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Baslow Health Centre Outstanding

We are carrying out a review of quality at Baslow Health Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Outstanding

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Baslow Health Centre on 21 June 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • The practice team were committed to deliver high quality and responsive patient-centred care. We found many examples where staff had provided exceptional care to support the individual needs of patients.
  • Feedback from patients was overwhelming positive with regards to the care they had received. Patients said they were treated with compassion, dignity and respect and they were actively involved in decisions about their treatment. Results from the latest national GP survey showed that the practice scored higher than the local and national averages in all 23 questions patients were asked. This included a 100% positive response rate in terms of patient confidence and trust in both the GP and nurse. Patients we spoke to on the day reinforced these results.
  • The practice provided excellent access to care and we observed a well organised, flexible and effective appointment system, which accommodated the needs of patients. Patients said they were able to access care and treatment when they needed to, and had a positive experience when making an appointment. This was complemented by a responsive approach to home visit requests, recognising the needs of their predominantly older patient profile.
  • Risks to patients were regularly assessed and reviewed in conjunction with the wider multi-disciplinary team, which met on a weekly basis. We spoke to community based staff who worked with this surgery, and all provided extremely positive accounts of their interactions with the practice. They told us that GPs were approachable and accessible; that their views were respected; and that any requests were acted upon without delay.
  • There were processes in place to safeguard children and adults, and staff had received appropriate training and knew how to report concerns.

  • The practice team had the skills, knowledge and experience to deliver high quality care and effective treatment, and were supported to develop their roles via an established appraisal process. Staff had been supported to undertake training to enhance their skills and some had developed areas of special interest to support them in taking lead roles within the practice.
  • There was an open approach to safety with a system in place for the reporting and recording of significant events, although the number of reported incidents was low. We observed examples where learning had been applied from events to enhance the delivery of safe care to patients.
  • The practice dispensary provided medicines to 86% of registered patients. This service enabled a responsive and personal service for the supply of medicines, including the delivery of medicines to frail and housebound patients. However, some areas for improvement were identified within the operation of the dispensary, which the practice immediately rectified.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit was used to drive quality improvement within the practice.
  • Information about services and how to complain was available and easy to understand, although some details required an update to reflect current guidance. Improvements were made to the quality of care as a result of complaints and concerns.
  • The premises were clean and tidy with good facilities. The practice was well-equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff told us that they felt extremely well-supported by management. There was strong leadership and governance arrangements were generally robust.
  • The practice analysed and responded to feedback received from patients to review and improve service provision.
  • The patient participation group (PPG) influenced practice developments. For example, some amendments had been made to the appointment system further to a survey undertaken by the PPG.

We saw several examples of outstanding practice:

  • The delivery of first class patient-centred care on the individual needs of patients was evident in all aspects of the practice’s work. The high level of compassion and respect provided was highlighted in the national GP patient survey, comment cards, and from patients we spoke with on the day of the inspection. For example, the GP survey showed 100% of patients who responded had confidence and trust in the last GP they saw. GPs provided personal contact details for community nursing staff and sometimes directly to families to support excellent end of life care. They would visit patients at weekends and bank holidays to ensure patients received continuity of care and rapid intervention to reduce the need for hospital admission. Data for emergency hospital admissions demonstrated this was half the CCG rate, despite the practice having 31% of their patients aged 65 and over.
  • The practice had initiated a service that supported patients with a terminal illness to remain in their own homes and to die at home if this was their preference. This service had evolved into an independent charity and became available to all practices across the CCG area. Practice data showed that 97% of patients had died within their preferred place as a consequence of the planning and support offered by the practice working in conjunction with the wider health and social care teams.
  • The practice used innovative and proactive methods to improve patient outcomes, and worked with their Clinical Commissioning Group (CCG). The practice was dedicated to supporting new ways of working, and some projects had been rolled-out across other local practices. For example, they had initially developed a system to ensure that patients at the end of their life had rapid access to medicines they may require if their symptoms were to deteriorate. This had developed into the ‘just in case’ medicine boxes now widely used for palliative care patients across the CCG.

The areas where the provider should make improvement are:

  • Ensure a procedure is in place to monitor and action any uncollected prescriptions, especially when higher risk medicines have been prescribed.
  • Undertake a risk assessment for the delivery of medicines to patients’ home addresses by the driver and volunteers from the PPG.
  • Review and risk assess the use of a white board display of patients’ names with complex needs to raise staff awareness of those requiring care prioritisation.
  • The practice should ensure that cleaning schedules are signed and dated.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 August 2016

  • There was a system in place for reporting and recording significant events, and lessons were shared to make sure actions were taken to improve safety in the practice. However, reporting forms were not always fully documented to provide assurance that the agreed actions had been completed.
  • The practice had systems, processes and practices in place to keep people safe and safeguarded from abuse. Staff had been appropriately trained in relation to safeguarding, and understood how to raise any concerns.
  • The practice had robust recruitment procedures to ensure all staff had the skills and qualifications to perform their roles, and had received appropriate pre-employment checks.
  • Potential risks to patients and the public were assessed and mostly well-managed including site-related health and safety matters. Infection control audits were undertaken regularly.
  • Some concerns were identified in the operation and oversight of the practice dispensary. This included processes for the management of controlled drugs stock; and undertaking a risk assessment of the medicines’ home delivery service. The practice acknowledged these issues and confirmed action had been taken to address these following our inspection.
  • The practice had robust systems in place to respond to medical emergencies.
  • The practice ensured staffing levels were sufficient at all times to effectively meet their patients’ needs. 

Effective

Good

Updated 9 August 2016

  • The practice team delivered care in line with current evidence-based guidance, and we saw evidence that this was being used to influence and promote good outcomes for patients.
  • Data showed patient outcomes were generally in line or above average for the locality. The practice had achieved an overall figure of 97.4% for the Quality and Outcomes Framework 2014-15. This was in line with the CCG average, and above the national average.
  • Outcomes achieved for QOF indicators related to mental health were consistently higher than local and national averages with very low levels of exception reporting.
  • Clinical audits demonstrated quality improvement, and we saw examples of full cycle audits that had led to improvements in patient care and treatment.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Newly appointed staff received inductions, and all staff had received a performance review which included an analysis of their training needs.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs, and support the delivery of holistic care. This was supported by a weekly meeting on site attended by a wide range of health and care professional staff and members of the practice team.
  • Effective care planning and a highly responsive approach reduced the need for unnecessary hospital admissions.
  • Patients who were approaching their end of life received a highly effective, personalised and co-ordinated service that met their needs.
  • Emphasis was placed on supporting people to live healthier lives by offering health promotion advice, and encouraging regular health reviews and screening checks.

Caring

Outstanding

Updated 9 August 2016

  • Staff were motivated and inspired to offer personalised care that promoted patient-centred care. We observed that the practice team treated patients with kindness and respect throughout our inspection.
  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment. This was reflected within the most recent national GP survey which showed that patients rated the practice above local and national averages in respect of all aspects of care. For example, 99% of patients said the last GP they spoke to was good at treating them with care and concern which was above the CCG average of 91%, and above the national average of 85%.
  • The practice team knew their patients well and could often identify when additional support may be required, even if this had not been directly requested. GPs came into the waiting area to collect their patients as part of the caring ethos of the practice.
  • The practice had received the Derbyshire Dignity Campaign Award in 2014, an initiative developed by the local County Council. This award recognised that dignity was embedded into service delivery, raising the quality of individual patient experience.
  • The practice had identified 2.4% of their patients as carers and the practice manager had been assigned as the practice carer’s champion.
  • Feedback from community based health care staff and care home staff was consistently positive with regards to the high levels of care provided by the practice team.
  • GPs provided outstanding personalised care to those patients approaching end-of-life. GPs had undertaken visits to patients in the evenings and at weekends to provide continuity of care for the patient and their relatives/carers; this helped to avoid a hospital admission. Members of the district nursing team informed us how the GPs responded immediately to any requests for assistance with end of life care, such as acquiring particular medicines to keep patients comfortable and to manage their symptoms. GPs also provided comprehensive and personalised bereavement support to families and carers, after a patient had died.
  • Significant efforts were employed to accommodate patient preferences, including excellent outcomes for the number of patients that had died in their own homes and had expressed a wish to do so.  

Responsive

Outstanding

Updated 9 August 2016

  • We found many examples where staff had gone the extra mile to ensure that any matters requiring action were acted upon promptly to benefit the care and well-being of the patient.
  • Routine GP appointments were usually available within two days, and urgent appointments were available on the day. Extended hours GP appointments were available once a week from 7.30am until 7pm. Patients could book a routine appointment up to two weeks in advance on line, and a week in advance with reception.

  • Comment cards and patients we spoke to during the inspection were mostly positive about their experience in obtaining a routine appointment. This was reinforced by the national GP survey in January 2016 which found that 97% of patients were able to get an appointment to see or speak to someone the last time they tried (this was significantly above the CCG average of 88% and the national average of 85%).
  • Continuity of care was provided. The national GP survey demonstrated that 75% of patients with a preferred GP usually got to see or speak to that GP which was significantly higher than the CCG average of 61% and national average of 59%.

  • The practice hosted some services on site which made it easier for their patients to access them. This included a weekly Citizens Advice Bureau session to assist with benefits advice; counselling sessions; ante-natal clinics; and child developmental clinics.
  • The practice proactively sought patient feedback and implemented improvements and made changes to the way it delivered services as a consequence.
  • The premises were well-maintained and clean, and were well-equipped to treat patients and meet their needs. The practice accommodated the needs of patients with disabilities, including access via automatic doors and the availability of a hearing loop.
  • The practice had been designated to provide care for a local care home for older people and also provided input into some other local care homes where the patients had opted to remain registered with their own practice. We spoke to staff in the home who informed us that the practice was highly responsive to their patients’ needs. Urgent visits were done on the day when required, and planned weekly ‘ward round’ visits ensured patients were kept under regular review.
  • Information about how to complain was available and the practice responded quickly when issues were raised. Complaints were investigated and acted upon to improve services whenever this was applicable

Well-led

Good

Updated 9 August 2016

  • The partners aimed to deliver high quality care and promote good outcomes for patients. A focus on personalised care was reflected in all aspects of the practice’s work. The practice team and the PPG had produced a holistic set of core values which underpinned what the practice did.
  • The partners worked collaboratively with the CCG and with other GP practices in their locality.
  • The partners reviewed comparative data and ensured actions were implemented to address any areas of outlying performance.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice had developed a range of policies and procedures to govern activity.
  • Patients were actively canvassed for their views on the service. All feedback was reviewed and where possible was used to improve patient experience in the future.
  • The PPG made a valuable contribution to practice developments and we saw evidence of their impact.
  • The practice used innovative methods to improve patient outcomes and had initiated several developments and strived to continually improve. Some of these had been acknowledged by the CCG and rolled out across other practices to ensure consistency.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles. There were robust systems in place to aid communication between all groups of staff with regular formal and informal meetings. There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff told us they highly valued the level of support they received from the partners and practice management and highlighted the strong team working.
Checks on specific services

People with long term conditions

Good

Updated 9 August 2016

  • QOF achievements for clinical indicators were generally in line with the local CCG average and slightly higher than national averages. For example, the practice achieved 97.5% for diabetes related indicators, which was above the local and national averages of 96.7% and 89.2% respectively.
  • The practice undertook annual reviews as a minimum for patients with long-term conditions. Non-attenders were usually followed up via a telephone call and encouraged to attend for their review, and others were seen opportunistically if they attended the practice with another issue.
  • Patients with complex conditions were kept under review in weekly multi-disciplinary meetings to ensure they received optimal care. This helped to reduce the need for unnecessary hospital admissions.
  • The practice nurse worked closely with the diabetes specialist nurse, and the practice contacted other specialist nurses for advice when this was required.
  • A summary sheet had been devised for patients attending their annual review for diabetes. This recorded key health information to compare this against the previous year’s results. The form allowed for the patient to agree goals with the nurse, and also provided prompts to arrange foot and eye screening review appointments.

Families, children and young people

Good

Updated 9 August 2016

  • Regular meetings were held to discuss any vulnerable children. We spoke with the health visitor who informed us that the practice responded promptly to any issues raised, and were always responsive to younger people’s needs.
  • Urgent appointments were available each day for children who were ill, and telephone advice was offered to parents. Appointments were provided outside of standard school hours.
  • The health visitor provided child developmental checks and support. A midwife provided fortnightly ante-natal clinics.
  • Children of working people would be seen with a nanny or grandparent with written parental consent.
  • Immunisation rates for all standard childhood immunisations were comparable to local averages. For example, vaccination rates for children aged five and under ranged from 91% to 100%, compared against a CCG average ranging from 95% to 99%.
  • The practice had lower numbers of young children but responded to their needs effectively. For example, flu vaccination rates for two to four year old children was high with 80% of two year olds having received the vaccination compared to a local average of 52.7%.
  • The practice provided baby changing facilities, and there was a separate play and waiting area for younger children. The practice welcomed mothers who wished to breastfeed on site, and provided a private room for them if requested.
  • The practice provided a full range of contraceptive services. Information on sexual health was available for younger people, and chlamydia testing kits were available. Individuals expressing concern about unprotected sexual activity would be offered a same day appointment.
  • The PPG had established social media accounts to engage younger people with the practice. Whilst this had not any significant level of impact, it demonstrated the awareness of an inclusive approach towards all patients, and was an issue that practice and PPG kept under ongoing review. 

Older people

Outstanding

Updated 9 August 2016

  • The practice had higher numbers of older people registered with them compared against local and national averages (for example 31% of patients were over 65, compared against a local average of 21.7% and a national average of 17.1%). There was a high incidence of frail elderly patients living alone with complex medical conditions, and due to the rural location there were additional issues regarding social isolation. The practice ensured that their services were tailored to meet the needs of older people.
  • The practice held weekly multi-disciplinary meetings to discuss the most vulnerable patients and those at risk of hospital admission. This facilitated planning and the co-ordination of care to best meet their patients’ needs and helped to reduce the number of unnecessary hospital admissions. Data showed the practice’s emergency admissions at 8 per 1,000 population was significantly lower than local and national averages (at 16.8 and 14.6 per 1,000 respectively).
  • The GPs provided contact details for community nursing staff at weekends and bank holidays to ensure patients received continuity of care and rapid intervention to reduce the need for hospital admission.
  • The practice used bespoke care plans to provide clear information on individual needs, including patient preferences. This information was shared with out of hours’ services and other agencies to provide co-ordinated care for patients.
  • Longer appointment times were available, and the practice was very responsive in offering home visits where appropriate for those unable to attend surgery. In addition, urgent appointments were available for patients who could attend the surgery, and patients had access to a local voluntary transport scheme.
  • The practice employed a driver and the dispensary provided home deliveries for frail and housebound patients. In addition, same day delivery of urgently required medicines could be organised via volunteer drivers co-ordinated by the PPG.
  • The practice provided care to patients at a local care home for older people. A named GP visited this home each week. We spoke to a manager at the home who told us that they received an excellent service and described the relationship with the practice as extremely positive.
  • The flu vaccination rates for people aged 65 and over at 81.6% was higher than both the CCG average of 75.9%, and the national average of 72.8%.

Working age people (including those recently retired and students)

Good

Updated 9 August 2016

  • The practice offered on-line booking for appointments and requests for repeat prescriptions.
  • Extended hours’ GP consultations were available each Monday from 7.30am and until 7pm. GPs offered flexibility in staying behind after surgery to accommodate patients who were unable to get to the surgery on time.
  • The practice offered health checks for new patients and NHS health checks for patients aged 40-74.
  • The practice promoted health screening programmes to keep patients safe. For example, the rates of screening for bowel cancer were high. Data showed that 66.8% of patients aged 60-69 had been screened for bowel cancer within six months of invitation against a local average of 60.4% national average of 55.4%.
  • The practice referred or signposted patients to weight management programmes, smoking cessation support, and a service to help reduce alcohol intake.
  • The practice provided telephone appointments each day. Telephone advice was offered to patients to manage their conditions, for example, insulin titration, to avoid a visit to the surgery. 

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 9 August 2016

  • Patients experiencing acute mental health problems were offered same day appointments.
  • The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages. This was achieved with low rates of exception reporting at 4.7% (local 14.5%; national 11.1%)
  • 94.4% of patients with a diagnosed mental health problem had a care plan documented in the preceding 12 month period which was marginally above the CCG average of 93.3%, and above the national average of 88.3%. The exception reporting at 5.3% was significantly lower than the CCG (17.4%) and the national average (12.6%).
  • 93% of patients on the practice’s mental health register had received an annual health check during 2014-15.
  • 91.7% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was approximately 8% higher than local and national averages, and was achieved with lower rates of exception reporting.
  • Care home staff informed us that the GP would participate in best interest assessments for patients with dementia, and listened to the views of staff and relatives.
  • The practice was a designated dementia friendly practice and staff had received training to improve awareness of dementia and the support available to patients and their carers.
  • The practice had established good working relationships with child, adult and older people’s mental health teams. Professionals from these services attended the practice multi-disciplinary meetings where appropriate to offer advice and support regarding patients experiencing poor mental health.
  • GPs worked closely with the health visitor where there were any concerns relating to post-natal depression. 

People whose circumstances may make them vulnerable

Outstanding

Updated 9 August 2016

  • The practice provided personalised care to those patients at end-of-life, and worked in line with recognised standards of high quality end of life care. Palliative care patients were reviewed as part of weekly multi-disciplinary meetings.
  • GPs provided contact details for community nursing staff at weekends and bank holidays to ensure patients received continuity of care and rapid intervention to reduce the need for hospital admission.
  • The practice had initiated a service that supported patients with a terminal illness to remain in their own homes and to die at home if this was their preferred option. This service evolved into an independent charity that could be accessed by all practices across the CCG area. The practice continued to actively support the charity through fund raising.
  • An analysis of patient deaths was undertaken for patients to ensure any learning points were considered, and ensure that best practice was shared with the whole team. Practice data showed that 97% of patients had died within their preferred place as a consequence of the planning and support offered by the practice working in conjunction with the wider health and social care teams.
  • The practice adopted a co-ordinated approach to care by the use of care plans, which ensured key information was shared with other providers such as the out of hours service.
  • The practice had five patients with a learning disability, and all had received an annual review and had a care plan in place. We were provided with an example of how the practice had recently supported responsive and dignified end of life care for a patient with a learning disability.
  • Staff had received adult and child safeguarding training. Due to the location and small size of the practice, staff were able to identify any concerns promptly, and ensure any issues were confidentially raised and acted upon promptly.
  • The practice had identified that support was often needed for members of the farming community or those patients residing in more deprived rural settings, as they did not traditionally tend to access routine healthcare. This had led to involvement in the early development of a project to provide drop-in care for members of the farming community which had since been adopted by the local agricultural college.
  • The practice had a nominated carers champion.
  • The premises were easily accessible for patients with poor mobility or a disability. A member of staff had learnt sign language to aid communication with any patients with a hearing impairment.
  • Information was available on support for domestic violence, including a support and advice service for men.