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Shipston Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shipston Medical Centre on 01 March 2016. The overall rating for this service is outstanding.

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

  • Patients’ needs were assessed and care was provided to meet those needs in line with current guidance. Staff had the skills and expertise to deliver effective care and treatment to patients, and this was maintained through a programme of continuous development to ensure their skills remained current and up-to-date.
  • Information was provided to help patients understand the care available to them. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to reporting and recording these and learning was shared with staff at meetings relevant to their roles and responsibilities.
  • 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. For example, the practice engaged with a local Health and Wellbeing Board to improve the care of patients with mental health concerns and those who cared for them.
  • The practice had a clear vision which had quality and safety as its top priority. Planning was in place to demonstrate the intended development of the services provided by the practice.

We saw several areas of outstanding practice including:

  • The practice had initiated with people of Shipston on Stour for the town to become a dementia friendly community and a community steering group had been formed. Learning was shared within the community and safe places were established in areas such as cafes and shops that patients with dementia could feel safe. Families and carers of patients had commented on how patients had benefitted from this as people in the community showed greater awareness and understanding of patients’ needs.

  • The practice engaged with a local charity to educate the community and specifically younger people on the dangers of alcohol and drug misuse. One of the GPs provided regular educational sessions at the local youth club. Information was available to show these were well attended.

  • There were innovative approaches to providing integrated person-centred care. The GPs attended the local Children’s Centre every six weeks to provide educational sessions on minor illness and the care of young children with new parents. Practice nurses provided educational sessions on the use of inhalers at a local children’s nursery. Health visitors confirmed that the sessions were consistently attended by on average six mums, and that these helped young mums develop their knowledge and skills to become more confident in caring for their babies and young children.

  • The practice promoted health awareness through community groups such as the Lions and Rotary in which blood pressure and diabetes screening was carried out. They held on-site educational evenings for those patients with poorly controlled diabetes which were supported by local groups such as slimming clubs and local activity groups. In excess of 60 people attended to receive these checks and healthy living advice.

  • The practice provided a free loan of equipment for patients such as wheelchairs and nebulisers. They also facilitated the calibration of patients own equipment to ensure it worked correctly and accurately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 May 2016

The practice is rated as good for providing safe services.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • There was an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Lessons were shared to make sure action was taken to improve safety in the practice.
  • Risks to patients were assessed, well-managed with enough staff employed to keep patients safe.
  • The practice participated in the Identification and Referral to Improve Safety (IRIS) scheme (a domestic violence and abuse training support and referral programme). The project provided staff with training to help with detecting potential signs of abuse and sign-posted patients to appropriate support agencies. Staff reported that there was evidence to show that the programme was beneficial to patients.

Effective

Good

Updated 11 May 2016

The practice is rated as good for providing effective services.

  • Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. There was evidence that annual appraisals were carried out routinely and personal development plans were in place for all staff.
  • A specialist nurse provided a preventative service focussed on  patients aged 75 and over, to reach those patients who had not visited the practice, those patients discharged from hospital or those patients who were housebound. We saw that positive results had been achieved in the reduced number of patients who had been admitted to hospital in an emergency.

  • Clinical audits had been carried out in order to demonstrate quality improvement to services provided.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Meetings were held regularly and were attended by district and palliative care nurses.
  • The practice demonstrated their flexibility to provide services for patients throughout the community it served. They provided medical cover and support for the minor injuries unit at the local hospital and also provided local out of hours cover for weekends and bank holidays.

Caring

Outstanding

Updated 11 May 2016

The practice is rated as outstanding for providing caring services.

  • Patients said they were involved in decisions about their care and treatment, and treated with compassion, dignity and respect. We also saw that staff treated patients with kindness and respect and maintained confidentiality.
  • Data published January 2016 showed that patients rated the practice higher than others for almost all aspects of care. The practice achieved particularly strong results around patient’s involvement in care and treatment decisions. For example, 93% of patients said the last GP they saw was good at involving them in decisions about their care which was above the Clinical Commissioning Group (CCG) average of 86% and the national average of 82%. 95% of patients said the last GP they saw was good at explaining tests and treatments which was in line with the CCG average and above the national average of 86%.
  • Patients told us that they received excellent care from the GPs and the nurses and that practice staff were very caring. Data showed that reception staff scored highly compared with local and national averages. 94% of patients said they found the receptionists at the practice helpful (CCG average 89% and national average 87%).
  • We observed a strong patient-centred culture which encouraged long term relationships with patients that promoted continuity of care. The practice supported carers through a variety of initiatives. The practice offered health checks and referrals for social services support. They also encouraged patients to attend the monthly carers group meetings held at the local community hospital which the practice has supported.
  • They had worked with other agencies to identify carers in the location. They held carers events and planned to facilitate weekly clinics for carers at the practice. The practice ensured that carers were seen routinely so their health and welfare was monitored.
  • The practice linked with local services and charities such as two food banks, citizens’ advice and local hardship charities and signposted those patients who experienced difficult times.
  • Views of external stakeholders, such as the community healthcare professionals told us that the practice staff responded quickly to any concerns they raised about patients they saw in the community.

Responsive

Outstanding

Updated 11 May 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 met patients’ needs. Meetings were regularly attended with other practices and partner organisations from the locality so that services could be monitored and improved as required.
  • We saw numerous examples of the practice referring to and engaging with relevant community organisations to benefit both the physical and emotional health of the patients.
  • The practice held educational evenings to support patients in managing their diabetes. The practice won an award at The General Practice Awards in 2015 in recognition of the improvement achieved in patient control of their diabetes. The awards recognised and highlighted hard work and innovation in practices throughout the UK.
  • The practice promoted community screening events to promote health awareness which included blood pressure and diabetes screening.
  • 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 practices within the local Clinical Commissioning Group (CCG) group and the GP Federation.
  • There were innovative approaches to providing integrated person-centred care. The GPs attended the local Children’s Centre every six weeks to provide educational sessions on minor illness and the care of young children with new parents. Practice nurses had provided educational sessions on the use of inhalers at a local children’s nursery.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services through annual patient meetings, the Patient Participation Group, patient involvement in practice working groups, patient survey and other surveys for monitoring specific services (phlebotomy, dispensary and minor surgery). The practice also contributed regular articles for the Shipston Forum community newsletter.
  • Patients could access appointments and services in a way and at a time that suited them. Online appointments could be booked up to eight weeks in advance. There were urgent appointments available the same day. Extended hours were available to benefit patients unable to attend during the main part of the working day.

Well-led

Outstanding

Updated 11 May 2016

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

  • There was a clear leadership structure and staff felt supported by management. 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 practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff knew about the vision and their responsibilities in relation to this as they had been involved in developing the practice’s five year strategic plan.
  • Staff morale was high with a high level of staff satisfaction with evidence of teamwork. The practice encouraged a culture of openness and honesty. High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active Patient Participation Group (PPG) which was positive about their role in working with the practice to respond to patient feedback and make improvements where needed.
  • The practice worked with external agencies and groups to improve outcomes for patients, through education to encourage healthier lifestyles and opportunities for early detection of health concerns such as high blood pressure and dementia.
Checks on specific services

People with long term conditions

Outstanding

Updated 11 May 2016

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

  • There were systems in place to monitor patients with chronic diseases. The practice nurse had lead roles and closely monitored patients at risk of hospital admission. Longer appointments and home visits were available when needed.
  • Patients had a structured annual review to check that their health and medicine needs were being met. Where patients had more than one health condition patients were encouraged to attend for holistic reviews to reduce the number of visits they needed to make to monitor their conditions.
  • For those patients with the most complex needs, the GPs and practice nurses worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The Quality and Outcome Framework (QOF) data for 2014/2015 showed variable data for some long term conditions, for example diabetes and osteoporosis. This was due to data improvement work which improved the recording of patients with these conditions, enabling the practice to ensure better care for individuals in these groups.
  • Educational evenings were organised by the practice to support those patients whose diabetes was poorly controlled. Patients, staff, a dietician, local sports and activity groups, and slimming clubs also attended to provide support. Audits showed a significant improvement in the control of diabetes had been achieved, and the practice nurses gained an award in recognition of this at the National General Practice Awards in 2015.
  • Community screening events were held to promote health awareness. The practice engaged with groups such as the Lions and Rotary to encourage and promote screening for blood pressure and diabetes.

Families, children and young people

Outstanding

Updated 11 May 2016

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

  • The practice actively engaged with the community to support families, children and young people. One of the GPs attended a local children’s centre every six weeks to lead on managing minor illnesses and the care of young children for new parents. Practice nurses had provided educational sessions on the use of inhalers at a local children’s nursery. Health visitors confirmed that the sessions were consistently attended by on average six mums, and that these helped young mums develop their knowledge and skills to become more confident in caring for their babies and young children.
  • 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.
  • Information leaflets were routinely sent to patients as they reached 13 years of age about the services provided and to assure them that they would receive a confidential service from the practice.
  • The practice website provided details for help and advice on various topics such as eating disorders, healthy living and health advice specifically aimed at teenagers.
  • The practice engaged with a local charity to educate the community and specifically younger people on the dangers of alcohol and drug misuse. One of the GPs provided educational sessions at the local youth club which were well attended.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, those who had a high number of accident and emergency (A&E) attendances.
  • Childhood immunisation rates for the vaccinations given were overall higher than the local Clinical Commissioning Group (CCG) averages.
  • Monthly meetings were held with health visitors and the GP safeguarding lead where any concerns they might have were shared.
  • The practice contacted parents when babies and children did not attend for their vaccinations and informed Child Health Services when appropriate.
  • Appointments were available outside of school hours and the premises were suitable for children, with changing facilities available for babies. The practice also offered online services which included booking appointments and requesting repeat medicines.

Older people

Outstanding

Updated 11 May 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice held regular multidisciplinary integrated care meetings where all patients on the palliative care register were discussed.
  • There was a dedicated nurse who worked in conjunction with Age UK to provide holistic reviews of patients over the age of 75 years, and worked proactively to help patients maintain good health.

  • The practice worked closely with other services and community groups to maintain older patients in their own home, which included regular reviews for patients who attended the Day Unit at the local hospital.
  • Support and weekly ward rounds were provided routinely for a local care home for the elderly.

Working age people (including those recently retired and students)

Outstanding

Updated 11 May 2016

The practice is rated as outstanding 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.
  • Extended hours appointments were available from 4.30pm to 5.50pm weekdays, between 6.30pm and 8pm on Thursday evenings and Saturday mornings for pre-bookable appointments up to eight weeks in advance. The online service allowed patients to order repeat prescriptions and book appointments.
  • The practice offered a full range of health promotion and screening services that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 11 May 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those patients with dementia. Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
  • The practice had initiated a dementia friendly community in Shipston on Stour as which led to the development of a community steering group. The practice considered this as a positive initiative. The increased awareness locally particularly in local shops had helped in supporting patients with dementia. A leaflet about local support and activities that were available for patients with dementia was developed and the practice promoted this to patients.
  • Clinical staff understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005. Staff had received training on how to care for patients with mental health needs and dementia.

  • There was 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.
  • Counselling services were offered at the practice to support patients such as those who had experienced bereavement or poor mental health.

  • The practice had a shared care agreement with a local substance misuse support agency. Patients were seen on site by the drug support worker and GPs were closely involved in coordinating their care.

People whose circumstances may make them vulnerable

Outstanding

Updated 11 May 2016

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

  • The practice held a register of patients who experienced poor mental health including patients with a learning disability. Annual health checks were carried out and longer appointments were offered to patients in this population group.
  • Vulnerable patients were supported to register with the practice, such as homeless people or travellers. The practice supported approximately 40 -50 travellers who were registered with the practice, and offered flexible appointment times to meet their needs.
  • The practice engaged in local initiatives to provide additional services such as the Identification and Referral to Improve Safety (IRIS) scheme (a domestic violence and abuse training, support and referral programme). The project provided staff with training to help them with detecting any signs of abuse so patients could be sign-posted to support agencies.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Patients were provided with information about how to access various support groups and voluntary organisations. For example, through leaflets available in the waiting area and on the practice’s website.
  • Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
  • The practice worked to the Gold Standards Framework for the provision of palliative care, in conjunction with the wider primary health care team. Continual monitoring by all agencies ensured that areas for improvement were identified and changes made. Improvements demonstrated that patients chosen path for their end of life had been achieved.