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Ombersley Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ombersley Medical Centre on 30 September 2016. The practice is rated as outstanding for the caring and responsive domains and good for all other domains. The overall rating for this service is outstanding.

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

  • The practice was aware of and provided services according to the needs of their patient population.
  • Processes and procedures kept patients safe. This included a system for reporting and recording significant events, keeping these under review and sharing learning where this occurred.
  • Patients told us they were treated with dignity and respect and that they were fully involved in decisions about their care and treatment.
  • Information about services and how to complain was available and easy to understand. Patients told us that they knew how to complain if they needed to.
  • There was a clear leadership structure and staff told us they felt supported by management.
  • The practice proactively sought feedback from patients, which it acted on.
  • The practice had an active Patient Participation Group (PPG). The PPG were proactive in representing patients and assisted the practice in making improvements to the services provided.
  • Staff received regular training and skill updates to ensure they had the appropriate skills, knowledge and experience to deliver effective care and treatment.
  • Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure patients received the best care and treatment in a coordinated way.
  • Staff appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice.
  • The practice was aware of the requirements of the duty of candour and systems ensured compliance with this.
  • There was a culture of openness and accountability.

We saw areas of outstanding practice which included:

  • The practice had identified a large number of carers within their patient population, with 247 carers registered (6% of the practice population). They worked holistically to identify and support carers which included all members of the practice team and the integrated care team. This holistic approach had seen an increase in the numbers of carers identified within the patient list from 2% to 6% over the last five years.

  • The practice had reviewed the building environment to make this more dementia friendly for patients. For example, clear signage had been introduced in the reception area, picture cards were available to use with patients to help them communicate and a suitable clock had been installed in the reception area that indicated the day and date.
  • Results from the National GP Patient Survey published in July 2016 showed that patients’ satisfaction with services provided by the practice was significantly higher than local and national levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 April 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting and recording significant events and this supported the recording of notifiable incidents under the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
  • Lessons learned were shared throughout the practice with all relevant staff at weekly clinical meetings and monthly team meetings so that improvements made could be monitored.
  • The practice had systems, processes and practices to keep patients safe and safeguarded from abuse. Staff had received training relevant to their role.
  • Risks to patients were assessed and well managed.
  • Appropriate recruitment procedures were followed to ensure that only suitably qualified staff were employed to work at the practice.
  • Meetings took place each week with the health visitor and information was shared accordingly.
  • The dispensary had arrangements for managing medicines including emergency medicines and vaccines to ensure patients were kept safe.

Effective

Good

Updated 11 April 2017

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • The practice had improved the quality of care and treatment it provided through clinical audit and ongoing monitoring.
  • They also participated in local audits, national benchmarking, accreditation and peer review. The practice took part in the Clinical Commissioning Group (CCG) programme of monitoring and audit assessment called Improving Quality and Supporting Practices (IQSP). As part of the IQSP process the practice met three times per year with the CCG to discuss audits, interpret the results and plan areas for future monitoring.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to or above average for the locality and the national average.
  • Staff worked with other health care teams and there were systems to ensure appropriate information was shared.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • We saw evidence that staff received appraisals and had personal development plans which identified future training needs.
  • Patients were encouraged to attend national programmes for bowel and breast cancer screening, with results which were in line with or higher than local and national averages. Uptake for the cervical screening programme was 97% which was above the local average of 83% and above the national average of 82%.

Caring

Outstanding

Updated 11 April 2017

The practice is rated as outstanding for providing caring services.

  • Staff were courteous and very helpful to patients both attending at the reception desk and on the telephone.
  • We saw that patients were treated with dignity and respect.
  • Information to help patients understand and access the local services was available. Information was also available in easy to read formats where needed.
  • Results from the National GP Patient Survey published in July 2016 showed that the practice scored significantly higher than average results in relation to patients’ experience of the practice and the satisfaction scores on consultations with GPs and nurses.
  • Patients were very complimentary about the practice and commented that staff were very friendly, they were treated well by all staff, that they received excellent care from the GPs and the nurses, and could always get an appointment when they needed one.
  • Patients told us they were fully involved in their treatment including making decisions about their care and treatment options. The practice had supported 90% of palliative patients to fulfil their preferences for their place of care in the last days of their lives.
  • Patients receiving palliative care who moved out of the practice area had remained on the practice register so their continuity of care could be maintained. Four patients were supported in this way during 2016.
  • Staff were motivated and inspired to offer kind and compassionate care and demonstrated their willingness to go the extra mile for their patients. For example, most staff lived locally and often delivered medicines to patients if they had been unable to collect these, or facilitated access to the practice building by the weekend nursing team for supplies to avoid contacting the out of hours team.
  • The practice had identified a large number of carers within their patient population, with 247 carers registered (6% of the practice population). They worked holistically to identify and support carers which included all members of the practice team and the integrated care team. Their holistic approach had seen an increase in the numbers of carers identified within the patient list from 2% to 6% over the last five years.
  • Dispensary staff supported patients and their carers to manage their medicines in ways which ensured they took their medicines as prescribed and helped them to maintain their independence.
  • The practice manager was the countywide primary care representative on the Carer Support Group and was instrumental in the schemes inception and development.
  • The practice had invited a representative of the local carers association to talk to patients in the waiting room every month. The representative’s photograph was displayed in the waiting room so patients knew who they could approach for advice.

Responsive

Outstanding

Updated 11 April 2017

The practice is rated as outstanding for providing responsive services. This is because the population groups for patients whose circumstances make them vulnerable and patients experiencing poor mental health (including patients with dementia) were rated outstanding.

  • Ombersley Medical Centre reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to make improvements to the services they provided. For example, the practice provided an enhanced service for those patients at the end of their life.
  • Patients said they found they were able to make an appointment with the GPs and that there was continuity of care, with urgent appointments available the same day.
  • Results from the National GP Patient Survey published in July 2016 showed that the practice scored significantly higher than average results in relation to access to appointments.
  • All reception staff had received deaf awareness training this year to ensure that appropriate access for patients with a hearing impairment was offered.
  • Specialist services available at the practice included physiotherapy, midwifery and access to a volunteer counsellor who provided free sessions for patients at the practice.
  • The practice liaised with local businesses who employed transitional staff to coordinate support for patient appointments when needed which often included arranging interpreters.
  • Information about how to complain was available and easy to understand and evidence showed that the practice had responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders accordingly.
  • The practice had a higher than average proportion of patients with palliative care needs at 1.1% compared with the national average of 0.5%. GPs visited these patients out of core hours during evenings and at weekends to ensure they received continuity of care.
  • The practice had reviewed the building environment to make this more dementia friendly for patients. For example, clear signage had been introduced in the reception area, picture cards were available to use with patients to help them communicate and a suitable clock had been installed in the reception area that indicated the day and date.

Well-led

Good

Updated 11 April 2017

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

  • There was a clear vision and strategy to provide high quality care for all their patients. Staff were clear about the strategy and their role to achieve this.
  • There was a clear leadership structure and staff understood their roles and responsibilities. Governance systems ensured that services were monitored and reviewed to drive improvement within the practice.
  • The practice was aware of and complied with the requirements of the duty of candour.
  • A culture of openness and honesty was encouraged.
  • The practice had systems for responding to notifiable safety incidents and ensured this information was shared with staff so that appropriate action was taken.
  • The practice had an active Patient Participation Group (PPG) and responded to feedback from patients about suggestions for service improvements. A PPG is a group of patients registered with a practice who work with the practice team to improve services and the quality of care.
  • A newsletter produced by the practice, in conjunction with the PPG gave patients current news including details of any staff changes and information about practice future plans.
  • There was a strong focus on continuous learning and improvement at all levels. Formal clinical and full team meetings were held to share best practice or lessons learned.
  • Training and development of the pharmacist role was in progress. It was planned for the pharmacist to become qualified to prescribe and respond to minor patient concerns and share the clinical workload to broaden the clinical time available to patients with GPs.
  • Staff felt supported by management. They told us that should they have any concerns they would be able to speak to anyone about this as everyone at the practice was easy to talk to and approachable.
Checks on specific services

People with long term conditions

Outstanding

Updated 11 April 2017

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

  • Longer appointments and home visits were available when needed.
  • All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met.
  • The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nursing staff had received appropriate training in chronic disease management, such as asthma and diabetes.
  • GPs attended annual specialist palliative care training to continually develop their skills to provide up-to-date care for patients requiring palliative care.
  • Clinical staff had close working relationships with external health professionals to ensure patients received up to date care.
  • NHS health checks were offered for early identification of chronic disease and proactive monitoring.
  • The practice had a higher than average proportion of patients with palliative care needs at 1.1% compared with the national average of 0.5%. GPs visited these patients out of core hours during evenings and at weekends to ensure they received continuity of care.
  • Palliative care patients who moved out of the practice area had remained on the practice register so their continuity of care could be maintained. Four patients were supported in this way during 2016. The practice had supported 90% of palliative patients to fulfil their preferences for their place of care in the last days of their lives.
  • Dispensary staff supported patients and their carers to manage their medicines in ways which ensured they took their medicines as prescribed and helped them to maintain their independence.

Families, children and young people

Good

Updated 11 April 2017

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

  • Staff had been trained to recognise signs of abuse in vulnerable children and the action they should take if they had concerns. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level in safeguarding children. All safeguarding concerns were discussed at the weekly GPs meetings.
  • Same day appointments were offered to all children under the age of five.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were systems to identify and follow up children living in disadvantaged circumstances and who were considered to be at risk of harm. For example, children and young people who had a high number of accident and emergency attendances.
  • The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
  • The practice worked with midwives and health visitors to coordinate care.
  • Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
  • The practice’s uptake for the cervical screening programme was 97% which was above the local average of 83% and above the national average of 82%. Exception reporting at 11% was however higher than local and national levels of 7% and 6% respectively. The practice had taken action to address this which included letters to patients encouraging them to attend for screening and disclaimer forms for those patients who, after four attempts declined the opportunity.
  • The practice offered a number of online services including requesting repeat medicines and booking appointments.

Older people

Good

Updated 11 April 2017

The practice is rated as good for the care of older patients.

  • The practice offered personalised care to meet the needs of the older people in its population and was responsive to the needs of older patients.
  • They offered home visits and rapid access appointments for those patients with enhanced needs.
  • The practice offered a range of enhanced services, for example, in dementia and end of life care.
  • Nationally reported data showed that outcomes for patients were generally above average for conditions commonly found in older patients.
  • Staff liaised with Age UK to provide support and assess the social and health needs of older patients in the community.

Working age people (including those recently retired and students)

Good

Updated 11 April 2017

The practice is rated as good for the care of working-age patients (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 services that reflected the needs of this age group.
  • Extended hours were provided for pre-bookable appointments two days per week from 7am to 8am for those patients who were unable to attend appointments during daytime hours. Telephone consultations were also offered to provide patients with more flexibility.
  • Health promotion advice was offered such as smoking cessation and nutrition, with health promotion material available at the practice and on its website.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 April 2017

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

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health.
  • Clinical staff were trained to recognise patients presenting with mental health conditions and to carry out comprehensive assessments.
  • Three members of staff were Dementia Friends. The practice staff were aware of local dementia cafes and signposted patients and their carers to these.
  • The practice had reviewed the building environment to make this more dementia friendly for patients. Clear signage had been introduced in the reception area, picture cards were available to use with patients to help them communicate and a suitable clock had been installed in the reception area that indicated the day and date.
  • The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system to follow up patients who had attended accident and emergency departments where they may have been experiencing poor mental health.
  • Nationally reported data showed that outcomes for patients were higher than local and national averages for conditions commonly found for patients with poor mental health.

People whose circumstances may make them vulnerable

Outstanding

Updated 11 April 2017

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

  • Staff had been trained to recognise signs of abuse in vulnerable adults and the action they should take if they had concerns. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level in safeguarding adults. All safeguarding concerns were discussed at the weekly GPs meetings.
  • Clinical staff regularly worked with multidisciplinary teams in the case management of vulnerable patients. Alerts were added to patients records for staff awareness so that longer appointments could be allocated.
  • Services were provided for vulnerable patients including a transient population of travellers, seasonal workers who were employed by nearby fruit farms and overseas visitors. The practice liaised with the employers to coordinate support for patient appointments when needed which often included arranging interpreters.
  • All reception staff had received deaf awareness training to ensure that appropriate access for patients with a hearing impairment was offered. Patients commented that this helped them when they needed to see their GP or nurse.
  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
  • Longer appointments were available for patients with a learning disability. There were 15 patients registered and during 2015/2016 seven patients had attended for their health checks, with five patients invited but declined. A further three patients were monitored under the children’s services for their health needs.
  • Information was available in different formats, such as large print, braille and picture format.
  • Interpreter and translation services were provided should patients need these.
  • The practice had identified a large number of carers within their patient population, with 247 carers registered (6% of the practice population). They worked holistically to identify and support carers which included all members of the practice team and the integrated care team. This holistic approach had seen an increase in the numbers of carers identified within the patient list from 2% to 6% over the last five years. Support included a dedicated care telephone line to maintain regular contact with carers. Care navigators linked with other agencies depending on the type of support carers needed at the time; they sought views from carers on how to improve the support they provided and held events for carers at the practice.