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Inspection Summary


Overall summary & rating

Good

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

                                                                                                                                                   

We carried out an announced comprehensive inspection at The Maples on 25 May 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 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.
  • 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 including:

  • The Maples has a higher than average rate of childhood obesity and had taken a leading role in developing a pathway for managing families affected by childhood obesity. The services provided to parents and children included cookery lessons, behaviour support and advice and family activity programmes which took place at local children’s and sports centres.
  • The Nurse Practitioners had led a family health project and delivered sessions on self-management of minor ailments at local children’s centres.

The area where the provider should make improvement is:

  • Ensure that verbal complaints are recorded and reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 July 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 learnt were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received support and a verbal and written 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 patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 July 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. For example, the practice had achieved 100% of the total number of points available, with 6% exception reporting which was in line with the local and national average.
  • The Nurse Practitioners held minor illness clinics on a daily basis.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice was proactive in ensuring staff learning needs were met.
  • 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.

Caring

Good

Updated 7 July 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey results published on 7 January 2016 showed patients rated the practice higher than others for several aspects of care. For example, 99% of respondents said they had confidence and trust in last GP they saw or spoke to compared with the CCG and national average of 95%.
  • The practice offered flexible appointment times based on individual needs.
  • 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.
  • The practice held a register of carers with 393 carers identified which was 3% of the practice list. A member of the administration team was the nominated Carers’ champion who promoted a carers pack and managed a display board in the practice. A member of the Patient Participation Group (PPG) was also a nominated Carers’ champion who attended carers meetings and provided support at a local carers’ cafe.

Responsive

Good

Updated 7 July 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 East and North Hertfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice provided a Teledermatology service (Teledermatology is the remote delivery of dermatology services and clinical information using telecommunications technology). This service enabled patients to have a photograph of skin lesions taken at the practice. The images were then sent securely to a Consultant Dermatologist to diagnose whether further treatment was necessary or not. This saved patients from having to travel to hospital to see a Consultant Dermatologist.
  • The practice participated in the local area winter resilience scheme and offered more appointments. This service had given patients the opportunity to attend the practice for urgent appointments rather than travel to the local A&E department. The practice had offered 2,502 additional face to face appointments and 1,077 telephone appointments between 2 November 2015 and 31 March 2016.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Urgent appointments were available on the same day and the practice provided a telephone consultation service for those who needed urgent advice.
  • 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. The practice did not record or review verbal complaints.

Well-led

Good

Updated 7 July 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • The practice 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 identifying 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 Patient Participation Group was active.
  • There was a strong focus on continuous learning and improvement and the practice worked closely with other practices, a local GP Federation and the local CCG.
Checks on specific services

People with long term conditions

Good

Updated 7 July 2016

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

  • Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice held weekly multidisciplinary clinics for patients with long term conditions.
  • Performance for diabetes related indicators was better than the CCG and national average. The practice had achieved 98% of the total number of points available (with 8% exception reporting), compared to local average of 89% (9% exception reporting) and national average of 89% (11% exception reporting).
  • 76% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the local and national average of 75%.
  • Longer appointments and home visits were available when needed.
  • All patients with a long-term condition 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

Good

Updated 7 July 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.
  • The Maples has a higher than average rate of childhood obesity and had taken a leading role in developing a pathway for managing families affected by childhood obesity. The services provided to parents and children included cookery lessons, behaviour support and advice and family activity programmes which took place at local children’s and sports centres.
  • The practice held six weekly meetings with health visitors to support and manage vulnerable children and families
  • 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 Nurse Practitioners had led a family health project and delivered sessions on self-management of minor ailments at local children’s centres.
  • The practice’s uptake for the cervical screening programme was 86% which was comparable with the national average of 82%.
  • Appointments were available on the same day and outside of school hours. The premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 7 July 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.

  • Regular visits to a nursing home were carried out by a named GP for continuity of care and emergency visits were also provided when needed. We spoke with the home manager who described the practice as very good, responsive and committed to meeting the individual needs of the residents.
  • The practice worked closely with a multidisciplinary rapid response service in place to support older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.
  • The practice had completed 496 health checks for patients aged over 75 since November 2014, which was 75% of this population group.

Working age people (including those recently retired and students)

Good

Updated 7 July 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
  • Bowel and breast cancer screening rates were comparable with local and national averages. Data showed 72% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 72% locally and 72% nationally.
  • The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
  • Extended opening times were available one evening each week and from 8.30am to 11.30am on the first Saturday of each month.
  • A NHS health and wellbeing specialist attended the practice once a week and supported patients in becoming more physically active.
  • The practice had a room available in the waiting area for patients to monitor their weight and blood pressure.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 July 2016

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

  • 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was better than the local average of 86% and national average of 84%.
  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
  • The practice would refer patients to the Improving Access to Psychological Therapies service (IAPT) and would encourage patients to self-refer.
  • Performance for mental health related indicators was in line with the CCG and national average. The practice had achieved 98% of the total number of points available (with 18% exception reporting), compared to 96% locally (12% exception reporting) and 93% nationally (11% exception reporting).
  • 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 A&E 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

Outstanding

Updated 7 July 2016

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

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

  • The practice staff supported their vulnerable patients and the GPs and practice manager had attended a performance by a local creative arts group for adults with learning disabilities. The practice offered longer appointments and annual health checks for people with a learning disability. The practice had completed 46 health checks out of 48 patients on the learning disability register since April 2015.

  • The practice held a register of carers with 393 carers identified which was 3% of the practice list. A member of the administration team was the nominated Carers’ champion who promoted a carers pack and managed a display board in the practice. A member of the Patient Participation Group (PPG) was also a nominated Carers’ champion who attended carers meetings and provided support at a local carers’ cafe.
  • The practice worked closely with a local women’s refuge centre and fast tracked new registration and urgent medication requests for these patients.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Vulnerable patients had been told how to access various support groups and voluntary organisations.
  • Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.