You are here

Inspection Summary


Overall summary & rating

Good

Updated 31 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Reedyford Health Care on 14 April 2016. Overall the practice is rated as good.

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

  • The practice sought out innovative methods to share health information and health promotion campaigns through Facebook and Twitter.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients were able to get urgent appointments but said they sometimes found it difficult to make an appointment with a named GP. The practice was actively trying to address patient access.
  • 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 staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The practice offered drop in sexual health clinics and childhood vaccinations outside the core working day.
  • The practice identified that not all external test results were being recorded on patient medical notes during the inspection, for two out of 151 patients who were prescribed warfarin. The practice began addressing this whilst we were on site.

We saw one area of outstanding practice:

The practice had begun using social media to communicate with patients and reached a wide audience through Facebook and Twitter. For example, The practice had 1,800 followers on Twitter and its Facebook page showed over 2,000 views in one week. A variety of health promotion campaigns were being shared with a large group of patients in this way. A cardiac rehabilitation video which explained the signs and symptoms of cardiac arrest had been shared, this had reached over 10,000 people through Facebook groups.

The areas where the provider should make improvement are:

  • Review procedures to update patient medical records consistently with information from other providers, including clinical information and test results.
  • Review access to emergency drugs to ensure these are easily accessible in an emergency and review the signage around the emergency oxygen in the reception area.
  • Review access to complaints leaflets so patients can access these without requesting them from reception staff.
  • Conduct annual significant event reviews to ensure all learning has been implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 May 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events, though there was no annual review of these to ensure all learning had been implemented.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal 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.
  • Risks to patients were generally assessed and well managed.
  • During the inspection a GP partner identified gaps in updating all relevant clinical information into patient medical records. This related to two patients of 151 who were prescribed warfarin. The practice recognised this issue and began to review and rectify this during the inspection.
  • Emergency drugs were stored securely, though we noted they might be difficult to access swiftly in an emergency.
  • The new storage area for emergency oxygen was not clearly identified with warning signs.

Effective

Good

Updated 31 May 2016

The practice is rated as good 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.
  • A range of clinical audits demonstrated the practice reviewed clinical effectiveness consistently.
  • Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group. For example, 86% of patients with hypertension had a blood pressure reading which was within a normal range in the preceding 12 months, compared to the national average of 84%.
  • 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.
  • The practice was signed up to the Pharmacy First scheme locally which gave vulnerable direct access to pharmacies for treatment for minor illness and ailments.

Caring

Good

Updated 31 May 2016

The practice is rated as good for providing caring services.

  • The practice had a staff photo board by the main reception desk so that patients could see the names and faces of all clinical and non-clinical staff.
  • Data from the National GP Patient Survey showed patients rated the practice higher than others for some aspects of care, for example 97% said that the nurse they was or spoke with was good at giving them enough time compared with a CCG average of 93% and a national average of 92% .
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • The practice had given additional support to receptionists and introduced telephone monitoring to ensure that patients were cared for appropriately following concerns raised by GPs.
  • Information for patients about the services available was easy to understand and accessible.
  • The practice actively identified carers and provided a range of helpful carer information in the waiting areas, including information for young carers on the waiting room information screen.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice shared a number of individual case studies where patients were given individualised care.
  • The practice actively publicised Carers Link services and support services available in the local area and offered additional support to carers.
  • The practice referred patients to counselling which was facilitated within the practice building.

Responsive

Good

Updated 31 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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. An example included discussions regarding access and resources required for seven day access to primary care.
  • Urgent appointments were always available, although patients explained that it was sometimes difficult make an appointment with a named GP. The practice was aware of this and working hard to improve patient access.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. Complaint leaflets had to be requested from receptionists at the time of our visit, though the practice assured us they would be made widely available.
  • The practice offered sexual health drop in clinics on Monday evenings, and childhood immunisations were offered at the monthly Saturday mornings clinic at the Barrowford branch site.
  • The practice engaged with a wide range of patients using social media and was regularly reaching over 2,000 patients to share health improvement information and campaigns.
  • The practice introduced 15 minute routine appointments following analysis of national GP survey results as part of their review of the appointment system.

Well-led

Good

Updated 31 May 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. 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 was a reflective learning organisation. It was a training practice, three GPs were GP trainers and two GPs were GP appraisers. GPs shared update information from meetings and actively supported staff to undertake professional development.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 31 May 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 patients at risk of hospital admission were identified as a priority.
  • Data showed the practice was performing in line with national averages for the indicators relating to patients with diabetes. For example, 98% of patients with diabetes received an influenza immunisation in the previous flu season compared to 94% nationally and 89% had a recent blood pressure test which was within a normal range compared with 78% nationally.
  • Longer appointments and home visits were available when needed.
  • The practice worked closely with the community diabetes nurse specialist. Two practice nurses and one GP were trained to initiate insulin prescribing and worked closely with the community specialist diabetes nurse in caring for patients with more complex diabetes.
  • 93% of patients with chronic obstructive pulmonary disease (COPD, a lung disease) had a full annual review compared with a national average of 90%.
  • 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.

Families, children and young people

Good

Updated 31 May 2016

The practice is rated as good for the care of families, children and young people, with outstanding as responsive for this population group.

  • 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.
  • 86% of women aged 25-64 had a cervical screening test carried out in the previous 5 years compared with 82% nationally.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Childhood immunisations were in line with or slightly above local CCG averages. These were offered once a month on Saturday mornings as well as during the week for parents who found it easier to attend outside the working week.
  • The practice offered drop in sexual health clinics at a time suitable for young people to call in on Monday evenings. Emergency and long-term contraceptive advice and fitting was available.
  • The practice nurses offered travel advice, vaccinations, and the practice was registered as a yellow fever centre.
  • The practice engaged with over 2,000 patients via social media sharing health information and campaigns via Facebook and Twitter.
  • Staff had all completed basic life support training for children and new-born babies as well as additional safeguarding training to identify patients at risk of female genital mutilation.

Older people

Good

Updated 31 May 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • 74% of patients over 65 years old had received a seasonal flu vaccination compared with the national average of 73% in 2013-14.

  • The practice worked closely with a tele-hub service at Airedale Hospital which provided immediate telephone support to care homes for older patients.

Working age people (including those recently retired and students)

Good

Updated 31 May 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.
  • The practice had adjusted opening hours and services it offered to ensure these were accessible, flexible and offered continuity of care.
  • 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.
  • The practice offered extended hours access on Monday evenings and Saturday mornings to patients who could not attend during the working day, as well as telephone appointments where appropriate.
  • The practice embraced social media and information technology to engage with engage with over 2,000 patients sharing health information and campaigns.
  • Telephone appointments and electronic prescription services were available within the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 May 2016

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

  • 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which higher than the national average of 89%.
  • 83% of patients with dementia had a face to face review, similar to the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • Counselling and local well-being services were available in the practice building.
  • The practice carried out advance care planning for patients with dementia.
  • The practice aimed for early diagnosis and support for patients with depression and anxiety.
  • The practice had informed 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 31 May 2016

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

  • The practice allocated a GP and the practice triage nurse to patients who were terminally ill, in order to ensure good continuity of care during a difficult time for patients and their families.
  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, and actively identified vulnerable patients who needed greater health care support.
  • The practice informed vulnerable patients about how to access a range support groups and voluntary organisations.
  • Staff actively identified and reported potential incidents 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 referred patients to the local well-being service for support with social needs when appropriate. This service was available most days within the practice building.
  • The practice referred patients with additional social and health needs to the integrated neighbourhood team.
  • The practice offered joint clinics with the local drug and alcohol service.
  • The practice identified individuals who were particularly vulnerable, and kept records of additional care, support and treatment for these patients.