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Kingswinford Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 7 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingswinford Medical Practice on 12 January 2017. Overall the practice is rated as good.

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

  • Patients said they were treated with care and respect. We saw that staff were friendly and helpful and treated patients with kindness and respect.

  • Staff spoken with demonstrated a commitment to providing a high quality service to patients. Audits were used to monitor quality and to make improvements. The practice was proactive in identifying, managing and learning from significant events, incidents, complaints and patient survey responses.

  • Patients could access appointments and services in a way and at a time that suited them.

There were longer appointments available for patients when needed. The practice offered urgent access appointments for children, as well as those with serious medical conditions.

  • Clinical staff carried out home visits for older patients and patients who would benefit from these. The practice nurses also visited families from a local travelling community to ensure that children were up to date with their immunisations.

  • Staff, teams and services were committed to working collaboratively. We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services including local health visitors and school nurses.

  • Some of the practices protocols reflected best practice and were well embedded. For example, the practice utilised a comprehensive system to review their patients’ attendances at the local Accident and Emergency department, use of the ambulance service and emergency hospital admissions. The practice maximised use of this system to aid monitoring and recall systems and to reduce prescription wastage.

  • However, during our inspection we noted that governance arrangements were not always effective across specific systems and processes when managing complaints. We also noted that in areas documentation was unclear with regards to patient specific directions (PSDs); for the health care assistant to administer specific vaccinations and to demonstrate that review and authorisation was made by the prescribing GP.

  • Staff assured us that they would amend their PSD system to incorporate adequate record keeping and we received further assurance from the practice shortly after our inspection to demonstrate that a more effective system was being utilised.

  • Members of the management team indicated that some coding work was required across specific areas to accurately reflect the care plans in place across their mental health and dementia registers. However during our inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

  • We observed the premises to be visibly clean and tidy. Notices were displayed to advise patients that a chaperone service was available if required however we noted that no male members of staff provided a chaperone service and the clinical team was mostly female, with one male GP registrar in post during our inspection.

The areas where the provider should make improvements are:

  • Continue to identify carers in order to provide further support where needed.

  • Ensure that policies associated with complaint management reflect guidelines and are embedded in practice.

  • Continue to ensure that records and processes are well governed to reflect patient specific direction (PSD) requirements including review, specification and authorisation.

  • Consider the need of a male chaperone so that male patients have the option of a male or female chaperone.

  • Maximise the functionality of the computer system to consistently code all patient groups and produce accurate performance data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 February 2017

The practice is rated as good for providing safe services.

  • There were effective systems in place for reporting incidents, near misses and positive events, as well as comments and complaints received from patients. Staff also reflected on significant events and incidents during practice meetings.

  • The practice had systems, processes and practices in place to keep people safe and safeguarded from abuse. Staff we spoke with were aware of their responsibilities to raise and report concerns.

  • 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.

  • Notices were displayed to advise patients that a chaperone service was available if required. No male members of staff provided a chaperone service and the clinical team was mostly female, with one male GP registrar in post during our inspection. We discussed this during our inspection and members of the management team acknowledged that it was worth considering having a male chaperone available so that male patients had a choice of a female or a male chaperone.
  • We observed the premises to be visibly clean and tidy. There were adequate arrangements in place to deal with emergencies and major incidents.

Effective

Good

Updated 7 February 2017

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff assessed needs and delivered care in line with current evidence based guidance. Staff, teams and services were committed to working collaboratively.

  • The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital. The practice also utilised a comprehensive system to review their patient’s attendances at the local Accident and Emergency department, use of the ambulance service and emergency hospital admissions. The practice maximised use of this system to aid monitoring and recall systems and to reduce prescription wastage.

  • The practice had a programme of continuous clinical audits. The audits demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes.

  • Clinical staff had received annual appraisals and regular supervision and training support was in place. Members of the management team explained that appraisals were overdue for members of the non-clinical team. In response to this, a new appraisal form was developed and we saw that all of the staff members who were due appraisals had been sent an appraisal form to complete as part of the appraisal process. We also saw that appraisal meetings had been scheduled with eight staff members and three staff members had been through a complete appraisal process at the point of our inspection.
  • Medication reviews were documented in patient consultations but not always effectively coded; members of the management team assured us that they would focus on coding moving forward. However, during our inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews. We also noted that the CCG pharmacists supported the practice with medication reviews. 

Caring

Good

Updated 7 February 2017

The practice is rated as good for providing caring services.

  • Notices in the patient waiting room told patients how to access a number of support groups and organisations. The practice also supported patients by referring them to voluntary counsellors who provided counselling services on a weekly basis in the practice.

  • The practice had identified that 1% of their registered patients as carers. Staff we spoke with advised that they were continuously working on identifying cares to offer them support.

  • The practice proactively utilised the local Integrated Plus scheme. This scheme was facilitated by the Dudley Council for Voluntary Service (CVS) team to help provide social support to people who were living in vulnerable or isolated circumstances.

  • Results from the national GP patient’s survey published in July 2016 highlighted that patients were mostly happy with how they were treated. However, the practice was rated below average for some aspects of care. During our inspection we saw a comprehensive analysis carried out by the practice to address any areas for improvement. We found that some measures had been implemented to improve aspects of care and development areas were factored in to staff appraisals to help embed improvements whilst supporting staff.
  • We saw that staff were friendly and helpful and treated patients with kindness and respect. Patients told us told us they were satisfied with the care provided by the practice and this was consistent with the feedback gathered on CQC comment cards.

Responsive

Good

Updated 7 February 2017

The practice is rated as good for providing responsive services.

  • Patients could access appointments and services in a way and at a time that suited them. There were longer appointments available for vulnerable patients, for patients with a learning disability, for carers and for patients experiencing poor mental health. Urgent access appointments were available for children and those with serious medical conditions.

  • Clinical staff carried out home visits for older patients and patients who would benefit from these. Immunisations such as influenza and shingles vaccines were also offered to vulnerable patients at home, such as housebound patients who could not attend the practice. The practice also cared for a number of patients from local travelling communities and regularly carried out site visits to administer vaccinations such as child immunisations.

  • There were disabled facilities, hearing loop and translation services available at the practice. Information was made available to patients in a variety of formats, online and also through easy to read paper formats.
  • Results from the national GP patient survey published in July 2016 highlighted below average response rates with regards to telephone and appointment access. We found that measures had been implemented to improve patient access including increased opening hours, more appointments, due to a successful recruitment drive and encouraging patients to utilise online services to book appointments and ease pressure on the telephone lines. 

Well-led

Good

Updated 7 February 2017

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

  • There was a documented practice vision, with aims and objectives in place. Staff we spoke with were familiar with the practice aims and objectives and conversations with staff demonstrated that they were committed to providing a high quality professional service.

  • The practice operated a programme of regular staff meetings and staff were actively engaged in activities to monitor and improve quality and patient outcomes. Key topics such as audits and themes from significant events, incidents and complaints were also discussed in practice meetings.

  • Policies and documented protocols were well organised and available as hard copies and also on the practice’s intranet. Some of these protocols reflected best practice and were well embedded. However, in some areas we noted that governance arrangements were ineffective and did not reflect best practice. For example, the practices complaints policy did not clearly advise patients on what to do in the event that they were unhappy with the complaint response and did not signpost them to support organisations such as the Ombudsman.

  • During our inspection we observed the practices system to ensure that patient specific directions (PSDs) were in place to authorise the health care assistant to administer specific vaccinations. We noted that although there was a policy in place which was signed by the prescribing GP, there was no clear audit trail in place to demonstrate that patients had been reviewed by the prescribing GP prior to the health care assistant administering vaccinations.
  • Staff assured us that they would amend the PSD system to incorporate adequate record keeping moving forward and we received further assurance from the practice shortly after our inspection to demonstrate that a more effective system was being utilised.
Checks on specific services

People with long term conditions

Good

Updated 7 February 2017

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

  • We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services.

  • Performance for overall diabetes related indicators was 97%, compared to the CCG average of 86% and national average of 89%.

  • The percentage of patients with hypertension having regular blood pressure tests was 86%, compared to the CCG average of 92% and national average of 96%.
  • We saw that regular reviews and discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment. Patients with a long term condition were regularly seen in practice for care planning and medication reviews, the practice operated an effective recall system and care plans also formed part of the local quality framework.

Families, children and young people

Good

Updated 7 February 2017

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 (A&E) attendances.

  • The practice offered urgent access appointments for children, as well as those with serious medical conditions. The practice nurses also visited families from a local travelling community to help ensure that children were up to date with their immunisations.

  • Childhood immunisation rates for under two year olds ranged from 71% to 100% compared to the CCG averages which ranged from 74% to 98%. Immunisation rates for five year olds were ranged from 83% to 98% compared to the CCG average of 72% to 98%.

  • Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 99%, compared to the CCG average of 72% and national averages of 73%.
  • The local health visitors and school nurses also met with the practice on a monthly basis to discuss specific care needs for families and children. These meetings took place in addition to weekly visits from the health visitors and regular communication with both the school nurses and the health visitors.

Older people

Good

Updated 7 February 2017

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.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital.

  • Immunisations such as influenza and shingles vaccines were also offered to patients at home, such as housebound patients who could not attend the practice.
  • The practice was also supporting a local initiative to bring hospital specialists in to the community and therefore began inviting elderly care physicians to the monthly multi-disciplinary team (MDT) meetings. 

Working age people (including those recently retired and students)

Good

Updated 7 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • Patients could access appointments and services in a way and at a time that suited them.

Appointments could be booked over the telephone, face to face and online.

  • The practice offered early appointments from 7:30am during weekdays and also offered extended hours on Mondays until 7pm to suit their working age population.

  • To help with the winter pressures the practice also offered Saturday clinics for appointments with either one of two GPs on duty or the advanced nurse practitioner. These clinics started from 3 December 2016 and were due to run until 4 March 2017 as part of the winter pressures scheme.

  • The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group.
  • Practice data highlighted that they identified and offered smoking cessation advice and support to 224 of their patients and 6% had successfully stopped smoking.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 February 2017

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

  • The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

  • Performance for mental health related indicators was 94%, compared to the CCG average of 74% and national average of 92%. The practice had 40 patients on their mental health register. The data provided by the practice highlighted that 45% of these patients had a care plan in place.

  • 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the national average of 84%.
  • The practice also supported patients by referring them to voluntary counsellors who provided counselling services on a weekly basis in the practice.

People whose circumstances may make them vulnerable

Good

Updated 7 February 2017

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

  • Vulnerable patients were regularly seen in practice for care planning and medication reviews, the practice operated an effective recall system and care plans also formed part of the local quality framework. For example, there were 18 patients registered at the practice with a learning disability and all of these patients had a care plan in place.

  • The practice had 35 patients on their palliative care register. The data provided by the practice highlighted that all of these patients had a care plan in place and 86% received medication reviews where eligible within a 12 month period and there were further reviews planned.

  • The practice utilised the local Integrated Plus scheme. This scheme was facilitated by the Dudley Council for Voluntary Service (CVS) team to help to provide social support to people who were living in vulnerable or isolated circumstances.
  • Immunisations such as influenza and shingles vaccines were also offered to vulnerable patients at home, such as housebound patients who could not attend the practice.