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Inspection Summary


Overall summary & rating

Good

Updated 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Discovery Practice on 28 September 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
  • 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. For example, the installation of a self-help notice board.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, 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 acted upon feedback from staff and patients.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

However there was an area of practice where the provider should make improvements:

  • Nursing staff should participate in clinical supervision sessions and these should be documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 November 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation.

  • Information about safety was highly valued and was used to promote learning and improvement.

  • When things went wrong patients received reasonable support, truthful information, and an 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.

  • The practice used a national reporting system for the notification of significant incidents, where required.

Changes in clinical guidance were conveyed to staff members through daily communication.

Effective

Good

Updated 11 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly around average compared to the national percentages.

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

  • Clinical audits demonstrated quality improvement.

  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

The practice worked with other local providers to share best practice.

Caring

Good

Updated 11 November 2016

The practice is rated as good for providing caring services.

  • 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, some of it was also available in other languages.

  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • We saw evidence of reception staff being extremely patient and understanding towards patients trying to communicate their needs.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Responsive

Good

Updated 11 November 2016

The practice is rated as good for providing responsive services.

  • 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.

  • Patients could access appointments and services in a way and at a time that suited them, with appointments ranging from early morning right through to 6pm.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, it was in the process of setting up a teleconferencing facility to offer video consultations to its nursing homes.

  • The practice had set up a ‘connect’ clinic, offering a long appointment to patients with more than one condition, to review their condition and medication and see a range of professionals within the practice.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Evidence showed the practice responded quickly to complaints and issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 11 November 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • 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 governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The patient participation group was virtual and the practice were striving to increase the profile and involvement of the group.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 11 November 2016

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

  • A practice nurse within the team had an accredited Diabetes qualification.

  • In advance of NICE guidance regarding multimorbidity, the practice had set up dedicated monthly clinics for patients with more than one long term condition.

  • 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 usual 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.

  • The practice had set up a Connect clinic which ran once a month. It offered a ‘one-stop shop’ to patients, enabling them to have blood tests and review their long term conditions conditions and medication, by a range of clinicians in one extended appointment.

Families, children and young people

Good

Updated 11 November 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. Uptake rates were high for all standard childhood immunisations.

  • The practice had a system of follow up when it had been informed that a child had not attended an appointment with an external agency or alternative care provider.

  • 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.

  • The practice had close, regular links with midwives, health visitors and school nurses.

  • The practice has a high number of university students from the UK and abroad and offers flexibility to meet their needs.

Older people

Good

Updated 11 November 2016

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

  • The practice demographic indicated a lower than average percentage of older people within its registered list.

  • As part of the unplanned admission scheme the practice offered same day telephone appointments with a GP and refer patients who were elderly or vulnerable to community matrons for support.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population, including home visits.

Working age people (including those recently retired and students)

Good

Updated 11 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, 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.

  • Working in federation with the local STAR (South Tees Access and Response) service, the practice were able to offer extended hours appointments through dedicated hubs.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 November 2016

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

  • Performance for mental health related indicators was better than the national average.

    The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 94% which was around 5% higher than the CCG average and higher than the national average of 88%.

  • The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 74% which was lower than the CCG average of 83% and the national average of 84%

  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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 practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 11 November 2016

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

  • The practice had a good in depth knowledge of its vulnerable patients.

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

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • 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 had good links with the alcohol liaison team.

  • There were carers champions within the practice.

  • The practice actively promoted dementia friendly activities through the Alzheimer’s society, inviting workers to give talks within the practice premises.