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Inspection Summary


Overall summary & rating

Good

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sprake & Partners on 13 September 2016. Overall the practice is rated as good.

Our key findings were as follows:

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Nationally reported data showed that outcomes for patients with long-term conditions were consistently better than national averages. The practice had achieved at least 99% of the total points available in all but one of the 19 quality and outcomes framework (QOF) clinical indicators:
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • 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 were able to get an appointment with a GP when they needed one, 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 in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
  • Managers promoted a culture of continuous reflection and learning. Clinical education meetings were held twice weekly. One of the GP partners and the practice manager had completed a strategic leadership skills course.
  • There were very high levels of staff satisfaction. There was a stable team; the majority of staff had worked at the practice for many years. Staff told us they were proud to work at the practice and many referred to the practice as a fantastic place to work.

We saw several areas of outstanding practice including:

  • Innovative training processes were in place, this included members of the practice’s patient participation group (PPG) carrying out ‘simulated surgeries’ with the trainee GPs. There were comprehensive debriefs following the surgeries with the PPG patients, trainee GPs and their trainers to ensure all learning was captured. The practice was keen to promote general practice as a career choice and as such, had invited a number of sixth form students to work in the practice on a two day placement.
  • Clinicians worked closely with patients and their families to prepare care plans and help prevent unnecessary admissions to hospital. In the previous year, the practice had the lowest non-elective (emergency) admission rate across the clinical commissioning group (CCG), 293 per 1,000 population, compared to the average of 413.
  • One of the doctors was a GP with a special interest (GPwSI) in musculo-skeletal services. As a result, the practice was able to reduce referrals to secondary care by treating patients within the practice. The practice’s referral rate to orthopaedics outpatient services was the lowest across the CCG (31.5 per 1,000 population, compared to the average of 47.7). Other neighbouring practices also used the service provided by the GP and their referral rates were also well below average (37.4 and 35.5 per 1,000 population).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 November 2016

The practice is rated as good for providing safe services.

The nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. There was an open culture where all safety concerns raised were valued as integral to learning and improvement. Risks to patients were assessed and well managed.

There was evidence of good medicines management. Good infection control arrangements were in place and the practice was clean and hygienic. Effective staff recruitment practices were followed and there were enough staff to keep patients safe. Disclosure and Barring Service (DBS) checks had been completed for all staff that required them.

Effective

Outstanding

Updated 4 November 2016

The practice is rated as outstanding for providing effective services.

Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

Data showed that the practice was performing highly when compared to practices nationally. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness. The latest publicly available data from 2014/15 showed the practice had achieved 99% of the total number of points available, which was above the England average of 95%. The data showed that outcomes for patients with long-term conditions were consistently better than national averages. The practice had achieved at least 99% of the total points available in all but one of the 19 clinical indicators.

The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. Clinicians worked closely with patients and their families to prepare care plans and help prevent unnecessary admissions to hospital. In the previous year, the practice had the lowest non-elective (emergency) admission rate across the CCG, 293 per 1,000 population, compared to the average of 413.

The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high quality care. Innovative training processes were in place, this included members of the practice’s patient participation group (PPG) carrying out ‘simulated surgeries’ with the trainee GPs.

Caring

Good

Updated 4 November 2016

The practice is rated as good for providing caring services.

Patients said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about the services available was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Results from the National GP Patient Survey, published in July 2016, showed patients were satisfied with how they were treated and that this was with compassion, dignity and respect. The practice was above average for their satisfaction scores on consultations with doctors and nurses. For example, of those who responded: 98% said they had confidence and trust in the last GP they saw, compared to the clinical commissioning group (CCG) average of 96% and the national average of 95%; 99% said they had confidence and trust in the last nurse they saw, compared to the CCG average of 98% and the national average of 97%.

Responsive

Good

Updated 4 November 2016

The practice is rated as good for providing responsive services.

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 evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality. For example, there were good arrangements in place to support patients with learning disabilities; reviews were carried out by the same GP and organised by the same administrator for several years.

Results from the National GP Patient Survey, published in July 2016, showed that patients’ satisfaction with how they could access care and treatment was above national averages, but below local averages. For example: 83% of patients were able to get an appointment when they needed, compared to the CCG average of 86% and the national average of 85% and 75% of patients described their experience of making an appointment as good, compared to the CCG average of 77% and the national average of 73%. Patients we spoke with on the day were able to get appointments when they needed them.

However, the survey showed that some patients felt they waited too long to be called in for their appointment; 39% of patients said they usually waited more than 15 minutes after their appointment time, compared to the CCG average of 21% and the national average of 27%.

Managers were aware of these results and had taken action; for example, reviewing GPs’ working sessions and building in blocks of time between appointments to allow them to catch up.

Well-led

Good

Updated 4 November 2016

The practice is rated as good for providing well-led services.

The leadership, management and governance of the practice assured the delivery of person-centred care which met patients’ needs. The practice had a clear, documented vision to deliver high quality care and promote good outcomes for patients. There was a systematic approach to working with other organisations to improve care outcomes and obtain best value for money.

There was a well-defined leadership structure in place with designated staff in lead roles. There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff spoke very highly of managers; several staff had worked at the practice for many years. Team working within the practice between clinical and non-clinical staff was good.

The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk.

There was a strong focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and had implemented a number of innovative systems.

Checks on specific services

People with long term conditions

Good

Updated 4 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
  • Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
  • Patients had regular reviews to check with health and medicines needs were being met.
  • For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • National indicators showed that outcomes for patients with long-term conditions were consistently better than national averages. The practice had achieved at least 99% of the total points available in all but one of the 19 quality and outcomes framework (QOF) clinical indicators. For example, performance for COPD (chronic obstructive pulmonary disease) related indicators was better than the national average (100% compared to 96% nationally).

Families, children and young people

Good

Updated 4 November 2016

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

  • The practice had identified the needs of families, children and young people, and put plans in place to meet them.
  • 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. Immunisation rates were relatively high for all standard childhood immunisations.
  • 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 staff arranged on the day appointments for unwell children.
  • There were monthly child health meetings with practice staff and health visitors.
  • The practice’s uptake for the cervical screening programme was 84.4%, which was above the clinical commissioning group (CCG) average of 83.1% and the national average of 81.8%.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Older people

Good

Updated 4 November 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. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
  • Weekly multi-disciplinary team meetings with the community nursing team were held to discuss at risk patients who had recently been discharged from hospital and care planning for those at high risk of admission to hospital.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • All patients over the age of 90 were contacted prior to the annual ‘flu vaccination day’ to check if they wanted to attend the practice or preferred a home visit for immunisation.
  • A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Working age people (including those recently retired and students)

Good

Updated 4 November 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 and flexible. Extended hours surgeries were offered on every Tuesday and Thursday evening until 8pm for patients who could not attend during normal opening hours.
  • The practice offered appointments throughout the whole day and pre-bookable telephone consultations were also available.
  • Appointments were available with a healthcare assistant from 7.30am two mornings per week.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
  • Additional services were provided such as health checks for the over 40s and travel vaccinations. The practice was a pilot site for NHS health checks before they were rolled out nationally.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 November 2016

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

  • The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
  • Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
  • A counsellor was available at the practice three sessions per week.
  • The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests. Appointments were made with the same GP wherever possible.
  • Staff had developed close links with the community matrons for mental health and wellbeing; they were able to provide further support for patients.

People whose circumstances may make them vulnerable

Good

Updated 4 November 2016

The practice is rated as good 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.
  • There were good arrangements in place to support patients with learning disabilities; annual health checks were carried out by the same GP and organised by the same administrator for several years. This continuity of care allowed staff to build up relationships with patients and their carers and families. The practice was involved in a national project ‘Getting it right - from the start’ to improve the patient experience for those with learning disabilities.
  • Staff, teams and services were committed to working collaboratively to ensure patients with complex needs were supported to receive co-ordinated care. For example, multi-disciplinary team (MDT) meetings took place on a weekly basis. In-house training sessions had been provided by a national charity and the local community learning disabilities liaison nurse.
  • 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 and out of hours.
  • Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.