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Daybrook Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Daybrook Medical Practice on 18 November 2015. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Whilst some patients said they found it difficult to get through to the surgery by phone, urgent appointments were available the same day and there was evidence of continuity of care.
  • 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 the patient participation group (PPG) and it’s patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

The provider should continue to improve telephone access to the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 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. Staff we spoke with were able to provide examples of events and subsequent action taken.

  • Lessons were shared to make sure action was taken to improve safety in the practice. This included reviewing procedure and training of staff.

  • When there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again. We found an open and transparent approach where the practice sought to meet with patients affected to discuss issues presented.

  • We reviewed existing policy and spoke with a number of staff regarding safeguarding processes for vulnerable patients and children. This showed the practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed. For example, we found robust process in place in relation to infection control.

Effective

Good

Updated 18 February 2016

The practice is rated as good for providing effective services.

  • Quality Outcomes Framework (QOF) data showed patient outcomes were generally below average for the locality with some exceptions such as dementia. The practice however, had low exception rate reporting compared with local and national averages. This affected their overall results.

  • Staff assessed needs and delivered care in line with current evidence based guidance. This included the National Institute for Health and Care Excellence (NICE) guidance which was used routinely by practice clinicians.

  • We reviewed four clinical audits. These demonstrated quality improvement and positive patient outcomes. The practice also worked with the local CCG pharmacist to undertake audits.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice had also recently appointed new staff which included a GP partner, a nurse practitioner and another member of nursing staff. Staff we spoke with were positive about the new recruitment and meeting patient needs.

  • There was evidence of an induction programme, training, appraisals and personal development plans for all staff. An induction pack had also been produced for locum doctors.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. Our discussions held with staff, review of multi-disciplinary team meeting minutes and care plans implemented supported that the practice met patient’s needs.

Caring

Good

Updated 18 February 2016

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. This included that patients felt GPs listened to them, gave them enough time and they felt confidence and trust in the last GP they spoke with.

  • 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. This included information displayed in the practice and available on their website. The website information could be read in a number of different languages. Translation services were available to those who required this assistance.

  • Carers were identified by clinicians and reception staff from markers placed on their files.

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

Responsive

Good

Updated 18 February 2016

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 to secure improvements to services where these were identified. This included extended hours appointments in the mornings and on some weekday evenings. Same day appointments were available for children and those who urgently required them. Longer appointments were also available for those patients who were identified as requiring them.

  • Whilst data suggested patients found it difficult to get through to the surgery by phone to make an appointment, a high proportion of patients still described their experience of making an appointment as good. We found urgent appointments were available the same day and there was evidence of continuity of care.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had undertaken a Disability Discrimination Act / Equality Act 2010 audit of their premises.

  • 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 lessons learned.

Well-led

Good

Updated 18 February 2016

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

  • It had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. The practice’s mission statement was displayed in the practice waiting area. Staff were clear about the vision and 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 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 knowing about notifiable safety incidents. Learning points were shared amongst staff and documented.

  • The practice proactively sought feedback from patients and it’s patient participation group (PPG), which it acted upon. The practice welcomed staff feedback informally and through staff appraisals undertaken.

  • There was a strong focus on continuous learning and improvement at all levels. This was demonstrated through clinical audits and national and local guidance. Learning was disseminated amongst practice clinicians.

Checks on specific services

People with long term conditions

Good

Updated 18 February 2016

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 received close support from the advanced nurse practitioner. Patients at risk of hospital admission were identified as a priority and action taken to reduce attendance. Nursing staff took an active role in the regular review of unplanned admissions patients.

  • National data showed the practice was performing under the local and national averagesfor eleven diabetes related indicators. The practice received total points of 69.8% compared with the CCG average of 87.3% and national average of 89.2%. The practice exception rate reporting was however lower than the CCG average in ten of the related indicators and lower than national average in eleven of the related indicators. This varied from 0.6% to 10.5% across the eleven indicators.The practice had told us that recent investment in staffing would help to ensure their performance increased to similarly high levels as achieved in recent years.

  • Longer appointments and home visits were available when required. Patient records were highlighted so reception staff knew to allocate a longer appointment time if needed.

  • All these patients had a named GP and a structured annual review to check that their health and medicines 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.

Families, children and young people

Good

Updated 18 February 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.

  • The practice undertook joint working with the health visitor and with the school nurse who was able to provide information of concern about school aged children registered at the practice. Regular meetings took place which were documented.

  • Immunisation rates were relatively high for all standard childhood immunisations and were similar to Clinical Commissioning Group (CCG) averages.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Clinicians recorded that young patients were competent in their notes when this was deemed appropriate. Young patients aged 13 or over were required to register themselves independently for the purpose of online access to the practice.

  • A range of family planning services were available which included the fitting of contraceptive devices.

  • National data showed the practice was above the local and national averages in relation to cervical screening indicators. The practice received total points of 100% compared with the CCG average of 99.8% and national average of 97.6%.

  • Priority appointments were given to pregnant women and sick children. Appointments were available outside of school hours. The premises were suitable for children and babies.

Older people

Good

Updated 18 February 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice list included 889 registered patients who were aged over 75.

  • The number of patients who received the seasonal flu vaccination was in line with national averages. 72.83% of patients had received the vaccination which was comparable to the national average of 73.24%.

  • Care plans were implemented for those patients identified as close to the end of life. The practice held regular multidisciplinary meetings where all patients on the palliative care register were discussed. The practice also followed the Gold Standards Framework (GSF) for end of life care guidelines.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included 20 patients registered at the practice living in residential homes and 220 patients living in a local gated community.

  • The practice identified patients with caring responsibilities and those who required additional support including health reviews. A member of reception staff was the nominated lead for carers and signposted these patients to a local carers hub.

Working age people (including those recently retired and students)

Good

Updated 18 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 offered extended hours appointments which included early morning weekday appointments starting at 7.30am and evening appointments up to 6.30pm on Mondays, Tuesdays and Fridays and 7.00pm on Mondays. Telephone appointments with a clinician were also offered if a patient was unable to attend the surgery.

  • 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. This included health checks and new patient checks which were undertaken by a practice nurse.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 February 2016

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

  • 83.3% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was lower than the CCG average of 87.8% but similar to the national average of 84%. The practice exception reporting was 1.8% which was under the CCG exception reporting average of 9% and the national reporting average of 8.3%
  • 68.5% of patients on the practice’s mental health register had received an annual health check from April 2015 to November 2015.

  • 67.3% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive and agreed care plan. This was below the CCG average of 86.4% and the national average of 88.3%. The practice exception reporting was 5.5% which was significantly below the CCG exception reporting average of 18.6% and the national average of 12.6%.

  • 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.

  • Staff had a good understanding of how to support people with mental health needs and dementia. For example, the practice ensured that future appointments made for particular patients experiencing poor mental health or dementia recurred on the same day and time on a weekly / monthly basis. They said this had helped those patients to remember to attend the practice.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. This included Alzeimers Society, Healthtalkonline and the Mental Health Foundation.

  • It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. The practice regularly analysed admissions into hospital and took appropriate action following discussion with the practice clinicians.

People whose circumstances may make them vulnerable

Good

Updated 18 February 2016

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

  • The practice sought to accommodate the needs of patients who were considered as vulnerable. This included those with a learning disability and carers.

  • The practice cared for homeless patients who were temporarily residing at a local unit which provided 24 beds for these patients. The practice told us they knew who these patients were, would give them extra time and engage with their support workers.

  • It offered longer appointments for people with a learning disability. Markers were placed on these patients’ records so receptionists were aware when booking appointments.

  • Annual health reviews were offered to patients who had a learning disability. Patients were given a 30 minute appointment with a practice nurse followed by a 30 minute appointment with a GP.

  • The practice regularly worked with multi-disciplinary teams and other external contacts in the case management of vulnerable people. We were provided with an example where the practice liaised with a care nurse at the Accident and Emergency department (A & E) in respect of a frequent attender at the A & E department. A strategy was developed to redirect the patient towards their GP.

  • The practice had informed vulnerable patients about how to access various support groups and voluntary organisations. Information was available in the practice and on their website. The practice nominated a carers lead who signposted carers to a local carers hub.

  • 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. We interviewed staff and reviewed practice policies and information displayed in the practice which supported this.