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Inspection Summary


Overall summary & rating

Good

Updated 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 6 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. Learning was applied from events to enhance the delivery of safe care to patients.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice used clinical audits to review patient care and took action to improve services as a result.
  • The practice worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
  • 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 and learning from complaints was shared across the practice.
  • There was a clear leadership structure and staff told us that they felt supported by management. The leadership and governance arrangements were robust and focused upon continuous improvement.
  • There was a clear leadership structure and staff felt supported by management. The practice analysed and responded to feedback received from patients. Comments were used to adapt services where possible to best meet patients’ needs.
  • The practice had an active Patient Participation Group (PPG) and worked with them to review and improve services for patients.

We saw one area of outstanding practice:

  • The practice had championed the role of care coordinator and the team were proactive in building relationships with community teams. They worked closely with community teams to support patients in their homes and had developed specialist programs for dementia patients to improve quality of life and support carers.

The areas where the provider should make improvement are:

  • Review access to appointments to enable patient access to appointments in a timely manner with improved continuity of care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 June 2016

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. The practice had robust processes in place to investigate significant events and to share learning from these.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. The practice had designated GPs responsible for safeguarding and had regular meetings with community based health professionals to discuss patients at risk.
  • Where people were affected by safety incidents, the practice demonstrated an open and transparent approach to investigating these. Apologies were offered where appropriate
  • Risks to patients were assessed and well managed. There were designated leads in areas such as infection control, and training was provided to support their role.

Effective

Good

Updated 27 June 2016

The practice is rated as good for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Full cycle clinical audits were undertaken. For example, an audit was conducted to assess the cholesterol levels of patients with diabetes, it highlighted 82 patients who went on to receive further monitoring and treatment to reduce cholesterol levels.
  • Data showed most patient outcomes were in line or above those of the locality. For example, the practice’s uptake for the cervical screening programme was 78% which was in line with the national average of 82%.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and actively sought further training to develop their skills to contribute to practice development.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. The care coordinators were constantly developing their role to liaise with charities and agencies who could support patients at home and trials were run to quantify the effectiveness of additional support run in trials.

Caring

Good

Updated 27 June 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice in line with others for several aspects of care. For example:

    • 89% of patients said the GP gave them enough time compared to the CCG average of 85% and the national average of 87%.

  • Patients told us they were treated with care and concern by staff and their privacy and dignity was respected. Feedback from comment cards aligned with these views.
  • The practice provided information for patients which was accessible and easy to understand.
  • We observed staff treated patients with kindness and respect, and maintained confidentiality. Reception staff were observed to be friendly and made every effort to accommodate patients’ needs.

Responsive

Good

Updated 27 June 2016

The practice is rated as good for providing responsive services.

  • A majority of patients we spoke to had experienced difficulty booking an appointment and told us they often came to the practice early in the morning, to book an appointment as the telephone system was often engaged.
  • Patients also told us they had to take an allocated GP rather than their preference which reduced continuity of care.
  • 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 the practice leaflet had been translated into Polish to aid in communication. Evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 27 June 2016

The practice is rated as good for being well-led.

  • The practice had a vision to deliver high quality care. Staff were clear about the vision and their responsibilities in relation to this. The practice had a developed a five year plan which outlined its aims for the future.
  • There was a clear leadership structure, succession planning was in place to manage staffing levels in the future, and staff felt supported by partners and management.
  • The practice had a wide range of policies and procedures to govern activity and these were regularly reviewed and updated.
  • The partners and practice manager encouraged a culture of openness and honesty, and staff felt supported to raise issues and concerns.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was well established and met regularly. The PPG worked closely with the practice to review issues and were well supported by the practice.
Checks on specific services

People with long term conditions

Good

Updated 27 June 2016

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

  • The practice was broadly in line with other local practices in respect of the care of patients with long-term conditions. For example:

    • The percentage of patients with lung disease who had a review undertaken including an assessment of breathlessness in the preceding 12 months was 82% compared to a national average of 90%.

  • GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.
  • Patients at risk of hospital admission were identified as a priority and assistance put in place by the care coordinator team if appropriate, with additional home visits made by the community matron.

Families, children and young people

Good

Updated 27 June 2016

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

  • Immunisation rates were in line with the CCG for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to two year olds ranged between 98% and 100%, compared to a CCG range of between 96% and 98%
  • 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. Urgent appointments were always available on the day.

Older people

Good

Updated 27 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 older people in its registered population.
  • The practice developed an integrated approach to caring for older people through a Joined Care Programme which ensured a care coordinator was established in the practice and monitored admissions and discharge from secondary care and assisted in supporting recovery. This was later adopted by the CCG and is now in place within all GPs in the area.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, a dedicated practice nurse visited all care homes where practice patients were resident, on a weekly basis to ensure continuity of care, support staff and pro-actively review patients.
  • The practice 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 27 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. This included access to telephone appointments, and the availability of extended hours’ appointments.
  • The nursing team had identified that patients found it difficult to attend the practice during the day for cervical screening. To assist access, an evening clinic was introduced once a week which had increased attendance for screening.
  • The practice offered online services such as electronic prescriptions, and GP appointments were offered through the online booking system.
  • Health promotion and screening was provided that reflected the needs for this age group. The practice promoted patients to attend the national bowel screening programme and 60% of patients aged between 60-69 had attended for bowel cancer, which was in line with the CCG average of 60%.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 27 June 2016

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

  • A GP had been a Dementia Champion for NHS England and had co-written national guidance for GPs ‘Dementia Revealed’ leading on the commissioning locality dementia services in Derbyshire.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • Staff had a good understanding of how to support people with mental health needs and dementia.
  • A GP partner set up a dementia care pilot in 2012 and funding was sought to support patients as well as host events such as ‘Alzhiemers café’ and ‘singing for the brain’. Feedback from patients and carers had been overwhelmingly positive and in some cases drastically improved their communication with others.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The care coordinators monitored admissions to the emergency department to assess patients who would benefit from further care at home or a review and contact the patients to arrange support.
  • Performance for mental health related indicators where a care plan was in place was 96% which was 7% above the CCG average and 8% above the national average. This was achieved with a no exception rating, significantly lower when compared to local and national averages.
  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 93% which was 7% above the CCG average and 9% above the national average. This was attained with an exception rate of 9.0%, 1% above the national average.

People whose circumstances may make them vulnerable

Good

Updated 27 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Practice leaflets have been translated into Polish as a large proportion of the local population were Polish speaking and additional time could be allocated for appointments to aid in translation services.
  • The practice offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.
  • The practice and safeguarding lead regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.