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Inspection Summary


Overall summary & rating

Good

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lapal Medical Practice on 15 December 2015. 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 compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance

  • Staff were aware of their responsibilities to raise and report concerns, incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment

  • Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that monthly multi-disciplinary team meetings and gold standards framework for end of life care (GSF) meetings took place.

  • We observed the premises to be visibly clean and tidy. The practice had good facilities and was equipped to treat patients and meet their needs.

  • The practice had very active patient participation group which influenced practice development. Whilst the PPG had only been in place for 12 months, we found that they had been involved in a number of successful events and projects at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 February 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events.

  • The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses. We saw that significant events were regularly discussed with staff during practice meetings

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. The practice had not yet assessed the risk of legionella. Shortly after the inspection, the practice manager shared records with the lead inspector to demonstrate that they contacted a service on 16 December 2015 in order to arrange for an up to date legionella risk assessment to be completed.

Effective

Good

Updated 11 February 2016

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment, we saw several audit records to support this, results were circulated and discussed in the practice.

  • 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. We saw evidence that monthly multi-disciplinary team meetings and gold standards framework for end of life care (GSF) meetings took place.

Caring

Good

Updated 11 February 2016

he practice is rated as good for providing caring services.

  • Patients said they were satisfied with the care provided by the practice and that their dignity and privacy was respected.

  • Information for patients about the services available was easy to understand and accessible. Notices in the patient waiting room told patients how to access a number of support groups and organisations.

  • Results from the national GP patient survey published in July 2015 showed patients were happy with how they were treated and that this was with compassion, dignity and respect.
  • We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 11 February 2016

The practice is rated as good for providing responsive services.

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised.

  • The practice worked with the local CCG and the Dudley Council for Voluntary Service (CVS) team to improve outcomes for patients in the area. For example, the practice was part of a scheme in the area to help to provide social support to their patients who were living in vulnerable or isolated circumstances.

  • 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. The practice offered a walk in and waits service for childhood immunisations. The GPs carried out home visits for older patients and patients who would benefit from these.
  • There were disabled facilities, hearing loop and translation services available.
  • The practice provided an in-house phlebotomy service for patient blood tests.

Well-led

Good

Updated 11 February 2016

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

  • There was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care.

  • The partners encouraged a culture of openness and honesty. The practice had systems in place for managing notifiable safety incidents.
  • The practice proactively sought feedback from staff and patients, which it acted on. Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans.
  • The practice had very active patient participation group which influenced practice development. Whilst the PPG had only been in place for 12 months, we found that they had been involved in a number of successful events and projects at the practice.
Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

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

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

  • Performance for overall diabetes related indicators was 90% compared to the CCG average of 88% the national average of 89%.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 11 February 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
  • The practice offered a walk in and waits service for childhood immunisations. Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for under two year olds ranged from 90% to 100% compared to the CCG averages which ranged from 80% to 100%. Immunisation rates for five year olds ranged from 95% to 100% compared to the CCG average of 93% to 98%.
  • 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.

Older people

Good

Updated 11 February 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.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice was part of a scheme in the area to help provide social support to their patients who were living in vulnerable or isolated circumstances. The practice was able to demonstrate the success of this scheme with examples of how members of the practice’s older population who been living in isolated circumstances were now living more active lifestyles through attending local centres and community clubs.
  • 90% of the practices patients above the age of 75 had received a health check

Working age people (including those recently retired and students)

Good

Updated 11 February 2016

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

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

  • The practice’s uptake for the cervical screening programme was 83%, compared to the national average of 81%.
  • Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP each morning.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health.

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

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The PPG held a successful mental health awareness day in November 2015 which provided people with information and guidance on mental health.

  • Annual reviews had been provided to 90% of the practices patients experiencing poor mental health.
  • Data showed that diagnosis rates for patients with a dementia were 100%, with an exception rate of 0% and 94% of these patients had received an annual review.

People whose circumstances may make them vulnerable

Good

Updated 11 February 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 homeless people, travellers and those with a learning disability.

  • 78% of the practices patients with a learning disability had a care plan in place and 94% had received an annual review.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations.