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Kingswood Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingswood Health Centre on 16 August 2016.

Overall the practice is rated as good, with the domain of responsive rated as outstanding.

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; there was an active patient group.
  • Information about services and how to complain was available and easy to understand; the practice website was very informative and easy to navigate, and received approximately 3000 visitors per month.
  • Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said it was 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.
  • The practice were proactive in many areas of service development to improve access to treatment for patients; they were involved in an ophthalmology pilot which gave patients rapid access to assessment and treatment for a range of eye conditions.

We saw areas of outstanding practice:

  • The practice worked collaboratively with a community based alcohol advisory service to provide community detoxification from alcohol for patients which allowed swifter access for patients who required this type of treatment.

  • The practice employed a sexual health and contraceptive nurse who adjusted their working shifts according to when patientscould attend appointments. This was the only post of this kind in the area; the nurse also followed up those women whose circumstances make it imperative that they have adequate contraceptive advice for example, thoseat risk of sexual exploitation working as sex workers.

  • The practice also supported the “interim beds pilot project” with South Gloucestershire Council in nursing and residential homes. These 20 beds were for patients (not necessarily registered with the practice) who were medically fit for discharge from hospital, but who needed a further period of rehabilitation or recovery before they returned home. The care the practice offered as part of the pilot included a weekly review, responsive care if patients became acutely unwell, and the management of their medicines as well as advice and support to the home staff team.

The areas where the provider should make improvement are:

The practice should ensure that the record of the emergency equipment detailed exactly what had been checked.

The practice should introduce a failsafe system which ensured all equipment was calibrated.

The practice should monitor the protocol for use of patients’ own medicines in the practice to ensure it is fully embedded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 October 2016

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 were informed as soon as practicable, 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.

  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.

  • We found some areas within the practice which needed amendment such as the medicine protocol for use of the patient’s own supply within the practice and ensuring there was a failsafe system to ensure all equipment is calibrated.

Effective

Good

Updated 14 October 2016

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.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice.

Caring

Good

Updated 14 October 2016

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

Outstanding

Updated 14 October 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and The South Gloucestershire Clinical Commissioning Group to secure improvements to services where these were identified. For example, they were involved in an ophthalmology pilot which gave patients rapid access to assessment and treatment for a range of eye conditions.

  • There were innovative approaches to providing integrated patient-centred care. For example, the practice was active in the One Care consortium which gave patients direct access to same day physiotherapy assessment which had been used for 100 patients since it started in November 2015.

  • 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 offered a range of appointment types to balance routine access with urgent care. They had 13 early morning phlebotomy appointments per week reserved for people who could not attend the practice during normal working hours.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Patients can access appointments and services in a way and at a time that suits them. For example, the practice employed a sexual health and contraceptive nurse who adjusted their working shifts according to when patients could attend appointments. This was the only post of this kind in the area. 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 14 October 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 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.

  • The clinical team met every day to discuss clinical queries, referrals and arrange home visits by the most appropriate person to provide the best care for the individual patient.

  • The practice had reviewed their staffing establishment and had employed a wide range of health care professionals to meet demands for services. This included a nurse practitioner, a clinical pharmacist and an acute care paramedic.

Checks on specific services

People with long term conditions

Good

Updated 14 October 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.

  • 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.

  • There were weekend review appointments available for patients in order to prevent any potential hospital admissions and for those who have difficulty accessing appointments during the week.

  • The practice had employed a clinical pharmacist to work with older patients and those with long term conditions to promote medicines .

  • The practice used emergency care practitioners from the community healthcare services to undertake some home visits. This was initiated by the duty doctor who triaged requests for home visits.

Families, children and young people

Good

Updated 14 October 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • 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. Health visitor clinics were held at the surgery once a week, these were run at the same time as the immunization clinic for patient convenience.

  • The practice offered access to sexual health advice for both registered and unregistered patients.

  • The practice had a nurse practitioner and paramedic practitioner who saw patients with minor illness.

  • The practice operated a minor injuries service.

Older people

Good

Updated 14 October 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.

  • The practice had registered 226 patients in eight residential and nursing homes with a named GP lead for each home. Five of these care homes had weekly GP clinics.

  • The practice held an annual review of all patients in care homes in conjunction with the clinical commissioning group pharmacy team and the South Gloucestershire community active ageing service.

  • The practice employed a paramedic practitioner who was able to visit patients in their own home.

  • The practice hosted the community nurses, the community matron and active ageing team on site and had an “open door” approach for discussing complex patients. The practice undertook the enhanced service for admission avoidance, there was a fortnightly “virtual ward” meeting at the practice which included members of the community nursing team and community matron, the rehabilitation team, social workers and an Age UK support worker.

  • The practice used emergency care practitioners from the community healthcare services to undertake some home visits. This was initiated by the duty doctor who triaged requests for home visits.

  • The practice supported the “interim beds pilot project” with South Gloucestershire Council in nursing and residential homes. These beds were for patients who were medically fit for discharge from hospital, but who needed a further period of rehabilitation or recovery before they return home. The care the practice offered as part of the pilot included a weekly review, responsive care if patients became acutely unwell, and the management of their medicines.

Working age people (including those recently retired and students)

Good

Updated 14 October 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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care such as daily phlebotomy clinics from 8.20am. They offered a range of appointment types to balance routine access with urgent 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.

  • The nursing team ran an evening travel clinic.

  • The practice offered NHS health checks to patients aged 45 – 74, and were currently at the beginning of a new five year cycle. Of patients invited for health checks, approximately 70% attended their appointment.

  • The practice operated a “sit and wait clinic” to see any additional patients in the morning ensuring that they were always able to offer patients an appointment if their need was urgent.

  • There was a text reminder service for appointments, with the option to cancel appointments and provide the practice with the Friends and Family test feedback.

  • The practice offered a variety of health promotion clinics and social prescribing such as weight management sessions.

  • The practice employed a sexual health and contraceptive nurse who adjusted their working shifts according to when patients could attend appointments. This was the only post of this kind in the area; the nurse also followed up those women whose circumstances make it imperative that they have adequate contraceptive advice for example, those at risk of sexual exploitation working as  sexual workers.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 October 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 multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice signposted patients to the South Gloucestershire dementia prescription programme.

  • 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. They had recruited patients to participate in research programmes related to antidepressant prescribing.

People whose circumstances may make them vulnerable

Good

Updated 14 October 2016

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

  • 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.

  • The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. The practice responded to chaotic circumstances of vulnerable individuals who arrived without an appointment by including them in the duty GP system and seeing unregistered patients as temporary residents to ensure they had access to health care.

  • The practice had engaged with the local research network on the HepCATT study, a trial designed to evaluate interventions to increase the diagnosis and treatment of vulnerable and at risk patients with Hepatitis C.

  • The practice had 246 (2%) of patients registered as a carer who could access support at the practice from a member of the carer’s support centre based at the practice.

  • Patients with severe anxiety or autism were known to reception staff and offered the opportunity to wait in the patient information room until they are called for their appointment.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice hosted a substance misuse service; they had a dedicated GP who had additional knowledge and skills, and worked closely with the service.

  • The practice hosted an alcohol misuse worker who worked closely with the practice to support patients to undergo a community based detoxification programme.