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Archived: Hasland Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 7 April 2016

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Hasland Medical Centre on 25 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, and we saw evidence that learning was applied from events to enhance patient care and safety.
  • There was a clear leadership structure and staff felt supported by management. The partners and practice manager worked collaboratively with other local GP practices and made an active contribution to Clinical Commissioning Group (CCG) workstreams.
  • 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, and clinicians had lead areas of responsibility.
  • Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Most patients said they found it easy to make an appointment with a GP, and usually this was with a GP of their choice. Routine appointments could usually be booked within one week, and demand for appointments was actively monitored so that additional consultations could be made available in periods of high demand. Urgent appointments were available the same day.
  • The practice used clinical audits to review patient care and took action to improve services as a result.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
  • The practice had an active Patient Participation Group (PPG) and worked with them to review and improve services for patients.
  • The practice made changes to the way it delivered services as a consequence of feedback from patients. For example, further to comments made on the NHS Choices website regarding telephone access, an additional phone line had been installed.
  • Information about services and how to complain was available and easy to understand.

We saw three areas of outstanding practice:

  • The practice reviewed all deaths to ensure care had been delivered appropriately and to consider any learning points. This included sharing learning with other providers including care homes. For example, if the patient had remained in their preferred place of care; if medicines had been prescribed to anticipate coping with pain at short notice; and checking if follow-up bereavement support been offered.

  • The practice had adapted a computer template used for childhood vaccinations to ensure this could not be accessed until the child reached the required age for the immunisation. This prevented vaccinations being administered too early, and had been implemented as a learning point from a significant event.
  • The practice had ensured the requirements of vulnerable patients had been fully assessed and adapted to meet their individual needs comprehensively. For example, all patients with a learning disability had received an annual health check, and had a personal care plan in place. The practice provided information in a format that patients with a learning disability would understand such as letters with picture prompts, and a DVD aimed to help them to understand the cervical screening process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 April 2016

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure actions were taken to improve safety in the practice. For example, adapting an electronic template for use when administering childhood immunisations so that it could only be accessed when a child was eight weeks old. This helped to prevent vaccinations being given too early.

  • When there were unintended or unexpected safety incidents, people received support and were provided with an explanation and an 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 people safe and safeguarded from abuse.

  • The practice had effective recruitment procedures to ensure all staff had the skills and qualifications to perform their roles, and had received appropriate pre-employment checks.

  • Risks to patients and the public were assessed and well-managed including procedures for infection control and other site-related health and safety matters. Risks to vulnerable patients with complex needs were monitored by multi-disciplinary team meetings to provide holistic care and regular review.

  • Medicines, including vaccines and emergency drugs, were stored safely and appropriately with good systems to monitor and control stock levels.

  • The practice had effective systems in place to deal with medical emergencies.

  • The practice ensured staffing levels were sufficient at all times to respond effectively to patients’ needs.

Effective

Good

Updated 7 April 2016

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

  • Data showed patient outcomes were at or above average for the locality. The practice had achieved an overall figure of 96.4% for the Quality and Outcomes Framework 2014-15. This was 1.7% below the CCG average and 2.9% above the national average.

  • The partners monitored patient outcomes and proactively addressed any shortfalls. For example, outcomes achieved for foot screening in patients with diabetes had improved by approximately 8%, after this had been identified as an area for improvement.

  • Clinical audits demonstrated quality improvement, and we saw examples of full cycle audits that had led to improvements in patient care and treatment.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. GPs had specific areas of interest including diabetes and chronic obstructive pulmonary disease, and acted as a resource for their colleagues.

  • All staff had role specific inductions, and had received a performance review in the last 12 months which included an analysis of their training needs.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs, in order to deliver care more effectively.

Caring

Good

Updated 7 April 2016

  • Data showed that patients generally rated the practice above the local and national averages in respect of care. For example, 98% said the GP was good at giving them enough time compared to the CCG average of 90% and the national average of 87%.

  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.

  • The practice adopted a flexible approach in dealing with vulnerable patients to ensure their individual needs were accounted for. This included reminding patients about their appointment, and ensuring the allocated appointment time was suitable.

  • A member of the reception team had been assigned as the practice carer’s lead.

  • We observed that staff treated patients with kindness and respect, and maintained confidentiality. We were given examples of where staff had undertaken additional duties to ensure patients were cared for including delivering prescriptions to the pharmacy to ensure patients received their medicines as soon as possible.

  • Views of community based health staff and care home managers were extremely positive with regards the level of care provided by the practice team.

Responsive

Good

Updated 7 April 2016

  • The partners and practice manager reviewed the needs of their local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice had submitted a successful bid to refurbish its premises and provide an additional treatment room for patient care.

  • The practice implemented improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, an additional telephone line had been installed further to comments regarding telephone access.

  • Routine GP appointments were usually available within five working days, and urgent appointments were available on the day. The practice offered an extended hours surgery every Monday evening until 8pm. Patients could book a routine appointment up to four weeks in advance. Access was closely monitored and additional GP and nurse practitioner sessions would be organised when demand was high.

  • Comment cards and patients we spoke to during the inspection were generally positive about their experience in obtaining a routine appointment. This was reinforced by the national GP survey in January 2016 which found 82% patients described their experience of making an appointment as good. This was in comparison to a CCG average of 77% and a national average of 73%

  • The premises provided modern and clean facilities and were well-equipped to treat patients and meet their needs. The practice accommodated the needs of patients with disabilities, including access via automatic doors and the availability of a hearing loop.

  • The practice hosted other services including a weekly Citizen’s Advice session, a hearing assessment clinic, and a wellbeing worker to promote healthy lifestyles.

  • Information about how to complain was available and the practice responded quickly when issues were raised. Learning from complaints was shared with staff to improve the quality of service.
  • If patients at reception wished to talk confidentially, or became distressed, they were offered a private room, or moved into a quiet corridor away from the waiting area.
  • Clinicians spoke Hindi, Urdu, Punjabi, Welsh and French, and translation services were available to assist other patients whose first language was not English.

Well-led

Good

Updated 7 April 2016

  • The partners had a clear vision and strategy to deliver high quality care and promote good outcomes for patients, and this was supported by a comprehensive business plan. Staff were clear about the vision and their responsibilities in relation to this.

  • 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 partners contributed to the wider CCG agenda, and both partners had a lead clinical role within their CCG. The partners had identified a gap in local provision for patients with lymphoedema. This resulted in a local service being re-commissioned by their CCG to enhance patient care and experience.

  • The practice team worked collaboratively with other local practices to share resources and plan future developments.

  • The partners reviewed comparative data and ensured actions were implemented to address any areas of outlying performance.

  • There was a clear leadership structure and staff felt supported by management. The practice had a range of policies and procedures to govern activity and held regular staff meetings.

  • The practice sought feedback from patients and staff, which it acted on to improve service delivery.

  • The PPG was active and helped inform practice developments, for example, the installation of a rope barrier at the reception desk to improve patient confidentiality.

Checks on specific services

People with long term conditions

Good

Updated 7 April 2016

  • All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

  • A recall system ranging from six to 12 months was in place to ensure patients received a regular review of their condition. This included reviews being done on home visits by the practice nurse.

  • The practice had a low prevalence for long-term conditions due to the lower percentage of registered older people. The exception was asthma, which was slightly higher than local and national figures due to the higher proportion of younger patients at the practice.

  • QOF indicators for asthma were higher than CCG and national averages. For example, 73.4% of patients with asthma received a review in the preceding 12 months, compared to the CCG average of 66.2% and the national average of 69.7%. This was achieved with a lower rate of exception reporting.

  • The achievement for QOF indicators related to the management of diabetes at 93% was in-between local and national averages (96.7% and 89.2% respectively). The practice had established a pre-diabetes register, and routinely tested bloods for patients with a long-term condition to assess any risks of them developing the disease. This enabled patients to be directed to support to reduce the risk of them going on to develop diabetes.

  • Patients with diabetes were referred into the ‘Diabetes and You Programme’ to provide patients with advice and education to help manage their condition.

  • The GP partners had lead clinical roles for the CCG for patients with diabetes and breathing problems. This facilitated collaborative working and being kept updated on local and national developments.

Families, children and young people

Good

Updated 7 April 2016

  • The practice had a higher percentage of patients within this population group compared with local averages. For example, 23% of patients were under 18 (CCG average 18%).

  • Urgent appointments were available on the day to accommodate ill children.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Monthly liaison meetings were in place between the practice and the midwife and health visitor to discuss any child safeguarding concerns.

  • Immunisation rates were high for all standard childhood immunisations. For example, vaccination rates for children ranged from 96.9% to 100%, compared against a CCG average ranging from 95.2% to 99.1%. The practice achieved 100% vaccination rates in ten of the 15 immunisation categories for two and five year olds.

  • The practice referred children and young people into an age-specific counselling service. This helped younger people manage traumatic experiences including bereavement.

  • Contraceptive services and advice was available, and the female GPs provided a service to fit coils and contraceptive implants. Sexual health support was available for younger people, and the practice provided chlamydia self-testing kits.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments with the practice nursing team were available outside of school hours.

  • The practice provided baby changing facilities, and could accommodate mothers who wished to breastfeed on site. A designated area was available for children to sit quietly with a drawing book and crayons.

Older people

Good

Updated 7 April 2016

  • Patients over the age of 65 accounted for 12.6% of the total registered practice population. This was significantly lower than the average figure of 21.7% across the CCG. However, the practice ensured it still prioritised care for their older patients and offered proactive, personalised care to meet the needs of older people. Care plans were in place for older patients with complex needs. All patients had a named GP.

  • It was responsive to the needs of older people, and offered home visits either from a GP or nurse practitioner. Urgent appointments were available for those with enhanced needs.

  • Monthly meetings were held with the wider multi-disciplinary team to support patients to live in their own homes and ensure they were kept safe, and had their individual needs met.

  • The practice accessed the Single Point of Access to organise additional support for patients, for example input from the community rehabilitation team, to meet their needs and avoid an admission into hospital. The practice ensured that patients in need of social support were referred into the voluntary single point of access (VSPA) to access a range of voluntary services to support them to live in their homes.

  • The practice provided primary medical services to the majority of the 45 residents at a local nursing and residential care home. The GP or nurse practitioner undertook a weekly ward round at the home. All the patients received a full assessment at the first visit and care plans were formulated. We spoke to a manager from the home who was highly satisfied with the level of care provided by the GPs, and described the relationship with the practice as extremely positive. They told us the practice were responsive and caring, that they accommodated the individual needs of their patients, and the practice achieved good outcomes for their residents.

  • The practice nurse provided a home INR service for housebound patients to monitor safety in those patients using warfarin to prevent their blood from clotting.

  • An audiology service was provided at the practice each fortnight for patients aged over 55.

  • Flu vaccination rates for the over 65s were 80.7% which was higher than the national figure of 73.2%. Saturday morning clinics were held to increase uptake.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

  • The practice did not perform annual reviews for all patients aged over 75. However, 81% of these patients were included on a long term condition register and 100% of these patients had received an annual review.  The practice were reviewing their current approach and were considering providing health checks with the health care assistant for the remaining patients aged over 75.

Working age people (including those recently retired and students)

Good

Updated 7 April 2016

  • The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included good access to appointments including telephone consultations. An extended hours surgery was available on a Monday evening until 8pm.

  • The practice offered online access for patients to book GP appointments, request repeat prescriptions, and to view their summary care record (this record enables healthcare staff in emergency and out of hours services to access key clinical information, for example, medicines being prescribed)

  • The practice’s uptake for the cervical screening programme was 88.1% which was above the CCG average of 83.9% and the national average of 81.8%.

  • NHS Health checks were available to patients and 64% of eligible patients had attended for a check since the service became available.

  • The practice had a priority on women's health issues in recognition of the demographics of their registered patients. The nurse had undertaken additional training to support the provision of a well-women clinic on site.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 April 2016

  • The practice achieved 96.2% for mental health related indicators in QOF, which was 1.9% below the CCG and 3.4% above the national averages, although the rate of exception reporting was generally higher.

  • 82% of patients with ongoing serious active mental health problems had received an annual health check during 2014-15 at the time of our inspection. The practice were trying to encourage the remaining patients to attend for their review before the QOF year-end date of 31 March 2016.

  • 77.4% of people diagnosed  with dementia had received a review of their care in a face-to-face consultation in the last 12 months. This compared CCG average and national average of 83%
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had a room available that could be booked by community based mental health services to offer counselling when patients found it difficult to attend other locations.

  • It carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.
  • Staff had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 7 April 2016

  • The practice had carried out annual health checks for people with a learning disability, and 100% had attended for an annual review during 2014-15. All these patients had supporting care plans. The practice offered longer appointments for people with a learning disability.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • Homeless people could register with the practice. The partners informed us how they had instigated urgent action to provide support for a patient who had been made homeless.

  • The practice also enabled other vulnerable groups to register at the practice without an address, including those who had been subject to domestic violence.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

  • The practice ensured that patients in need of support were referred into the voluntary single point of access (VSPA) to access a range of voluntary services to support them to live in their homes.

  • 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.

  • The practice provided good care and support for patients at end of life, and worked within nationally recognised standards of high quality end of life care. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team.

  • The practice adopted a supportive approach to patients with a learning disability. This included reminding patients in the morning about their appointment; providing letters in a format which patients would understand; and providing an appointment at a time which best suited each individual.

  • The practice had signed up to be a safe haven for vulnerable people. Any person in need could enter the practice as a point of refuge until they could be safely collected by relatives or carers.