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Woodlands & Clerklands Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 21 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Woodlands and Clerklands Partnership on 19 April 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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. Results from the GP patient survey showed patients’ satisfaction with access to care was better than national averages.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice offered a wide range of clinics including those due to the specialist interests of GPs and nurses. For example, on site vasectomy, epilepsy reviews and a specialist treatment for a type of benign vertigo (dizziness). They also offered a walk-in blood test clinic twice per week.
  • 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.
  • There was a strong focus on education and shared learning throughout the practice.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • The practice had an ethos of education and had designed a competency framework for the patient services team, to provide a standard process for staff to achieve and progress within their role. The framework included key competencies that should be achieved within the first year, and then onward progression towards additional tasks that carried an upscale in pay. Appraisals were used to monitor achievements and work with staff to develop their skills. Staff we spoke to within this role told us they enjoyed the opportunities at the practice and the flexibility to choose training in different aspects of the role.

  • The practice had high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture of learning and improvement. There were consistently high levels of constructive staff engagement. Staff at all levels were actively involved in identifying learning, and facilitating improvement to quality of care and patients experiences

  • The partners and management had an inspired shared purpose, strive to deliver and motivated staff to succeed, including that they were actively supporting the nursing team to progress within their career.

The areas where the provider should make improvement are:

  • Ensure patients who are carers and who are cared for are pro-actively identified and supported.
  • Continue to ensure the care and treatment of all diabetic patients is reviewed, and ensure plans are in place to reduce the exception reporting results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 June 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 comprehensive systems to monitor and prevent the spread of infection.

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

  • The arrangements for managing medicines, including emergency medicines and vaccines, in the practice kept patients safe.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 21 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • 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 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.

  • The practice proactively identified housebound patients in order to provide additional care and support.

  • Patients suffering a chronic disease were recorded on a separate list by the practice in order to ensure their care was reviewed at least annually.

Caring

Good

Updated 21 June 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.

  • We saw examples of personalised care plans for patients with a learning disability and for patients with dementia.

  • The practice had created a poster at the reception area to assist patients to communicate their spoken language with staff at the reception desk.

Responsive

Good

Updated 21 June 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice offered an on-site vasectomy service for patients in the Crawley area.

  • 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. Patients’ satisfaction with access to care was above local and national averages.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included a portable hearing loop, disabled facilities and baby changing facilities.

  • The practice had identified patients who may require extra assistance on separate lists that were recorded on the practice computer system in an easily accessible location, including those with a sight or hearing impairment, wheelchair users and housebound patients.

  • 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

Outstanding

Updated 21 June 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 practice had a culture of education, and placed quality patient care at the centre of their decision making.

  • There was a clear leadership structure and staff felt supported by management. Staff told us they felt encouraged to make suggestions for improvement of the practice.

  • The practice held annual business strategy meetings, six monthly away days, and a range of meetings to ensure all staff were involved in identifying learning and facilitated improvement across all staffing groups.

  • The practice team had won awards the nursing team, who won a Sussex-wide “proud to care team award” for compassion in 2013. Additionally one of the health care assistants won a Crawley CCG award for “putting patients at the heart” in 2014 for her work with learning disability checks at the practice.

  • Most of the GPs and nurses had a specialist interest and additional qualifications in those areas.

  • The practice had designed a competency framework for the patient services team, to provide a standard process for staff to achieve and progress within their role.

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 21 June 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.

  • 87% of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was comparable with national average 88%.

  • 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.

  • The practice offered a range of services to people with long term conditions. This included clinics for diabetes, asthma and hypertension.

Families, children and young people

Good

Updated 21 June 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.

  • 87% of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was comparable with national average 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice offered antenatal checks with an on-site midwife, full contraception counselling, and dedicated coil clinics.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 21 June 2016

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

  • 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.

  • All patients aged over 75 had a named accountable GP.

Working age people (including those recently retired and students)

Good

Updated 21 June 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 offered a full range of health promotion and screening that reflects the needs for this age group.

  • The practice was proactive in offering online services including booking/cancelling appointments and an electronic prescribing service.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 June 2016

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

  • 92% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average 84%.

  • 95% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was better than the national average 88%.

  • 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 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 21 June 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 offered longer appointments for patients with a learning disability.

  • Appointments were offered to patients with no fixed address. Staff told us that they would support those patients by registering them with a temporary address.
  • 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.