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Inspection Summary


Overall summary & rating

Good

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Rycote Practice on 20 July 2016. 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.
  • There were nine patients registered with the practice who were diagnosed with a learning disability. All these patients had an annual health check in 2014/15 but only three had the same check in 2015/16.

  • Two vials of medicine held for emergency use were found to be past their expiry date. These medicines were removed and replaced during the inspection and the practice reinforced their checking procedure.

We saw areas of outstanding practice including:

  • The practice had enlisted the support of patients with long term conditions to act as patient teachers for medical students and GPs in training. These patients related their experiences of living with long term conditions to the trainees and students to give them a better understanding of how to treat and care for patients with similar conditions. Other patients with these conditions were able to benefit from the knowledge gained by the students and trainees.

  • The practice took a proactive approach to encouraging patients to attend for cancer screening. For example, 97% of eligible patients attended for cervical cytology screening compared to the national average of 82%.

  • A visiting counsellor led regular sessions to support the senior leadership team work through the challenges of general practice.

The areas where the provider should make improvements are:

  • Ensure patients with a learning disability are supported to access the practice or other services for health checks.

  • Ensure reception staff are trained to operate the hearing loop to assist patients who wear a hearing aid.

  • Ensure that the practice policy for checking emergency medicines is operated consistently to make sure checks of these medicines are carried out thoroughly

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 September 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 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 generally well managed. However, on the day of inspection we found two medicines held for use in an emergency were past their expiry date. The last check of these medicines had not identified this. The practice removed and replaced the medicines before the inspection was concluded.

Effective

Good

Updated 12 September 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.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • There were nine patients registered with the practice who were diagnosed with a learning disability. Three patients had an annual health check in the previous year.

Caring

Good

Updated 12 September 2016

The practice is rated as good for providing caring services. We observed a strong patient centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, delivering prescriptions to patients who found it difficult to get to the pharmacy.

  • We foundpositive examples to demonstrate how patient’s choices and preferences were valued and acted on

  • 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.

  • Staff assisted patients who found it difficult to book their hospital appointments.

Responsive

Good

Updated 12 September 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.

  • Patients said they found they could 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 12 September 2016

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

  • Governance and performance management arrangements had been proactively reviewed. The practice had lead GPs for specific activities and management functions. The partnership took joint responsibility for managing the service with one of the partners taking a co-ordinating role.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • 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 and clinical performance review 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 practice enlisted the support of an external counsellor to support the team by provision of regular sessions at which the team were encouraged to support each other. These included the opportunity to discuss both successes and challenges the practice encountered or faced.

Checks on specific services

People with long term conditions

Good

Updated 12 September 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. These reviews were scheduled using a recall programme. 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.

  • Performance for diabetes related indicators was 90% which was comparable to the clinical commissioning group (CCG) average of 94% and national average of 89%. More patients than the national and local averages attended for checks related to their diabetes.

  • Every effort was made to reduce the number of review appointments for patients with more than one long term condition. Recall programmes were kept under review to co-ordinate one recall for this group of patients.

Families, children and young people

Outstanding

Updated 12 September 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 98%, which was significantly higher than the CCG average of 83% and the national average of 82%.

  • 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 and health visitors.

Older people

Good

Updated 12 September 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 patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The GPs undertook a weekly visit to the local care home where fifty patients lived who were registered with the practice.

  • Practice nurses visited older patients in their homes to administer their annual flu immunisations.

  • The practice worked closely with a local voluntary group to support older patients to maintain independence.

  • The practice had worked with other local organisations to set up a website for carers. The website contained additional information about local support organisations.

Working age people (including those recently retired and students)

Good

Updated 12 September 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.

  • 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 clinics were held on a Monday evening and Tuesday and Thursday mornings in response to patient feedback.

  • Saturday morning extended hours clinics included both pre-bookable and walk in appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 September 2016

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

  • 94% of patients diagnosed with a severe and enduring mental health problem had an agreed care plan in place. This was above the CCG average of 89% and national average of 88%.

  • 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.

  • 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.

  • The practice offered a dementia screening programme to identify signs of dementia at an early stage. We saw that 35 patients had attended for screening in the last year and 18 had been identified with early onset of the disease. Early intervention to support these patients had been possible.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice used their mental health and dementia registers to identify patients who may need more flexible access to see the GPs and nurses.

People whose circumstances may make them vulnerable

Good

Updated 12 September 2016

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 carers and those with a learning disability.

  • The practice had identified 28 patients whose social circumstances or complex health needs also made them vulnerable. The patients identified were not included on any other patient register. The medical records for these patients carried an alert to identify them as needing either urgent or longer appointments.

  • 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.

  • There were nine patients registered with the practice who were diagnosed with a learning disability. Three patients had an annual health check in the previous year.