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Eastwood Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 5 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastwood Group Practice on 22 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, well-led, effective and responsive services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working aged people (including those recently retired and students), people whose circumstances make them vulnerable and people with mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Significant events were recorded however these records were brief and dos not include details who was responsible for actions and learning. Reviews were not recorded to demonstrate that learning had been embedded into practice.
  • There were robust arrangements for managing medicines and minimising the risks of infections.
  • The practice had robust systems for safeguarding adults and children and sharing information with other agencies as appropriate.
  • Staff were recruited with all the appropriate pre-employment checks carried out. The induction for newly employed staff did not include details of the length of induction or specifics for what the induction covered. There were enough staff employed to keep patients safe.
  • There were appropriate measures in place for assessing risks to staff and patients’ health and safety, including a detailed business continuity plan to deal with any untoward event that may impact on the delivery of service.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance and referrals to secondary care services were made in a timely way.
  • Policies and procedures were written with reference to appropriate guidance. The practice worked with other health and social care providers to ensure that patients received continuity of care and treatment.
  • Patients said they were treated with empathy, compassion, dignity and respect. They said that they were listened to and involved in making decisions about their care and treatment.
  • Information about services and how to complain was available and easy to understand. Written responses to some complaints we saw could be interpreted as defensive in nature.
  • Appointments were flexible to meet the needs of all population groups. The practice was accessible and GPs provided a flexible service to patients in their homes as needed.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff were supported by management.
  • The practice sought feedback from staff and patients. They demonstrated learning from listening to staff, patients and other stakeholders.

We saw one area of outstanding practice:

  • One of the GPs carried out twice weekly scheduled visits to patients in the five local care homes. This helped to effectively monitor and treat patients thereby identifying and treating changes in patients’ health. The managers of care homes we spoke with told us that these visits benefited both patients and their relatives. One care home manager told us that these visits had reduced the need for unscheduled home visits, increased confidence in the practice and allowed patients relatives to meet with and discuss any concerns or changes in treatment with the GP. The practice was monitoring the effectiveness and benefits of these visits. Initial findings suggested that the planned twice weekly visits had resulted in a reduction in requests for unscheduled home visits and the numbers of unplanned hospital admissions indicating that patients’ needs were being met effectively.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Review the systems for recording significant and other safety events so that they describe in detail the analysis of the event, the person(s) responsible for completing actions; and a record of when these actions have been completed.
  • Ensure that all new staff undertake a period of induction when the start work at the practice.
  • Ensure that complaints are responded to in line with the practice policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 November 2015

The practice is rated as good for providing safe services. Safety alerts and serious incidents were acted on and learned from to improve patient safety. Significant events and safety incidents were investigated. Although records were kept these were brief and would benefit from further detail of the analysis of the incident, what went wrong and who was responsible for any actions required.

The premises and equipment was suitable and safe, and risks to patient and staff safety were identified and well managed. The practice was clean and there were effective infection control procedures in place. Medicines were stored, handled and disposed of safely. Staff were recruited robustly and employed in appropriate numbers and trained to treat patients safely. A staff induction checklist was in place for newly employed staff. This did not specify the duration of the induction period or the specific areas covered.

Effective

Good

Updated 5 November 2015

The practice is rated as good for providing effective services. Nationally published data made available to us including comparisons to other GP surgeries within the area showed that most patient outcomes were similar in relation to assessing and treating patients with long term conditions, vaccination and screening programmes. Treatment was planned and delivered in line with local and national guidance for GP practices. The practice staff worked with multidisciplinary teams including community nurses, health visitors and social workers to improve outcomes for patients and ensure that they received coordinated care and support as needed.

Caring

Good

Updated 5 November 2015

The practice is rated as good for providing caring services. Data from the National GP Patient Survey from 2014/15, Friend and Family Test and NHS Choices showed that patients rated the practice in line with or higher than others in the area for several aspects of care. Patients expressed satisfaction for how they were treated by GPs and nurses, their involvement in their care and treatment, and being listened to. Patients we spoke with during the inspection said they were treated with dignity and respect and they were involved in decisions about their care and treatment. The practice considered the needs of patients and their families when patients were receiving palliative care and nearing their end of their life and supported families following bereavements.

Responsive

Good

Updated 5 November 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and monitored and changed access to services to meet these needs. The appointments system was flexible and extended hours were available on Monday and Wednesday  evenings at their Belfairs Branch and Thursday evenings at their Rayleigh Road Branch. Home visits were available all day for those patients who were unable to attend the practice. Twice weekly visits were made to review and treat patients in each of the five local care homes where patients resided. The practice premises were purpose built and easily accessible to patients including those with physical disabilities or impairment. Improvements were needed in the way in which complaints were responded to.

Well-led

Good

Updated 5 November 2015

The practice is rated as good for being well-led. It had a clear vision and strategy to meet the individual needs of patients taking into consideration the health care needs of the local population. The practice sought and acted on the views of patients and staff to make improvements to the services provided. There was a clear leadership structure and staff felt supported by management. Learning and improvement was promoted through a system of forward planning, audits and reviews.

Checks on specific services

People with long term conditions

Good

Updated 5 November 2015

This practice is rated as good for the care of people with long term conditions. The practice had effective arrangements for making sure that people with long term conditions had regular health and medication reviews. The practice offered a number of clinics including clinics for diabetes, asthma, Chronic Obstructive Pulmonary Disease, heart disease, peripheral vascular disease and some recurrent eye conditions. Comparative data showed that the practice performed above or in line with other practices both locally and nationally for reviewing and treating patients with long term health conditions. The practice proactively encouraged patients to attend appointments for routine screening so as to help early detection and diagnosis of a number of long term conditions including heart disease, diabetes and respiratory illnesses. When patients required referral to specialist services, including secondary care, patients were offered a choice of services, locations and dates. These referrals were made in a timely way and monitored to ensure that patients received the treatments they needed.

Families, children and young people

Good

Updated 5 November 2015

The practice is rated as good for the population group of families, children and young people. Appointments were flexible and walk-in services were available each day. Ante-natal and post-natal checks were available. The practice monitored the physical and developmental progress of babies and young children. Appointments for children were made available outside of school hours wherever possible and urgent same day appointments were available for children under 5 years. There were arrangements for identifying and monitoring children who were at risk of abuse or neglect. Staff were trained and aware of their responsibilities to recognise and report concerns about the safety and welfare of children and young people.

There was information available to inform mothers about all childhood immunisations, what they are, and at what age the child should have them as well as other checks for new-born babies. Staff proactively followed up patients who failed to attend appointments for routine immunisation and vaccination programmes. Information and advice on sexual health and contraception was provided during GP and nurse appointments.

Older people

Good

Updated 5 November 2015

This practice is rated as good for the care of older people. All patients over the age of 75 years had a named accountable GP who was responsible for their care and treatment and a full range of screening and vaccinations were available. The practice identified patients who were at risk of avoidable unplanned hospital admissions and planned care in conjunction with other health and social professionals to prevent unplanned admissions. Regular multidisciplinary team meetings were held with other health and social care professionals to support patients and ensure that they received coordinated care and treatment.

The practice demonstrated proactive and effective systems for monitoring and treating patients over the age of 75 years. They had reviewed their procedures for carrying out home visits and increased the numbers of home visits available each day. These visits could be requested throughout the day and were carried out by the duty GP.

The practice carried out twice weekly visits to the five local care homes where their patients resided. The managers of four of these care homes were contacted by us and they reported that these visits benefited both patients and their relatives. Managers of these care homes told us that these scheduled visits helped to identify any changes in patients’ health and manage these effectively. They also told us that patients’ relatives found the visits beneficial as they could plan to meet with the GP and discuss treatments or any concerns they had. The practice was monitoring the effectiveness of these visits and told us that they had reduced the number of requests for unscheduled home visits thus indicating that patients’ needs were being met. The practice had also reviewed the impact of these visits on unplanned hospital admissions for patients who lived in care homes and found that the weekly visits to patients had reduced these numbers.

Working age people (including those recently retired and students)

Good

Updated 5 November 2015

The practice is rated as good for the population group of working-age people (including those recently retired and students). Appointments were flexible with telephone consultations, pre-booked and on the day appointments. Extended hours were available three evenings a week and morning and appointments are available fro 8.30am each day. NHS health checks for patients aged between 40 and 75 years were available and promoted within the practice and on their website. Nurse led clinics were provided for well patient health checks.

The practice promoted good health and advice on disease prevention through health promotion clinics and information for patients around healthy lifestyle choices.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 November 2015

The practice is rated as good for people experiencing poor mental health (including people with dementia). GPs and practice nurses were trained and skilled in screening to help early detection and diagnosis of mental health conditions such as depression and dementia. People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multidisciplinary teams to support people experiencing poor mental health including those with dementia. The practice had proactive processes for dementia screening and referrals were made to specialist services as required. Patients who were diagnosed with dementia had holistic based care plans and the practice worked closely with the local dementia nurse team to help ensure that patients received appropriate care and treatment according to their changing needs.

The practice had suitable processes for referring patients to appropriate services such as psychiatry and counselling, including The Improving Access to Psychological Therapies (IAPT) and referrals to Child and Adolescent Mental Health Services (CAMHS) as required.

People whose circumstances may make them vulnerable

Good

Updated 5 November 2015

This practice is rated as good for the care of people living in vulnerable circumstances. Staff were trained to identify and respond to the needs of patients who may be vulnerable, including those who lacked capacity to make some decisions in relation to their care and treatment. The practice recognised the needs of people who were vulnerable such those with depression, alcohol or substance misuse issues, people with mental health conditions and those with learning disabilities. The practice had a dedicated clinical lead for learning disabilities and patients’ health was monitored through annual health checks.

The practice worked with other health and social care professionals and held regular multidisciplinary meetings to discuss, review and plan for the health care needs of vulnerable patients. Staff were trained and understood their responsibilities to report concerns about the welfare of patients to the appropriate agencies.