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Dr Monella & Partners Outstanding Also known as Medwyn Surgery

Inspection Summary


Overall summary & rating

Outstanding

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Monella & Partners – Medwyn Surgery on 9 December 2015. Overall the practice is rated as outstanding.

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.
  • 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 it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice :

The practice was extremely pro-active in supporting the well-being of its patients by engaging with and participating in numerous community support groups. The culture of the practice focused on community engagement and being central to community life. This culture benefited the emotional and physical well-being of the patients. In addition we noted many individual acts of care, compassion and kindness towards patients, by members of the practice team, often in their own time.

The areas where the provider should make improvements are:

  • Establish systems and processes to facilitate the efficient on-going monitoring of staff training and registration with professional bodies.

  • Ensure that all formal documents are dated or version controlled and records maintained to facilitate efficient review of such documents.

  • Ensure that infection control was addressed as part of the practice induction programme for all staff.

  • Establish robust systems and processes to ensure that all necessary and relevant recruitment checks are undertaken for all staff prior to employment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2016

The practice is rated as good for providing safe services as there are areas where it must make improvements:

  • There was an effective system in place for reporting and recording significant events. All staff spoken to demonstrated knowledge of the process and the outcomes of significant events.

  • Lessons were shared via meetings or email to ensure that relevant personnel were informed and action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, open and 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 defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. All staff were in receipt of safeguarding training to the level appropriate for their role and in relation to both adults and children. All staff spoken to demonstrated knowledge of the policies and procedures in relation to safeguarding.

  • Risks to patients were generally assessed and well managed. However, the systems and processes to address these risks in relation to recruitment and staffing were not always robustly implemented.

  • The practice recruitment process included the requirement for a satisfactory Disclosure and Barring Service (DBS) check in relation to staff carrying out registered activities. Our inspection identified that this had not been followed in relation to two members of staff. This was promptly resolved, evidence submitted to the inspection team, and the regulations have now been met. Staff management processes also did not always ensure that continuing registration with the relevant professional bodies was maintained.

Effective

Good

Updated 10 March 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.

  • Staff assessed needs and delivered care in line with current evidence based guidance. There was a system in place for clinical and other alerts and guidance to be received by the practice. management team and disseminated to all clinical staff. The relevant clinical lead then took any action or monitoring required.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Individual care plans were offered to those patients with long term debilitating conditions.

  • There was evidence of appraisals and personal development plans for all staff. Staff we spoke to and data obtained from the staff survey showed that 80% of staff believed that their appraisal helped them to improve, 100% felt that their work was valued and 100% felt that the appraisal system identified learning and development needs.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 10 March 2016

The practice is rated as outstanding for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care. 94.8% of patients said that the last GP they saw was good at listening to them compared with the Clinical Commissioning Group (CCG) average of 90.7% and the national average of 88.6%. 91.3% of patients said that they were treated with care and concern compared to the CCG average of 87.5% and the national average of 85.1%.

  • Feedback from patients who used the service and those close to them was continually and consistently positive about the care and treatment received. Patients thought that staff went the extra mile and the care received exceeded their expectations. We received 27 comment cards, all of which were overwhelmingly positive about the care, respect and dignity shown to them by all members of the practice team. We spoke to nine patients during the inspection who were all positive about the care and treatment received. We also spoke to a further five patients on the telephone following the inspection at their request. All of their feedback was also very positive.

  • We observed a strong patient-centred culture. People’s emotional and social needs were seen to be as important as their physical needs.

The practice had an identified member of the team as a Carer’s champion. This member of staff coordinated the registering of carers and provided relevant information and signposting to those patients.

  • There were numerous examples of staff members calling in to patients on their way home and in their own time, to deliver medicines or change dressings, when that patient had been unable to attend the surgery.

  • One GP regularly visited a site where the homeless congregated to talk to them, discuss their needs and challenges, encourage them to attend the practice and offer medical care.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Outstanding

Updated 10 March 2016

The practice is rated as outstanding 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 (CCG) to secure improvements to services where these were identified. Partners attended CCG meetings in rotation and then cascaded information to other clinicians at the following partners meeting. Dorking Healthcare, a group of local GPs, was set up to reduce referral waiting times.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care. Routine appointments were available up to four weeks in advance. Telephone appointments where appropriate, double appointments, commuter appointments and same day urgent appointments were also available.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was co-located with a number of other independent health services which benefited patients and enabled efficient close liaison between those services.

  • 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.

  • We saw numerous examples of the practice referring to and engaging with, relevant community organisations to benefit both the physical and emotional health of the patients.

Well-led

Outstanding

Updated 10 March 2016

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

  • The Partners at the practice recognised that without strong leadership, they would be unable to deliver the quality of care to which they aspired.

  • There was a clear, strong leadership structure and staff felt very supported by management.

  • There were a number of approaches to ensure staff were supported and felt valued. The practice had a mentorship programme, held staff meetings and surveys, had initiated a ‘Going the Extra Mile’ monthly staff award and various social team building activities.

  • 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.

  • 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 practice was supported by the ‘Friends of Medwyn’. This group of patients had been actively supporting patients and the practice for more than 11 years.

  • The Friends of Medwyn were complimented by a Virtual Patient Reference Group that enabled the working population and others to actively participate. Overall membership of both groups stood at 193.

  • There was a strong focus on continuous learning, training and improvement at all levels. Staff were in receipt of annual appraisals.

Checks on specific services

People with long term conditions

Outstanding

Updated 10 March 2016

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

  • Nursing staff were trained and had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • One GP at the practice had a special interest in diabetes

  • Performance data showed that the practice generally performed well in relation to diabetes indicators. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 93.13% compared to the CCG average of 88.3%.(01/04/2014 to 31/03/2015) The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015)

  • 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

Outstanding

Updated 10 March 2016

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

  • Antenatal clinics were held twice weekly, as part of the shared care programme.

  • Family planning clinics were available with specialist nurses.

  • The practice held baby clinics and met with the Health Visiting team on a monthly basis.

  • The practice was proactive in identifying and supporting young carers.

  • 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.

  • 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 percentage of women aged 24-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 81.43% compared to the CCG average of 81.83%. 01/04/2014 to 31/03/2015)

  • 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

Outstanding

Updated 10 March 2016

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

  • All patients falling within this population group had a named GP. There was a GP lead for older people within the practice.

  • GPs attended meetings in local care homes and associated social events in their own time.

  • Patients with long-term conditions, subject to end of life care or vulnerable due to a variety of circumstances were in receipt of a care plan which was reviewed regularly

  • There were raised chairs in the waiting areas for the comfort of older or immobile patients

  • The practice engaged with a community organisation focussed on providing physical and mental activities and learning for older people. Members of this group were invited to practice meetings to educate GPs in relation to what they could offer older people and patients were pro-actively encouraged to join.

  • The practice engaged with the Community Garden Project, a social horticultural project for those experiencing isolation, bereavement or recovery from psychological or physical ill health. A member of the practice staff volunteered at this project and patients were actively referred.

  • The practice engaged with an organisation designed to support patients and families following a Stroke. This group was set up by a patient and his or her family to deliver arts, crafts, excursions and other activities for members. Patients were referred to this group for support following a Stroke.

  • 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)

Outstanding

Updated 10 March 2016

The practice is rated as outstanding for the care of working age people.

  • 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.

  • Late night surgeries (commuter appointments) were offered twice weekly.

  • The practice operated an open-list policy to allow patients working but not living locally to register.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • The practice had also provided Saturday Flu Clinics to meet the needs of this population group.

  • A Virtual Patient Reference Group (VPRG) was in place, which complimented the Friends of Medwyn and facilitated patient engagement with this population group.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 10 March 2016

The practice is rated as outstanding for the care of people experiencing poor mental health.

  • The percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 94.64% compared to the national average of 89.55%

  • 94.55% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the national average of 88.47%.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice offered care to residents of a local residential mental health care facility. Residents were automatically provided with double time appointments to meet their needs.

  • The practice supported a local mental health project called ‘Art Matters’, by showing the work of its members on the practice premises.

  • 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.

  • The practice supported a locally based parent support group for parents of children on the autistic spectrum.

People whose circumstances may make them vulnerable

Outstanding

Updated 10 March 2016

The practice is rated as outstanding for the care of vulnerable people.

  • The practice engaged with many community organisations in order to meet the patient’s emotional and social needs.

  • The practice had a system in place to register patients who were homeless. Staff informed us that it was the only practice locally to offer this service. One of the GPs regularly visited a local site where homeless persons gathered to talk and encourage them to come forward for health checks and care.

  • Foodbank – The practice was a hub for the Dorking Food bank. The GPs had been allocated vouchers to give to patients of the practice they identified as being in crisis. The vouchers could be exchanged for three days of emergency food from the bank.

  • The practice offered an Interpreter service for those patients who required assistance. The practice also offered a hearing loop to assist the hard of hearing.

  • Vulnerable patients were identifiable via prompts on the computer system enabling staff to make appropriate adjustments to meet each individual patient’s needs.

  • Longer appointments were automatically offered to those patients with complex needs or vulnerabilities.

  • 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.