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Vale of the Red Horse Health Care Centres Good Also known as Kineton Surgery

Inspection Summary


Overall summary & rating

Good

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Vale of the Red Horse Health Care Centres on 22 November 2016. Overall the practice is rated as good.

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

  • People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.

  • Risks to patients were comprehensively assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were sufficiently trained and had the appropriate knowledge and experience to effectively deliver care and treatment.

  • Patient outcomes were in line with or above local and national averages.

  • Patients said they were treated with compassion, dignity and respect and that they were suitably involved in their care and decisions about their treatment.

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

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice including:

  • The practice had identified five previously unknown carers aged under 18 years following an event at a local school and had placed these on the carers’ register. This enabled these young carers to access additional support and guidance from the practice, including signposting to local support services. Practice staff had engaged with and sought feedback from this group in respect of provision for carers, and had used the feedback to make improvements. This included designing specific correspondence for young carers.

  • The practice had recognised they had higher than average numbers of teenage patients and provided additional services for this group, including weekly young persons' clinics specifically for those aged 16 to 19 years. The practice had engaged with a local school to visit and discuss aspects of health care, for example sexual health. This included question and answer sessions with groups of students.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2017

The practice is rated as good for providing safe services.

  • People were protected by comprehensive safety systems and there was a focus on openness, transparency and learning when things went wrong.

  • There was a system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence that events had been consistently recorded, reported, reviewed and shared.

  • Practice staff used opportunities to learn from incidents to support improvement. Learning was based on a thorough analysis and investigation and we saw that reviews were undertaken to ensure the learning was embedded. We saw that all staff were involved in discussions and learning.

  • Information about safety was valued and was used to promote learning and improvement, and was shared with outside agencies.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. Risks to patients were identified and dealt with.

  • The practice carried out monthly audits of where chaperones had been offered and used, and whether this information had been recorded in patients’ notes. The practice used this information to identify and implement improvements.

  • Arrangements for managing medicines kept patients safe.

Effective

Good

Updated 28 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were consistently above regional and national averages. The most recent published results showed that the practice achieved 99% of the total number of points available compared with the Clinical Commissioning Group (CCG) and national averages of 98% and 95% respectively.

  • 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.

Caring

Good

Updated 28 April 2017

The practice is rated as good for providing caring services.

We observed a strong patient-centred culture:

  • The practice provided extensive help and support for patients who were carers. For example,

    Practice staff wrote to carers once a year, to keep in touch and to invite them to a discussion with a GP to see if any further support was needed.

    The practice hosted a monthly surgery facilitated by Guideposts Warwickshire Carers Support Service for patients to access support and advice, and provided additional education and support events for carers at both practice locations.

  • The practice had identified five previously unknown carers aged under 18 years following an event at a local school and had placed these on the carers’ register. This enabled these young carers to access additional support and guidance from the practice, including signposting to local support services.

    Practice staff had engaged with and sought feedback from this group in respect of provision for carers, and had used the feedback to make improvements. This included designing specific correspondence for young carers.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the practice had a policy to telephone older patients and those with memory loss to remind them of their appointment details, on the day of their appointment.

  • Information for patients about the services available was comprehensive, easy to understand and accessible.

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

  • Managers and staff told us they were committed to providing the very best care for patients, and patient feedback aligned with this.

  • Feedback from patients about their care and treatment was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. For example:

  • 93% of patients said the last GP they saw or spoke to was good at treating them with care and concern, compared with the CCG average of 89% and the national average of 85%.

  • 90% of patients said the last nurse they saw or spoke to was good at involving them in decisions about their care compared with the CCG average of 88% and the national average of 85%.

Responsive

Good

Updated 28 April 2017

The practice is rated as good for providing responsive services.

  • The practice had carried out ongoing analysis of the needs of the population group and had considered and responded to specific challenges including the rural location, poor transport links and areas of deprivation.For example, home visits were offered for those whose circumstances resulted in difficulty for them to attend the practice premises.

  • The Clinical Commissioning Group (CCG) provided a phlebotomy (blood taking) service in patients’ homes. Practice staff chose to provide an additional at home phlebotomy service as some patients told them they felt more comfortable and were more satisfied when seeing the practice’s own staff.

  • The practice provided an ‘emergency bypass’ telephone number to all patients deemed to be at risk. When this number was called it rang on separate telephones around the practice and staff knew to answer these calls as soon as possible.

  • The practice had recognised they had higher than average numbers of teenage patients and offered weekly young persons' clinics specifically for those aged 16 to 19 years between 3.30pm and 5.30pm every Tuesday. Staff told us they saw approximately eight to 12 young people per week as part of this service.

  • The practice recognised that working-age patients (those aged between 40 and 65) were overrepresented compared with regional and national averages. Extended hours appointments were available on alternate Monday and Thursday evenings until 7.45pm to help meet the needs of this group. The practice also offered additional appointments on Tuesday evenings from 6pm until 8.30pm which were over and above extended hours appointments. This included providing reception and medicine dispensing services at these times.

  • The practice engaged with the local community, for example by holding weekend health awareness sessions at the local village hall and information sessions at a local school.

  • The Patient Participation Group (PPG) arranged a number of awareness sessions to provide advice and guidance to the local community.

  • The practice offered monthly women’s health clinics which took place in the evening which included cervical screening, contraception and breast examinations.

  • Results from the National GP Patient Survey published during July 2016 showed that patients’ satisfaction with how they could access care and treatment was above local and national averages. 86% of patients found it easy to get through to this practice by telephone compared with the CCG average of 78% and the national average of 73%. 98% of patients said the last appointment they got was convenient compared with the CCG average of 94% and the national average of 92%.

  • There was continuity of care with urgent appointments available the same day.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 28 April 2017

The practice is rated as good 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 had an overarching and comprehensive governance framework which was regularly reviewed and supported the delivery of the strategy and good quality care. This included extra measures to enable the partners to have effective oversight of performance, risk and quality, for example monthly audits of where patient chaperones had been offered and used, and whether this information had been recorded in patients’ notes.

  • Audits were used in a proactive way to ensure systems, policies and protocols were being followed correctly and that the service was being provided in the most safe and effective way for patients.

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

    All GPs and the practice manager were subject to an annual 360 degree feedback process as part of their appraisal, where all staff were invited to contribute.

  • Effective communication was prioritised and this was key to the success of the practice.

  • 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 for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and we saw examples of improvements made.

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

Checks on specific services

People with long term conditions

Good

Updated 28 April 2017

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 patients at risk of hospital admission were identified as a priority. We saw that nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

  • Performance for diabetes related indicators above Clinical Commissioning Group (CCG) and national averages. For example, 99% of patients with diabetes had received an influenza immunisation in the last 12 months compared with CCG and national averages of 97% and 94% respectively. The practice’s exception reporting rate for this indicator was 15% compared with the CCG average of 14% and the national average of 18%.

  • Longer appointments and home visits were available when needed.

  • All patients with long-term conditions had a named GP clinical lead and were allocated to a specialist nurse.

  • Structured annual reviews were provided to check 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.

Families, children and young people

Good

Updated 28 April 2017

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

  • There were systems 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 Accident and Emergency (A and E) attendances. Immunisation rates were high for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this including care planning.

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

  • The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

  • The practice had recognised they had higher than average numbers of teenage patients and offered weekly young persons' clinics specifically for those aged 16 to 19 years between 3.30pm and 5.30pm every Tuesday. Staff told us they saw approximately eight to 12 young people per week as part of this service.

  • The practice had engaged with a local school to visit and discuss aspects of health care, for example sexual health. This included question and answer sessions with students, and presentations designed to help students make informed choices about their healthcare. Staff told us they had spoken with up to two hundred students within the last 12 months.

  • The practice engaged with children locally to provide health advice, for example sessions with groups of Beavers, Brownies and primary school children to consider basic life support and how to deal with choking.

  • The practice had identified five previously unknown carers aged under 18 years following an event at a local school and had placed these on the carers’ register. Practice staff had sought feedback from this group into carers’ provision and had used this feedback to make improvements, for example designing specific correspondence for young carers to help identify and engage with this group.

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

Older people

Good

Updated 28 April 2017

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. This included individual care plans for patients aged over 75 including those in care home settings.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Enhanced checks for patients aged 75 and above were available, including a 30-minute appointment with the practice nurse for any new patients.

  • The Clinical Commissioning Group (CCG) provided a phlebotomy (blood taking) service in patients’ homes.

  • The practice provided an ‘emergency bypass’ telephone number to all patients deemed to be at risk such as older people at risk of hospital admission. When this number was called it rang on separate telephones around the practice and staff knew to answer these calls as soon as possible.

  • There was a bell outside the main practice premises for patients who required support to enter the building. Staff would assist these patients when necessary, and had received the appropriate training to do so.

  • The practice had a policy to telephone older patients to remind them of their appointment details, on the day of their appointment.

  • The practice directed older people to appropriate support services.

Working age people (including those recently retired and students)

Good

Updated 28 April 2017

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 had carried out ongoing analysis of the needs of the population group and had considered and responded to specific challenges.

  • The practice was proactive in offering online services. Patients were able to book appointments, order repeat prescriptions and send and receive secure messages online. The practice provided evidence of high levels of patient use of online resources, including the use of the practice’s social networking pages on Facebook and Twitter.

  • The practice recognised that working-age patients (those aged between 40 and 65) were overrepresented compared with regional and national averages. Extended hours appointments were available on alternate Monday and Thursday evenings until 7.45pm to help meet the needs of this group. The practice also offered additional appointments on Tuesday evenings from 6pm until 8.30pm which were over and above extended hours appointments. This included providing reception and medicine dispensing services at these times.

  • The practice held weekend health awareness sessions at the local village hall and information sessions at a local school.

  • The practice offered monthly women’s health clinics which took place in the evening which included cervical screening, contraception and breast examinations. Staff told us these sessions were regularly well-attended.

  • Performance for cervical screening indicators was in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 86% compared with CCG and national averages of 83% and 82% respectively.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2017

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 above CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the 12 months was 100% (all patients) compared with CCG and national averages of 94% and 90% respectively. The practice’s exception reporting rate for this indicator was 10% compared with the CCG average of 9% and the national average of 10%.

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

  • The practice carried out advance care planning for patients with dementia.

  • The practice had a policy to telephone those with memory loss to remind them of their appointment details, on the day of their appointment.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 28 April 2017

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, for example homeless people and those with a learning disability. All patients on this register were assessed at least every quarter by a GP partner.

  • We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.

  • The practice had a dedicated list of 24 patients registered as having a learning disability and had offered health checks for all of these patients. 20 of these checks had been completed in the last 12 months. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

  • The practice provided extensive help and support for patients who were carers.

  • 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.