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Inspection Summary


Overall summary & rating

Good

Updated 7 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holland House Surgery, Victoria Street, Lytham St Annes, Lancashire FY8 5DZ on 16 January 2017. 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • 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.

We saw areas of outstanding practice:

The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example; all staff were dementia friends. The practice worked closely with the Alzheimer’s society and other organisations to support patients and their carers. For example, the practice staff took part in a dementia sing-a-long and a dementia walk to raise awareness of the condition and raise funds. The patient participation group (PPG) were proactive in providing training for staff and patients to become dementia friends at the time of the inspection there were 503 dementia friends linked to the practice and the local community.

Where patients living with a learning disability were anxious about going to the GPs they were able to go into the practice as often as they wished to sit and familiarise themselves with the activities and sounds associated with the waiting room within the practice. Staff at the practice told us this had worked well to reduce the patients anxiety.

The practice employed a musculoskeletal (MSK) practitioner who specialised in assessing acute injuries with the aim of preventing them becoming longterm. The MSK practitioner also supported patients with chronic health conditions to help them to minimise the use of medicines.

There was an on site x-ray facility which provided same day access and reduced the need for patients to travel to the hospital.

The areas where the provider should make improvement are:

  • Improve the recording of significant events to demonstrate actions and learning and to identify trends more easily.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a 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 assessed and well managed.

Effective

Good

Updated 7 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • 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 7 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 7 March 2017

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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 7 March 2017

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 it.
  • 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 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.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 7 March 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.
  • The practice provided a Tier 2 diabetic service to patients, this involved commencing insulin injections. Tier 2 are enhanced services in primary care for Type 2 diabetes patients including injectable therapy initiation and management.
  • 84% of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) which was comparable to the CCG and national average of 82% and 78% respectively.
  • 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.
  • The practice offered an in-house musculoskeletal (MSK) service to patients. The MSK practitioner assessed acute injuries in an attempt to prevent longer term conditions.
  • The practice offered additional health checks to patients diagnosed with coeliac disease to ensure there were no obvious deficiencies developing due to malabsorption.

Families, children and young people

Good

Updated 7 March 2017

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. 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.
  • 83% of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2015 to 31/03/2016) which was comparable to the CCG and national average of 85% and 81% respectively.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 7 March 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified that older patients were not all receiving chronic disease reviews. To address this the practice introduced nursing domiciliary visits to older/housebound patients.
  • The practice participated in a local pilot for improving the care of patients with heart failure and met regularly with community matrons to discuss 'at risk' patients and plan the most appropriate plan of care.
  • The patient participation group provided training for staff and patients to become dementia friends. There were 503 dementia friends linked to the surgery and the local community.

Working age people (including those recently retired and students)

Good

Updated 7 March 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 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 March 2017

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

  • 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • 94% of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was better than the CCG and national average of 90% and 89% respectively.
  • 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. All of the staff at the practice and members of the PPG were dementia friends and the practice supported the Alzheimer's society with fundraising events such as; a sing-along at a local theatre and a dementia walk. Regular dementia friends meetings were held at the practice to offer support and raise awareness.
  • 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 advised patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 7 March 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 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 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.