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Stonefield Street Surgery Outstanding

We are carrying out checks at Stonefield Street Surgery. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Outstanding

Updated 15 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stonefield Street Surgery on 13 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.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • Feedback from patients about their care was consistently and strongly positive.
  • 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. The practice had worked with a neighbouring practice and Public Health to hold a “Health Summit” for men over the age of 50.
  • Data showed patient outcomes were above those locally and nationally.

  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Following patient feedback the practice had made improvements to the building to improve accessibility.
  • Information about how to complain was available and easy to understand.
  • 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 that there was continuity of care, with urgent appointments available the same day.
  • 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.
  • 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.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

  • The practice had reduced its unnecessary hospital admissions, for patients with a care plan, by 14% by extending the National Proactive Care programme.
  • One of the GPs had trained and worked closely with a drug liaison worker and all drug users had been actively screened and vaccinated against all relevant, infectious diseases.
  • The practice took part in a pilot with the local Memory clinic to streamline the referral process so that all investigations and discussions were held ahead of referral. This is now used as a pathway for all referrals within the Heywood, Middleton and Rochdale area.
  • The practice placed the needs of its patients at the centre of its operation. The practice constantly listened to its patients and responded in a timely way to improve the service. Most recently this had lead to them increasing appointments in the afternoon and the number of telephone lines each morning.
  • The practice were innovative and engaged effectively with local community groups and services to seek service improvement.
  • The practice had a clear vision which was owned by all the staff team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 March 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 understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. The practice carried out a recent risk assessment in infection control.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information 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.
  • Front line staff were aware of vulnerable patients and escalated any issues to the GP where they were concerned.
  • Risks to patients were assessed and well managed.
  • All new staff received a DBS check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • The GPs took part in peer reviews to ensure best and safe working practice.

Effective

Outstanding

Updated 15 March 2016

The practice is rated as outstanding for providing effective services.

Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. Monthly meetings were held between all clinicians where updates were discussed.

  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients.
  • Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group. For example one GP and one nurse had trained and were able to initiate insulin for the practices’ diabetic patients. This resulted in the practice being placed in the top quarter of practices in the CCG offering diabetes care. 96.39% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the CCG average of 88.9% and national average of 88.3%.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. One of the GPs worked closely with a drug liaison support worker ensuring that these patients were well controlled and that they had all been actively screened and vaccinated against relevant, infectious diseases. The patients were all reviewed by the GP every 3 months.
  • The practice had extended the national Proactive Care Programme and 5.6% of patients had an agreed care plan developed jointly with patients and carers.
  • The practice recently held a joint “Health Summit” with a neighbouring practice and Public Health to which men over the age of 50 were invited. Lifestyle advice and screening was offered. This was attended by several of the practices’ hard to reach people.
  • Clinical audits demonstrated quality improvement.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 15 March 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 almost all aspects of care. For example 83% of people describe their experience of making an appointment as good compared to the CCG average of 67%. 93% of people describe their overall experience of the surgery as good compared to the CCG average of 83% and 88% of people would recommend this surgery to someone new to the area compared to the CCG average of 72%.
  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • The patient participation group was representative of its population and included at least one carer and one person with mental health issues.

  • We found a strong patient-centred culture. We saw staff treated patients with kindness and respect, and maintained patient information confidentiality.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Bereaved families were contacted by the practice and the GP most familiar to the family offered support as needed.
  • Views of external stakeholders were very positive and aligned with our findings. Positive feedback regarding care plans from the North West Ambulance Service was evidenced during the inspection.

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

Responsive

Outstanding

Updated 15 March 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 the recent “Health Summit” where men over the age of 50 were offered lifestyle advise and screening.
  • 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 telephone lines were increased to four in a morning, more appointments were made available after 4pm and a self arrival screen was installed in the reception area.
  • Patients could access appointments and services in a way and at a time that suited them. For example, online, fax and automated telephone request for prescriptions, electronic prescribing where people could nominate a pharmacy and collect their prescription direct.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had offered Mindfulness to all staff which is a relaxation therapy. The practice nurses were also trained in this technique and were planning to offer the therapy to patients.
  • 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 15 March 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.
  • The practice had a mission statement “Our Vision” which was agreed and written by GPs and all staff. Posters were placed throughout the surgery for staff and patients.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.
  • There was a clear leadership structure and staff felt very supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • The practice carried out proactive succession planning.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • Staff development was actively encouraged and supported with some staff adding to, or changing from an administration role to clinical roles such as a phlebotomist and Health Care Assisitant.
  • The practice gathered feedback from patients using new technology, and it had a very active patient participation group which influenced practice development. The practice used an Elephant Kiosk for patient comments and a meeting was planned with Rochdale Young Advisors on developing an app that will encourage young people to make better use of primary care.
  • 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 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 was active and attended flu clinics to carry out the practice patient survey.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Outstanding

Updated 15 March 2016

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

  • Each clinical area had a lead GP and nurse who had additional skills and knowledge in those areas of clinical practice and patients at risk of hospital admission were identified as a priority.
  • Personalised care plans were offered to those with long term conditions where people were encouraged to self manage through joint development of these plans with each person.
  • The practice had extended the National Proactive Care Programme and 5.6% of patients had an agreed care plan developed jointly with patients and carers. This resulted in a reduction of unnecessary admissions to hospital by 14%.
  • One GP and one nurse in the practice had trained and were able to initiate insulin to its diabetic patients. This resulted in the practice being placed in the top quarter of practices in the CCG offering diabetes care. 96.39% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the CCG average of 88.99% and the national average of 88.3%.
  • Longer appointments and home visits were available when needed.
  • 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.
  • Patients with asthma had a personal asthma action plan showing contact details of who to contact when the surgery was closed. 70.9% of people diagnosed with asthma had a review in the preceding twelve months which is the same as the CCG average at 70.8%.The practice used agreed, uniform READ coding and ran recall systems to ensure active follow up for patients with long term conditions.
  • People that had been newly diagnosed with cancer were contacted by the GP and offered support if needed.

Families, children and young people

Outstanding

Updated 15 March 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 relatively 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, and we saw evidence to confirm this.
  • 80.96% of women aged 25-64 had their notes recorded as having a cervical screening test performed in the preceding 5 years which was comparable to the national average of 81.83%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. All children under the age of 12 were offered an appointment on the same day.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Pre pregnancy screening and advice was offered particularly to those with diabetes and epilepsy.
  • The practice offered support in the home for children, where possible with acute illness.
  • Appointments were available for contraceptive services including coil fitting and sub dermal implants.
  • The practice welcomed breast feeding mothers.

Older people

Outstanding

Updated 15 March 2016

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

  • The practice took part in a pilot with the local Memory clinic to streamline the referral process so that all investigations and discussions were held ahead of referral. This is now used as a pathway for all referrals within the Heywood, Middleton and Rochdale area.

  • All people over the age of 75 were offered proactive, personalised care plans to meet the needs of this population group.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • 83.38% of people aged 65 and over had received a flu vaccination compared to the national average of 73.24%.
  • The practice carried out regular medication reviews and worked with their pharmacy technician to ensure safe and evidence based prescribing.
  • The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.

Working age people (including those recently retired and students)

Outstanding

Updated 15 March 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.
  • Appointments were offered from 7.30am on Tuesday mornings and until 8pm on Thursday evenings. Telephone consultations were available for those who could not attend the surgery.
  • 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. This included electronic prescribing where a person can nominate a pharmacy and collect their repeat prescriptions direct.
  • Blood tests were offered until 4pm due to a later blood collection service.
  • The practice joined with a neighbouring practice and Public Health to hold a “Health Summit” inviting their male patients over the age of 50 for lifestyle advice and screening. It was attended by several of the practices’ hard to reach patients.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 15 March 2016

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

  • The practice took part in a pilot with the local Memory clinic to streamline the referral process so that all investigations and discussions were held ahead of referral. This is now used as a pathway for all referrals within the Heywood, Middleton and Rochdale area.
  • 95% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which is higher than the CCG average of 82.6% and national average of 84%.
  • 98.15% of people with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in the preceding 12 months was higher than the CCG average of 88.9% and national average of 88.47%.
  • The practice had an agreed practice formulary for the prescribing of anti-depressants and they worked closely with the psychological therapy services to support patients with depression.
  • 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.
  • 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice actively checked the physical health of those with mental health problems offering health reviews and appropriate immunisations.
  • The practice had links with the Dementia Wellbeing Café and actively referred to the local Alzheimer’s support worker.

People whose circumstances may make them vulnerable

Outstanding

Updated 15 March 2016

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

  • The practice held a register of people living in vulnerable circumstances including those with a learning disability, drug users, military veterans and housebound patients.
  • The practice offered longer appointments for people who were vulnerable and needed them.
  • The practice offered annual reviews to those with learning difficulties.
  • The practice actively encouraged the uptake of national screening programmes for those in vulnerable groups through proactive follow up where they had failed to respond to invites.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable people 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 worked with the local police service where it was concerned that welfare visits may have been necessary. There was a named social worker who liaised with the practice for any concerns and best practice meetings.
  • The practice had a guide dog policy and used the services of interpreters including signing.

  • One of the GPs had trained and worked closely with a drug liaison worker and all drug users had been actively screened and vaccinated against all relevant, infectious diseases.