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Archived: Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins Outstanding

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 10 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins (Ridgacre House Surgery) on 8 March 2016. Overall the practice is rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. The practice had developed an incident reporting system to encourage reporting. The system used was adopted by other practices and resulted in higher rates of reporting and increased openness.
  • The practice used innovative and proactive methods to improve patient outcomes and had worked with other local providers to share best practice. A range of schemes developed by the practice to deliver service improvements have been implemented widely with support from the CCG. These include ambulance triage, GP referral triage and a medicines waste project.
  • Feedback from patients about their care was positive.
  • The practice had worked closely with other organisations in planning how services were delivered to ensure that they met patients’ needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. Feedback from the patients survey had highlighted difficulties in patients seeing the same GP. The employment of several associate partners is hoped to create greater stability in the workforce and improve patient satisfaction as patients get used to the associate partners.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had business resilience in that they had multiple premises and staff that worked across sites. This meant it could adapt quickly to service disruption.
  • Information about how to complain was available and easy to understand and complaints were thoroughly investigated and handled in a sensitive and timely manner.
  • The practice had a clear vision which had quality and safety as its top priority. Strong governance arrangements with clear staff roles supported the running of the service and service improvement.

We saw areas of outstanding practice:

  • The provider had developed a reporting tool for incidents and significant events which risk rated incidents. The tool had been adopted by other practices within the local clinical network and had been recognised by the CCG as improving reporting. Practice staff were proactive in reporting incidents. The practice had high levels of incident reporting (148 in the last 12 months). High reporting is viewed positively as it enables the practice to identify trends, reflect on incidents that occurred and learn from them. Weekly clinical governance meeting ensured incidents and significant events underwent regular review and were acted on. Learning was shared internally and with other providers.
  • The provider was a key player in the CCG for driving innovation and developments for service improvement. Schemes developed by the provider that had been adopted by others included: Ambulance triage in which GPs gave advice and support to paramedics at the scene to reduce unnecessary referrals to A&E and provide more appropriate care. Early indicators show the number of patients that had attended A&E had reduced from 70% to 12% since September 2016 across participating practices. The provider had also undertaken a medicines waste project in which a savings of £1563 had been achieved in two months by targeting patients where over prescribing had been identified. This scheme was also being adopted by the CCG.
  • The provider had operated an internal triage referral system for 10 years, during which time over 4000 referrals had been reviewed by colleagues to improve the accuracy of referrals across both of their sites. With CCG funding this system was being extended within the locality with a pilot due to start in April 2016. GPs with specialist interests and training were being identified to undertake referral triage within a set time frame to help improve the quality of referrals and help reduce pressure on secondary care.
  • The provider worked with hospital services and the drug workers team to combine hepatitis C treatment for relevant patients with the treatment for substance misuse. By combining the treatments it was felt patients were more likely to comply. This approached successfully led to the eradication of hepatitis C in three patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 10 May 2016

The practice is rated as outstanding for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Reporting systems in place had been designed by the practice and adopted by other practices within the local clinical network resulting in increased openness for reporting across the locality.
  • Information about safety was highly valued and used to promote learning and improvement.
  • Learning from safety incidents was given high priority and was based on a thorough analysis and investigation.There were high levels of incident reporting with which learning was shared internally and with other practices in the locality.
  • Risk management was well embedded and recognised as the responsibility of all staff.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. For example, the provider’s safeguarding lead was also a CCG lead who kept up to date and supported staff on safeguarding matters at this and other practices.
  • The practice was proactive in promoting safe prescribing. Schemes identified by the practice to improve medicines safety were being adopted by the CCG.

Effective

Good

Updated 10 May 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.
  • Clinical audits were used to support service 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 10 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice similar to and in some cases 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.
  • The practice provided information about services and support available to patients.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 10 May 2016

  • The practice is rated as outstanding for providing responsive services.
  • The practice worked closely with other organisations to plan and deliver service improvements. For example, working with the ambulance service to support patients in receiving care in the most appropriate place.
  • The practice was innovative in its approach to providing integrated patient- centred care. For example, working in conjunction with the drug misuse team to support compliance with treatment for patients with hepatitis C.
  • The practice implemented suggestions for improvements and made changes in the way it delivered services in response to patient feedback. For example, the development of schemes for patients who were isolated.
  • Patients said they found it easy to make an appointments, with urgent appointments available the same day. Patients did not usually find it easy to make appointments with their preferred GP however the practice had taken action to try and address this through the recruitment of additional partners.
  • 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. Complaints were handled sensitively and in a timely way. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 10 May 2016

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

  • The practice had a clear vision with quality and safety as its top priority. Staff shared the vision to deliver high quality care and promote good outcomes for patients.
  • High standards were promoted and owned by all practice staff.
  • There was clear leadership. Staff were clear about their roles and responsibilities and took ownership of them. Staff felt valued and supported and there were high levels of staff satisfaction.
  • Governance and performance management arrangements were based on best practice for example, the high priority given to clinical governance, learning from safety incidents and other feedback received.
  • There were robust governance and performance management arrangements in place.
  • The practice actively engaged with their patient participation group, kept them informed and acted on feedback received.
  • There was a strong focus on continuous learning and improvement at all levels within the practice. The practice was forward thinking and a key player within the CCG for driving innovation. The practice had developed four schemes that had been adopted by local practices and the CCG to drive service improvement across the practice population and more widely in the CCG area.
Checks on specific services

People with long term conditions

Outstanding

Updated 10 May 2016

The practice is rated as outstanding for the care of older people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • Patients with long term conditions received regular reviews of their conditions to check their health and medicines needs were being met.
  • The provider had recently undertaken an audit to review and address issues relating to overprescribing and medicine hoarding. The CCG planned to adopt the scheme as part of their 2016/17 targets. The outcome of the audit was showing improved outcomes for patients.
  • The practice operated a number of clinics specifically for patients with long term conditions including diabetes, asthma, heart disease and hypertension.
  • The practice also undertook screening for atrial fibrillation (heart condition) for patients over 65 years and had to date screened 1018 patients out of 1341 eligible to support early diagnosis and treatment.
  • The practice was above average for patient uptake of national screening programmes such as bowel and breast cancer.
  • Nursing staff had lead roles in chronic disease management and received training and support for this.
  • Performance for diabetes related indicators overall was at 89% which was the same as both the CCG average and national average.
  • Longer appointments and home visits were available for those who needed them.
  • For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Outstanding

Updated 10 May 2016

The practice is rated as outstanding for the care of families, children and young people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • 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 or had failed to attend immunisations. The practice worked closely with the health visiting team to support children at risk.
  • Immunisation rates for standard childhood immunisations were comparable to the CCG and national averages.
  • The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 77% which was slightly higher than the CCG average of 74% and national average of 75%.

  • Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. For example information displayed which emphasised the rights of children and young people to privacy and being able to speak in confidence.
  • The practice was accessible for pushchairs, had baby changing facilities and advertised a breast feeding friendly service.Appointments were available outside of school hours.
  • The practice’s uptake for the cervical screening programme was 72%, which was comparable to the CCG average of 69% and the national average of 74%.

Older people

Outstanding

Updated 10 May 2016

The practice is rated as outstanding for the care of older people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • All patients over 75 years had a named GP and those who had been identified as having complex care needs.
  • There was a GP lead for the care of older people and for managing patients who were identified as having complex care needs and at risk of admission to hospital.
  • Ambulance triage was in place in which GPs gave advice and support to paramedics at the scene to reduce unnecessary referrals to A&E and provide more appropriate care. Early indicators showed that the number of patients that had attended A&E through this scheme had reduced from 70% to 12% since September 2016 across participating practices.
  • The practice held regular multi-disciplinary team meetings with district nurses, palliative care nurses and case managers to review the care of those who were most vulnerable including those with end of life care needs.
  • The practice offered home visits and urgent appointments for those with enhanced needs.
  • The premises were accessible to patients with mobility difficulties.

Working age people (including those recently retired and students)

Outstanding

Updated 10 May 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students). The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • 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 online services as well as a range of health promotion and screening that reflects the needs of this age group. This included NHS health checks, access to health trainers, travel vaccinations, sexual health and family planning services.
  • For the convenience of patients the practice offered extended opening hours on a Monday and Wednesday evening and on a Friday morning.
  • A self check in reduced the need for patients to queue at reception.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 10 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • National reported data from 2014/15 showed that 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was below the CCG average of 82% and national average of 84%. The practice told us that they had been actively working to improve the support for dementia patients and current data showed the practice performing now at 82%.
  • Specific dementia clinics were being delivered and the practice had also begun to work in partnership with the Alzheimer’s Society to review and support patients with dementia and their families.
  • National reported data from 2014/15 showed performance against mental health related indicators was 91% which was comparable to the CCG average of 92% and the national average of 93%.
  • The practice provided in house counselling services for patients who would benefit from it.

People whose circumstances may make them vulnerable

Outstanding

Updated 10 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

  • The practice held register of patients living in vulnerable circumstances including those with a learning disability or misused drugs and alcohol.
  • The practice ran drug misuse clinics which was open to patients within the locality. Two of the GPs had a special interest in substance misuse and five held the RCGP certificate in alcohol and substance misuse Part 2 who worked with drug workers to support these patients. In conjunction with this service the practice ran a hepatitis C clinic to improve compliance with treatment. There were currently 62 patients actively receiving drug and alcohol support at the practice.
  • Longer appointments were available for those who needed them.
  • The practice told us that they would register patients with no fixed abode but did not currently have any patients.
  • There were 124 patients registered as carers at the practice. A carers pack which provided information about support available was provided to those identified as carers.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children and were well supported. The safeguarding lead for the provider organisation also had lead roles in this area within the CCG and was an educator for other practices for domestic violence.
  • The practice had a register for patients with a learning disability, these patients had been sent a patient passport so that their needs, likes and dislikes could be recorded and understood when using services. We saw that patients had been invited for reviews with uptake this year of 61%. The lead GP for safeguarding had recently visited a residential home in which a number of patients registered with a learning disability lived to carry out their annual health reviews. Practice staff told us that all patients on the register had been invited for a review.
  • Those with specific needs were identified so that reception staff were aware and could support the patient as appropriate when they arranged an appointment.