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Inspection Summary


Overall summary & rating

Good

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Leys Medical Practice on 7 July 2015 and at the dispensary in the branch surgery at Fillongley on 8 July 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed including those in relation to recruitment checks.
  • Medicine management systems were overall robust; however we identified the potential risks around the safe and secure storage of medicines which we highlighted to the practice.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice provided a range of flexible and responsive services including a dispensary in a rural area where there was limited public transport.
  • Information about services and how to complain was available and easy to understand.
  • Patients described their experience of making an appointment as good 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 and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw some areas of outstanding practice:

  • The practice worked collaboratively with the medicines management team at the CCG to ensure the availability of all relevant emergency medicines for their end-of-life patients living in care homes. This had resulted in a central store of such medicines being available in the largest care home where the practice provided medical care. This project had been short-listed for a National Award at the Health Service Journal (HSJ) awards last year.
  • The practice had carried out a pilot with funding from the CCG to trial the use of a specialist machine in the diagnognosis and treatment of patients with asthma. The practice found that for this group of identified patients, up to 70% had a positive change in decisions about their treatment due to the use of the specialist machine.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Promote the availability of the chaperone service to enable patients to access this service, if required.
  • Complete a risk assessment in relation to the safe and secure storage of medicines held at Park Leys Medical Practice and at the dispensary at Fillongley Surgery.
  • Ensure guidance documents are regularly reviewed to ensure that they contain up-to-date information, for example the staff handbook and infection control policy

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 November 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. Medicine management systems were mostly satisfactory, however storage and security processes needed to be strengthened. Staff told us they would take steps to address these. The practice offered a chaperone service for patients; however no information was seen to advise patients of the availability of this.

Effective

Good

Updated 26 November 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 26 November 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice 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. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 26 November 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients were generally happy with the appointments system at the practice and urgent appointments were available the same day. 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 and other stakeholders. The practice had developed a number of initiatives to support patients at the end of their lives, one of which had been shortlisted for a National Award at the Health Service Journal awards the previous year. They had also carried out a pilot to improve asthma diagnosis and treatment for patients with this condition. This pilot had improvement treatment options for 70% of the patients involved.

Well-led

Good

Updated 26 November 2015

The practice is rated as good for being well-led. It had a clear vision and staff were clear about their responsibilities in relation to this. 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. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The staff handbook dated May 2009 did not appear to have been reviewed or updated since that time. The patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

Older people

Good

Updated 26 November 2015

The practice is rated as good for the care of older people. The practice provided care to over 500 older patients who lived in care homes in the area. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice had developed a number of initiatives to support patients at the end of their lives, one of which involved improving the availability of emergency medicines for patients in care homes who required end of life care. This project had been shortlisted for a National Award at the Health Service Journal awards the previous year.

The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

People with long term conditions

Good

Updated 26 November 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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. The practice was the only GP practice in the Clinical Commissioning Group to offer a specialist service for asthma patients. They had also carried out a pilot to improve asthma diagnosis and treatment for patients with this condition. This pilot had improvement treatment options for 70% of the patients involved.

Families, children and young people

Good

Updated 26 November 2015

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. Immunisation rates were in line with local and national averages 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 the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Working age people (including those recently retired and students)

Good

Updated 26 November 2015

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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People whose circumstances may make them vulnerable

Good

Updated 26 November 2015

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. It had carried out annual health checks for people with a learning disability and 100% of these patients had received a follow-up. It also offered longer appointments for people with a learning disability.

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

People experiencing poor mental health (including people with dementia)

Good

Updated 26 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Records showed that 78% of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. We saw that the practice had a lead GP who specialised in the care of patients with mental health needs and dementia.