patients who fall and minor illness advice from the local chemist. Patients told us they enjoyed the sessions and found them very informative and people travelled from other areas to attend.

Well-led

Outstanding

Updated 26 May 2016

The practice is rated as outstanding 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 it.
  • The partners were proactive rather than reactive and were exploring opportunities to improve services and outcomes for patients. There was a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money. 
  • Staff we spoke with told us there was a commitment to developing staff in any area which might have a benefit to patients. For example administrative apprentices were supported to develop their skills which led to permanent employment at the practice leading on to further training in management vocational qualifications.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity.
  • 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 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.
  • The practice offered placements for student nurses, medical students and national vocational qualification students to develop the future workforce and interest them in GP practice.  
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Outstanding

Updated 26 May 2016

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

  • Practice nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.  The iNurse would visit those patients who could not get to the practice at home.
  • The pharmacist would review patient's medicines to ensure they were receiving the most appropriate for their conditions and also offer appointments with patients to provide advice about their medicines and when best to take them.
  • Performance for diabetes related indicators was 100% which was 4% above the CCG average and 11% above the national average.

  • 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, clinical pharmacist and practice nursing staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.  

Families, children and young people

Good

Updated 26 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 accident and emergency 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.
  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average and the national average of 82%.

  • 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 26 May 2016

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

  • All of these patients had a named GP.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 26 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 May 2016

The practice is rated as 

good for the care of people experiencing poor mental health (including people with dementia).

  • 74% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%.

  • Of those experiencing poor mental health 97% had a comprehensive care plan in place which is above the national average of 88%.

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients living 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 those living with dementia.
  • A cousellor offered talking therapies and support to patient's to make healthy choices.
  • Patients with mental health conditions medicines were regularly reviewed by the clinical pharmacist and they received support and advice how to take their medicines. This supported patient's to reduce their dependency on some medicines.

People whose circumstances may make them vulnerable

Outstanding

Updated 26 May 2016

The practice is rated as outstanding for the care of people who 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 offered longer appointments for patients those who needed them.
  • The practice had liaised with the local bail hostel whereby residents were supported to access health care at the practice within a safe environment.
  • 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.
  • A cousellor offered talking therapies and support to patient's to make healthy choices.
  • The practice offered walk-in appointments for named patient's who benefited from being seen on request.