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Albrighton Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Albrighton Medical Practice on 5 January 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 but not always as well documented as acted upon.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice recognised the value of patient care over and above ensuring they achieved good Quality and Outcome Framework (QoF) results and they choose to maintain some former QoF requirements to ensure they captured all the quality aspects of the service they provided.

  • The practice GP staff accessed the RAF base nearby to provide a GP service where required.

  • Feedback from patients about their care was consistently positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

  • The practice welcomed young people and was a Department of Health (DoH) awarded ‘You’re Welcome’ practice. The practice provided young people with their own ‘You’re Welcome' brochure.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. Examples included: arranging a home delivery service from chemists for house bound patients, changes to the arrangement of seating so chairs with arms were readily available for those needing them, and the provision of community transport links to help patients attend surgery.

  • 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.

  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

  • The practice ensured that any children at risk from actual or potential abuse who re-located to another area were followed up by arranging a discussion with the new GP practice to share any known concerns.

  • The practice provided support considered to be above and beyond that which was expected with regards to palliative care patients. Each patient had priority in terms of appointments, telephone contact or visits from their preferred GP. GPs gave out their own mobile telephone numbers to these patients and continued to visit them on days off, weekends and evenings. The practice held a register of 79 palliative care patients, most of whom were elderly.Each patient was discussed monthly at a dedicated multidisciplinary meeting with representatives from the district nurses, local hospice and all available doctors.

  • The practice demonstrated a whole practice approach to significant event reporting and had a designated lead GP for significant events, who also presented any findings annually to the whole team. Events were risk rated to identify those with more serious implications for patient safety to prioritise them for action. Positive events were also recorded to ensure these could be celebrated and shared as good practice with the team.

However there were areas of practice where the provider should make improvements:

  • Complete documentation such as noting the serial numbers and number of prescription sheets to ensure blank prescription pads are auditable.

  • The practice should check that all the fire alarm call points work and investigate whether the smoke detectors and emergency lighting had been checked and maintained.

  • At the end of the complaints process a letter from the practice should inform the complainant of the further steps available to them if they remain unhappy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 February 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

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

  • Risks to patients were assessed and well managed.

Effective

Outstanding

Updated 25 February 2016

The practice is rated as outstanding for providing effective services.

  • Data showed patient outcomes were at or 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.

  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients.

  • The practice ensured that any children at risk from actual or potential abuse who re-located to another area were followed up by arranging a discussion with the new GP practice to share any known concerns.

  • The practice provided support considered to be above and beyond that which was expected with regards to palliative care patients. Each patient had priority in terms of appointments, telephone contact or visits from their preferred GP. GPs gave out their own mobile telephone numbers to these patients and continued to visit them on days off, weekends and evenings. The practice held a register of 79 palliative care patients, most of whom were elderly. Each patient was discussed monthly at a dedicated multidisciplinary meeting with representatives from the district nurses, local hospice and all available doctors.

  • The practice recognised the value of patient care over and above ensuring they achieved good Quality and Outcome Framework (QoF) results and they choose to maintain some former QoF requirements to ensure they captured all the quality aspects of the service they provided.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

Caring

Outstanding

Updated 25 February 2016

The practice is rated as outstanding for providing caring services.

  • Data from the National GP Patient Survey showed 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • We observed a strong patient-centred culture.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

Responsive

Outstanding

Updated 25 February 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, they worked closely with the Compassionate Communities (co-co) volunteers, the Care Coordinators in the local community as well as the out of hour’s providers and secondary care providers.

  • There were innovative approaches to providing integrated person-centred care. The nurses took on the role of ensuring that patients on disease modifying medicines had regular blood tests and the GPs took the role of monitoring the results and prescribing safely.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. Examples included: arranging a home delivery service from chemists for house bound patients, changes to the arrangement of seating so chairs with arms were readily available for those needing them and the provision of community transport link to help patients attend surgery.

  • Patients could access appointments and services in a way and at a time that suited them. For example on line repeat prescriptions and on line appointments and the practice offered a dispensing service to eligible patients.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 25 February 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. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • The practice GPs and staff provided medical students and GP registrar training and support, with some staff returning as a GP at the practice.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • The practice carried out proactive succession planning.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients and it had a very active patient participation group which influenced practice development. The practice had purchased a syringe driver from the practice’s ‘Comfort Fund’ in order that staff may further support their palliative care patients.

Checks on specific services

People with long term conditions

Outstanding

Updated 25 February 2016

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

  • Longer appointments and home visits were available when needed.

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

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • We found a marked improvement to December 2015 in that the seasonal influenza vaccination uptake rates for patients with Chronic Obstructive Pulmonary Disease, diabetes or stroke/transient ischaemic attack (TIA) or "mini stroke was 95% which was better than their 2014/2015 Quality Outcome Framework (QoF) results of 60.56%, and the national average of 56.56%.

  • The practice held regular clinics with members of the nursing staff and GPs with specialist interests in the fields of diabetes and COPD/asthma. We saw that the percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 94% when compared to the national figure of 89.9%.

  • Patients experienced an evidence-based and thorough approach to hypertension and cholesterol assessment and management. As the practice had put into place procedures for clinical staff to follow in response to the National Institute for Health and Care Excellence (NICE) guidelines including hypertension (high blood pressure) and cholesterol management. For example, a patient with suspected hypertension had blood tests, ambulatory blood pressure monitoring and an electrocardiogram (ECG) before seeing a GP.

  • The practice recognised the value of patient care over and above ensuring they achieved good Quality and Outcome Framework (QoF) results and they choose to maintain some former QoF requirements to ensure they captured all the quality aspects of the service they provided.

Families, children and young people

Outstanding

Updated 25 February 2016

The practice is rated as outstanding 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 high for all standard childhood immunisations.

  • The ‘amber alert’ system at the practice allowed staff to be aware of which children were on a child protection register, and any new and existing cases of concern were discussed regularly at clinical and partnership meetings as well as opportunistically.

  • 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.

  • The practice’s uptake for the cervical screening programme was 85.9%, which was comparable to the national average of 81.83%. There was an 85% uptake in cervical screening within the last 5 years.The vast majority of those remaining were offered a smear test at least once. Smear taking formed part of the GP registrar training and patients were able to book with a doctor or a nurse.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • The practice was aware of and monitored their teenage pregnancy rates for under 18s which were low.

  • The practice had received the ‘You’re Welcome’ award for improving access for young people and had a dedicated area on their website and notice boards for young people. Young patients could make their own appointments, even if under 16. The practices 'You’re Welcome' literature contained links to useful websites for young people to access.

  • The practice offered full contraception services including free condoms and implant/coil fitting.

  • Within the practice there were weekly child health/vaccination clinics with the practice nurses, health visitors and a GP available.

  • The uptake of the flu vaccine in pregnant women was 82%.

Older people

Outstanding

Updated 25 February 2016

The practice is rated as outstanding for the care of older people.

  • The practice provided support to 118 patients who lived in three care homes. A named GP visited the care homes at least weekly to provide continuity of care, as well as on request. The time dedicated to routine care homes visits was in excess of one full day per week of GP time.

  • The practice had actively engaged in the ‘Care Home Advanced Scheme’ since its creation in 2013.This involved, over the last three winters, time of up to an hour spent with individual patients and their families, creating or reviewing care plans and discussing issues such as current medical concerns, ‘just-in-case’ or rescue medication, resuscitation orders and how to avoid admission to hospital in general.

  • The practice maintained a register of the two percent of their patients who were thought to be the most frail and vulnerable; these patients had dedicated book-on-day appointments and their patient record contained alerts to ensure reception staff were aware should these patients call for an appointment. All admissions to hospital within this group were monitored and they received a telephone call or visit as soon as possible after discharge.All admissions were discussed at monthly clinical governance meetings.

  • The practice held a register of palliative care patients the majority of which were older patients. Each patient was discussed monthly at a dedicated multidisciplinary meeting with representatives from the district nurses, local hospice and all available GPs.

  • The practice provided support considered to be above and beyond that which was expected with regards to palliative care patients.Each patient had priority in terms of appointments, telephone contact or visits from their preferred GP. GPs gave out their mobile telephone numbers to these patients and continued to visit them on days off, weekends and evenings. For example; within the last six months a GP visited a patient with advanced bowel cancer on a Saturday evening and avoided a potential emergency admission with chest pain by treating them for acute gastritis (a common condition in which the lining of the stomach becomes inflamed and irritated). Another example was a GP who visited a patient who had breast cancer every day for two weeks at home. They were able to provide enough support, in conjunction with the district nurse team, that despite the hospice having no beds available for the duration of this period, the patient had a comfortable death at home and the family received the support they needed.

  • The practice had achieved positive results for the shingles uptake in the 2014/15 campaign in those aged 70 years, 92%, aged 79 years, 86% and aged 78 years 96%.

  • To December 2015, 83% of over-65s had received or declined the ‘flu jab’. This was an improvement on the previous year’s uptake of 75.86%.

Working age people (including those recently retired and students)

Good

Updated 25 February 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, 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 reflects the needs for this age group.

  • Each Monday evening a ‘commuter clinic’ was run until 8.45pm with appointments available with a GP, nurse and Healthcare Assistant. These appointments were available at short notice and were popular with patients who worked or had other commitments during the daytime.

The practice also signed up for the West Midlands Patient Access scheme which involved opening the practice on an additional evening for routine pre-booked appointments. At the time of the inspection, this was occurring once or twice per month.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with who have a comprehensive, agreed care plan documented in

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 98.29% which was above the national average of 84.01%.

  • The percentage of patients with other mental health conditions who had a comprehensive, agreed care plan was 97.37% which was better than the national average of 88.47%.

  • The dementia register consisted of 130 patients. In August 2015 the practice carried out searches to identify which of their patients needed to be added to this register; which were not known to memory services and which of the patients known to memory services were not on the register. The motivation for this was a desire to ensure all patients had access to appropriate help and support.

  • All patients with a Deprivation of Liberty Safeguards (DoLs) order had this flagged on their medical records.

  • The practice sent letters to all patients for whom they received an A&E report of deliberate self-harm, offering support and an appointment if required. Many of these patients were also followed up with a telephone call.

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

  • The practice 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice offered a weekly substance misuse clinic for its patients.

People whose circumstances may make them vulnerable

Good

Updated 25 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.

  • The practice offered longer appointments for patients with a learning disability. The practice learning disability register consisted of 26 patients.A robust recall system was in place for these patients whereby they were invited for a health check with a Health Care Assistant and their preferred doctor, at least annually.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice informed 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.

  • The practice maintained a carers’ register which included 149 individuals.

  • An example of co-ordinated care having a dramatic effect on patient outcomes was a case of an older patient who attended the practice regularly. The patient missed their appointment and rather than continue with their busy clinic the Healthcare Assistant (HCA) tried to contact the patient with no reply. The HCA expressed concerns to a GP who subsequently visited the patient. With the help of the police the GP gained access to the patients’ home and it was found that they had been incapacitated for two days.

  • The Practice engaged with the local Compassionate Communities group known as Co Co. The initiative is not run by any one organisation but the community itself with the support of the hospice which provided training and ongoing guidance for volunteers. The scheme involves working with a number of local communities and medical practices.