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Reepham & Aylsham Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 23 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Reepham and Aylsham Medical Practice on 19 September 2016. The practice was rated as good for providing effective and caring services, requires improvement for providing responsive and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement.

We undertook a comprehensive inspection of Reepham and Aylsham Medical Practice on 06 July 2017 under Section 60 of the Health and Social Care Act 2008 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 September 2016. The practice was rated as good overall and requires improvement for providing safe services. The full comprehensive report following the inspection on 19 September 2016 and 06 July 2017 can be found by selecting the ‘all reports’ link for Reepham and Aylsham Medical Practice on our website at www.cqc.org.uk.

We undertook a follow up focused inspection of Reepham and Aylsham Medical Practice on 16 January 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Overall the practice is still rated as good, and has been rated as good for providing safe services.

Our key findings were as follows:

  • All equipment in the emergency bag was in date. There was a comprehensive policy and log in place to support the new checking system.

  • There was a system in place to monitor the use of blank prescription stationary which was in line with relevant guidance.

  • There was a system in place to record, learn from and discuss incidents such as near misses in the dispensary.

  • There were two dispensaries and the system for managing uncollected scripts was uniform across both dispensaries and ensured GPs were informed when medicines were not collected.

  • At the inspection on 06 July 2017, we found that exception reporting for 2015/16 for ‘the percentage of patients with cancer, diagnosed within the preceding 15 months, who had a patient review recorded as occurring within six months of the date of diagnosis’ was significantly higher than the local and national averages. (Exception reporting is the removal of patients from the Quality and Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had run an audit and data from 2016/17 showed this exception reporting had reduced and was comparable to the local and national averages.

  • The practice had implemented an audit calendar which ensured second audit cycles were completed in a timely manner. The practice had also implemented a system whereby each member of staff completed a yearly audit for professional development. Some of these audits included prescribing for urinary tract infections, prescribing blood thinning medicines, appointments and an audit of the practice website. The practice also completed audits on population groups to ensure audits were relevant to their practice. For example, the practice had completed an audit to ensure they had appropriately identified all patients approaching the end of life. Systems and processes were implemented and this resulted in increased staff awareness of the patient’s condition.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 January 2018

Effective

Good

Updated 14 August 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national results. The most recent published results showed that the practice had achieved 100% of the total number of points available. The practice reported 11% exception reporting, which was in line with the CCG average and 2% above national average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). When we reviewed the exception reporting for ‘the percentage of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 6 months of the date of diagnosis’ it was 54% which was 26 percentage points above CCG average and 29.3 above the England average. The practice acknowledged this needed to be reviewed.

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement, although there was room to improve the scope of audits.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 August 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2017 showed patients rated the practice generally in line with the average for most aspects of care.
  • Patients we spoke to 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.
  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had undertaken an audit of their carers list in May 2017 and contacted all existing carers to ensure all details were still correct. In total, the practice had identified 151 (approximately 1.6%) patients as carers. Written information was available to carers to inform them of the various avenues of support available to them.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 14 August 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.
  • Patients said 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.
  • The practice was proactive in trying to reduce the number of non-attended appointments. They did this by sending sms reminder messages to patients for their appointments and phoned patients that did not attend to assess the reasons why this occurred. Patients that were deemed vulnerable were highlighted on the practice’s computer system and were contacted on the morning of the day of their appointment.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.

Well-led

Good

Updated 14 August 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 we spoke with 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 various teams in the practice each had their own lead individual and there were GP leads for each team as an additional port of call for staff support. Staff members operated a buddy system to provide support to each other.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • 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 practice had undertaken a patient survey in October 2016. The survey focussed mainly on appointment booking and prescription questions. The practice had implemented an action plan as a result of the survey to address some of the feedback.
  • There was a focus on continuous learning and improvement at all levels. The practice had responded positively to the findings of our last inspection and made considerable improvements.
Checks on specific services

People with long term conditions

Good

Updated 14 August 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 employed a respiratory and diabetic nurse specialist to improve services available for patients with respiratory illness and/or diabetes, reducing the need to travel to hospital.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Performance for diabetes related indicators was higher compared to the CCG and national average. The practice achieved 100%, this was 7% above the CCG average and 10% above the national average.
  • Longer appointments and home visits were available when needed.
  • 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 14 August 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 in line with or above the local averages for most 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.
  • The practice had a comprehensive cervical screening programme. The practice’s percentage of patients receiving the intervention according to 2015-2016 data was 78%, which was in line with the local average of 78% and above the England average of 73%. Patients that had not attended for a screening appointment were followed up with letters and telephone calls.
  • 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.
  • The practice provided twice monthly sexual health clinics, one at Reepham and one at Aylsham.
  • A member of the nursing team had worked with a local school to develop detailed lesson plans for delivering education on sexual health and other medical matters. This member of staff was also actively involved in delivering the lessons and visited local schools to discuss sexual health matters with pupils.

Older people

Good

Updated 14 August 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.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
  • The practice had held an educational event for the local Rotary Club, advising and informing the attendees of various health matters such as men’s health.

Working age people (including those recently retired and students)

Good

Updated 14 August 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.
  • Extended hours appointments were available from 7am to 8am and between 7pm and 8pm on Mondays, these included appointments with clinicians and phlebotomy services.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 August 2017

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

  • The practice had 57 registered patients with dementia, of which 54 had received an annual review in the last 12 months.
  • The practice had 73 registered patients experiencing poor mental health, all of which had received a timely annual review.
  • The practice regularly worked with a integrated care coordinator and 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 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 had an effective system in place to support and safeguard patients that did not attend for their appointments.

People whose circumstances may make them vulnerable

Good

Updated 14 August 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 those with a learning disability. The practice had 79 registered patients with a learning disability, all of which had received a timely annual review.
  • 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. There was an integrated care coordinator active in area with whom the practice worked closely when managing these patients.
  • Patients who were carers were proactively identified and signposted to local carers’ groups. The practice had 151 patients registered as carers.
  • 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.