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The Oaks Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Oaks Medical Centre on 17 November 2015. Overall the practice is 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.

  • The practice reviewed significant events every six months to ensure improvements were implemented in a timely manner and full staff meetings were used to discuss learning outcomes and within the local CCG.

  • Information about safety was highly valued and used to promote learning and improvement. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Data from the GP survey was consistently high, this included access to appointments and confidence in care provided by GPs, where 100% of patients surveyed agreed they had confidence and trust in the last GP they saw or spoke to.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • 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.

We saw areas of outstanding practice:

  • The practice assessed appointments several times a day and when demand was high additional appointments were assigned for patients, reception staff were empowered to be patient advocates and accommodated patients’ needs. In practice this meant the vast majority of patients had access to an appointment on the same day.

  • Patients whose circumstances may make them vulnerable were able to see a GP or nurse without an appointment as this was found to improve attendance and accommodate their often chaotic lifestyles.The practice also allowed patients to use the practice address for post, allowing other agencies to engage and support patients where appropriate.

  • The practice staff had highlighted risks in administering adrenalin in an emergency. To mitigate this, a visual guide had been produced for quick reference to ensure the correct dose was administered to the patient.

  • The practice were routinely updating policies and procedures to reduce future reoccurrence of risks highlighted from significant events and complaints.Significant event analysis was comprehensively reviewed to ensure updates were effective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for providing safe services.

  • There was an open culture in which all safety concerns raised by staff and people who used the service were highly valued and integrated into learning and improvement.

  • Staff were committed to reporting incidents and near misses. The level and quality of incident reporting showed the level of concern staff placed on reporting near misses and incidents.

  • The practice had robust processes in place to investigate significant events and to share learning from these. Safety incidents were also shared within the CCG if appropriate.

  • Where people were affected by safety incidents, the practice demonstrated an open and transparent approach to investigating these. Apologies were offered where appropriate.

  • Risks to patients were assessed recognised as the responsibility of all staff and well managed. There were designated leads in areas such as infection control, who were empowered to suggest and make changes to keep staff working to best practice. Training was provided to support their role.

  • There were comprehensive systems in keep people safe, which took account of current best practice.The whole team was engaged in reviewing and improving safety and safeguarding systems.

  • The practice had systems and processes in place to deal with emergencies.Arrangements for managing medicines, including emergency drugs and vaccinations were robust and well managed.

Effective

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • The practice had a culture of using audits to improve patient outcomes and prioritised areas not covered by QOF. We saw examples of full cycle audits and ongoing audit activity that had led to improvements in patient care and treatment. Data showed patient outcomes were in line with those of the locality. For example, the practice’s uptake for the cervical screening programme was 78% which was in line with the national average of 82%. However, the practice highlighted this as an area for improvement and put in place plans to increase attendance, which included proactive monitoring and follow up, arranging translation services, using market research learning to improve response rates and appointments to discuss the implications of not participating.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and actively sought further training to develop their skills.
  • 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.

Caring

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care. For example:

    • 98% of patients said the GP gave them enough time compared to the CCG average of 88% and the national average of 87%.

  • Feedback from patients, their carers and community health and social care teams was consistently positive about the way staff treated people. Patients told us staff went the extra mile and the care they received exceeded their expectations. For example the GPs created a rota system with mobile phone numbers for a an end of life patient so a familiar GP could attend to the patient’s wishes and not involve the out of hours service at such a difficult time.

  • There was a strong and visible patient centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between patients, carers and staff were compassionate, caring and supportive.

  • Staff recognised and respected patients’ needs and always took a patient’s personal, cultural, social and religious needs into account.

  • Patients told us they were treated with care and concern by staff and their privacy and dignity was respected. Feedback from comment cards aligned with these views.

  • The practice provided information for patients which was accessible and easy to understand and patients’ emotional and social needs were seen as important as their physical needs.

  • We observed staff treated patients with kindness and respect, and maintained confidentiality. Reception staff were observed to be friendly and made every effort to accommodate patients’ needs.

Results from the national GP patient survey showed that patients’ satisfaction with how care and treatment was provided was consistently above the local and national averages.

Responsive

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for providing responsive services.

  • Patients told us it was easy to get an appointment with a GP over the phone or in person, with urgent and routine appointments available the same day.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

  • The practice offered flexible services to meet the needs of its patients. For example, they offered early morning appointments every Wednesday from 7am.

  • The receptionist role was seen as the patients’ advocate and they were empowered to assist those less able and put in place the most appropriate appointment or request further involvement for patients through telephone appointments with GPs or nurses.

  • The appointment availability was appraised several times a day and appointments increased if required.

  • Information about how to complain was available and easy to understand and patients were encouraged to complain, and especially to formalise the concern, so a thorough investigation could be undertaken and lessons learned. The practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders including the patient participation group (PPG).

  • The practice policy for complaints required two partners to sign off a complaint which had gone through the full process and been resolved; this had been implemented to increase the opportunity for review.

  • There was a proactive approach to understanding the needs of different groups of patients and deliver care in a way that met these needs and promoted equality. This included patients who were in vulnerable circumstances or had complex needs.

  • The practice monitored the number of patients receiving end of life care who die in their chosen place of death the latest audit showed 86% had their wishes achieved.

Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was consistently above the local and national averages.

Well-led

Outstanding

Updated 24 March 2016

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

  • The practice had a vision to deliver high quality care and to treat each patient as an individual without prejudice. Staff were clear about the vision and their responsibilities in relation to this. The practice had a developed a five year plan which outlined its aims for the future.

  • There was a clear leadership structure and staff felt supported by partners and management.

  • The partners and practice manager had a shared purpose and sought to motivate staff to succeed in providing high quality care. For example the practice recognised and celebrated good practice at every opportunity and operated an honest and no blame culture to encourage reporting of incidents and near misses to maximise the opportunity to improve practice. As a consequence of this staff felt supported to raise issues and concerns.

  • Governance and performance management arrangements were proactively reviewed and reflected best practice. The practice classed their policies and procedures as ‘living documents’ and constantly developed them as lessons were learnt from significant events or complaints, as updates were issued, or staff attended training courses and brought their learning back to the practice.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was well established and met regularly. The PPG worked closely with the practice to review issues including appointment access and complaints.

Checks on specific services

People with long term conditions

Outstanding

Updated 24 March 2016

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

  • The practice had put in place dedicated clinics for the support of patients with long term conditions such as diabetes and breathing problems, and operated a recall system to ensure patients were receiving appropriate care. The results for patients with a long term condition were in line with national averages. For example:

    • The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness in the preceding 12 months was 94% compared to a national average of 90%

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Care plans were in place for the patients identified as being at risk of admission.

  • Longer appointments and home visits were available when needed.

The practice worked with community specialist nurses who ran clinics at the practice for conditions such as heart failure and diabetes.  The practice computer system was connected to the community team’s system to provide up to date clinical notes and seamless transfer of information.

Families, children and young people

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for the care of families, children and young people.

  • Immunisation rates were in line with national averages for all standard childhood immunisations.

  • Following feedback from staff and patients the immunisation clinics were run by two nurses to ensure safety and so vaccines could be administered at the same time instead of one after another, reducing the stress caused to the patient.

  • 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 recognised once children were removed from the at risk register could still be at risk, so developed a ‘vulnerable child in the family’ code to alert clinicians that additional support might be required. This code was regularly reviewed by the safeguarding lead, health visitor and school nurse.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.

Older people

Outstanding

Updated 24 March 2016

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

  • The practice offered proactive, personalised care to meet the needs of older people in its population.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Home visits were co-ordinated with relatives, carers and district nurses, with the patient’s consent, which allowed additional support and planning to be undertaken during the appointment.

  • They worked effectively with multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met. For example the practice held a weekly meeting with the district nursing team to coordinate care.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 80% which was above the national average of 73%.

The practice had patients living in eleven local care homes which a designated GP visited each week undertaking urgent and routine appointments and health checks.  We spoke with staff at a care home who said the care the practice provided was compassionate and caring. The practice produced an updated patient summary every six months which assisted community health and social care teams, out of hours visits and ambulance crews gain a current medical history and provide effective care for the patient when the practice was closed.

Working age people (including those recently retired and students)

Outstanding

Updated 24 March 2016

The practice is rated as outstanding 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. This included access to telephone appointments, text reminders and the availability of early morning appointments.

  • The practice offered online services such as electronic prescriptions, and GP appointments were offered through the online booking system.

  • Health promotion and screening was provided that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 March 2016

The practice is rated as outstanding 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 people experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • Clinicians had moved to a more sensitive dementia diagnostic tool (the Montreal Cognitive Assessment Tool) which the Partners found more accurate in the early diagnosis of dementia, despite the additional time it took to perform.

  • There was 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 March 2016

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

  • The practice had an increasing Eastern European and Middle Eastern population and frequently made full use of interpreters to ensure effective communication.

  • Homeless patients were encouraged to become full time patients so they could access healthcare and support when required. With the patients’ consent the practice would use its address for registration, which allowed post received at the practice to be collected by the patient, this assisted in referrals to other healthcare teams and support workers.

  • The practice identified that appointments for this group often ended in missed or late attendance. To improve this, the practice encouraged patients to present at reception without an appointment whenever they felt in need of care or in crisis. An appointment would be found for them within 30 minutes of arrival and the patient seen by a nurse or GP as required. This has proved more acceptable to the patients in this group and has shown a marked increase in the attendance rate of homeless people as well as people with drug or alcohol problems.

  • The practice offered learning disability checks and sent out invites to attend this annually, however found performing at least some of this review during regular appointments had a positive impact on the patients’ health even if the full review was not completed.

  • The practice offered longer appointments for people who would benefit from one.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. For example all staff, including the reception team had completed training to recognise signs of domestic violence. 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.