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Garforth Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Garforth Medical Practice on 15 December 2015. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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 was in place for reporting and recording significant events.
  • The provider was aware of and complied with the requirements of the Duty of Candour. (Duty of Candour means health care professionals have a legal duty to be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to, cause harm.) 
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
  • Urgent appointments were available on the same day as requested.
  • The practice had good facilities and was well equipped to treat and meet the needs of patients.
  • The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
  • There was a clear leadership structure and staff were supported by management.
  • The ethos of the practice was to provide quality patient centred care.

We saw several areas of outstanding practice:

  • All vaccines had labels on which identified the date they had arrived in the practice, for audit purposes. We were informed this was common practice across all three locations and was undertaken by the nursing staff. This also supported stock rotation and prevention of waste.

  • The practice worked with a local further education college to ensure students who registered with the practice were given a ‘new starter’ pack, which contained information about the practice, contact details, what services were available and relevant health advice.

  • The practice took a positive approach to staff development, for example nursing staff were given two to four hours of development time each week. This time was protected for individual professional learning and development. Staff told us how they appreciated this time and felt valued by the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events.
  • There was a nominated lead who looked at the reporting mechanisms, safety issues and where improvements could be made in patient safety and experience.
  • Lessons were shared to ensure action was taken to improve safety in the practice.
  • There was a nominated lead for safeguarding children and adults, who attended local safeguarding meetings. Systems, processes and practices were in place to keep patients and staff safeguarded from abuse. All patients who were known to be at risk were coded on the electronic computer system.
  • There were processes in place for safe medicines management, which included emergency medicines. A record was kept of what medicines were carried in individual GP’s bags. All vaccines had labels on which identified the date they had arrived in the practice, for audit purposes.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 17 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were in line with both local and national figures.
  • Monthly meetings were held to coordinate care, review outcomes and performance. QOF was reviewed and patient care templates updated to reflect latest guidance.
  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs. For example, the community matron, local neighbourhood teams and district nurses.
  • Monthly reviews of all hospital discharges were undertaken to look at whether the admission could have been avoided and what could be put in place to support patients in the community.

Caring

Good

Updated 17 March 2016

The practice is rated as good for providing caring services.

  • Data showed patients rated the practice in line with other local and national providers for several aspects of care.
  • Patients we spoke with said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We observed a patient-centred culture and that staff treated patients with kindness and respect, whilst maintaining patient confidentiality.

Responsive

Good

Updated 17 March 2016

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Leeds South and East Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
  • Patients we spoke with said they found it easy to make an appointment. Telephone appointments and triage (assessment of need) with a GP were offered.
  • All patients who required urgent care were seen on the same day as requested.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.

Well-led

Good

Updated 17 March 2016

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

  • It 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 in place. GPs had practice lead roles for specific areas, for example dispensing, safeguarding, QOF, clinical guidelines and IT.
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings. The practice had recently purchased an electronic record storage system where documents and policies were stored centrally for all staff to access.
  • There were comprehensive staff personal files in place, which reflected an organised approach to practice management.
  • 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. There were systems in place for being aware of notifiable safety incidents, sharing with staff and actioning accordingly.
  • Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. The practice proactively sought feedback from patients through the use of patient surveys, the NHS Friends and Family Test and the patient participation group. For example, patient access to the practice by telephone.
  • The practice took a positive approach to staff development, for example nursing staff being given two to four hours of development time each week. This time was protected for individual professional learning and development.
  • Staff told us they felt extremely supported by the GPs and management.
Checks on specific services

People with long term conditions

Good

Updated 17 March 2016

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

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. The practice nurses had lead roles in chronic disease management and patients who were at risk of an unplanned hospital admission were identified as a priority.
  • The practice delivered care for patients using an approach called The House of Care. It was used with all patients who had diabetes, cardio-vascular disease or chronic obstructive pulmonary disease (a disease of the lungs). This approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians. The practice had been an early adopter of this approach.
  • Monthly reviews were undertaken of patients who were seen as being at risk. Information and care was shared with members of the multidisciplinary team.
  • The practice used the palliative care Gold Standard Framework (a systematic evidence based approach) to provide end of life care for patients.
  • Longer appointments and home visits were available for patients when needed.

Families, children and young people

Good

Updated 17 March 2016

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 accident and emergency (A&E) attendances.
  • Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • All children who required an urgent appointment were seen on the same day as requested.
  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group.
  • Childhood immunisation and cervical screening uptake rates were comparable to other practices in the locality.

Older people

Good

Updated 17 March 2016

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

  • The practice provided proactive, responsive and personalised care to meet the needs of the older people in its population. Home visits and urgent appointments were available for those patients who needed them. 
  • The practice worked closely with other health and social care professionals, such as the local neighbourhood team and district nurses, to ensure housebound patients received the care they needed.
  • Home visits were provided by the health care assistant for those frail and elderly patients who required blood tests. Follow ups were provided by a nurse or GP.
  • Patients who were resident in care homes and had a high risk of an unplanned hospital were visited weekly by the advanced nurse practitioner.
  • Patients who were elderly or frail were reviewed by a clinician following a hospital discharge.

Working age people (including those recently retired and students)

Good

Updated 17 March 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these patients 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 offered earlier and late evening appointments on specific days of the week. Telephone apppointments and triage were also available.
  • 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 worked with a local further education dance college to ensure students who registered with the practice were given a ‘new starter’ pack, which contained information about the practice, contact details, what services were available and relevant health advice.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2016

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

  • The practice regularly worked with multidisciplinary teams, such as the local mental health team, in the case management of people in this population group. Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
  • 78% of patients who were diagnosed as having dementia had received a face to face review of their condition in the past 12 months; compared to the CCG average of 82% and the national average of 84%. 
  • There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support people with mental health needs and dementia, with most staff having received training to become a dementia friend.
  • Patients known to have memory problems were contacted on the day of their appointment as a reminder.
  • The practice hosted a mental health services led memory clinic.
  • Risk registers were in place to identify those patients who had poor mental health or dementia.

People whose circumstances may make them vulnerable

Good

Updated 17 March 2016

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

  • The practice held risk registers for patients whose circumstances may make them vulnerable, for example persons of no fixed abode or children in need.
  • The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. Information was provided on how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
  • Longer appointments were available for patients as needed.