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Willingham-by-Stow Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willingham-by-Stow Surgery on 6 December 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.
  • Patient survey figures showed patients rated the practice consistently higher than others for all aspects of care.
  • 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.
  • 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.
  • Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons.
  • 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 meetings.

  • The practice had identified 105 patients as carers (2.7% of the practice list).

The areas where the provider should make improvement are:

  • Complete an annual review of significant events including near misses and complaints to identify trends and themes.
  • Update action plans accordingly to evidence completed actions
  • Consider including dispensing staff in clinical meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 December 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 although an annual review had not been completed.

  • 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.

  • National patient safety and medicine alerts were disseminated within the practice and actioned were applicable.

Effective

Good

Updated 23 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mainly 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 for all staff.

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

Caring

Good

Updated 23 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice significantly higher than others for many aspects of care.

    • 97% of patients said the GP was good at listening to them compared to the clinical commissioning group (CCG) average of 91% and the national average of 89%.

    • 98% of patients said the GP gave them enough time compared to the CCG average of 90% and the national average of 87%.

    • 96% of patients said they found the receptionists at the practice helpful compared to the CCG average of 90% and the national average of 87%.

  • The practice had identified 105 patients as carers (2.7% of the practice list).

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 23 December 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.

  • 87% of patients were satisfied with the practice’s opening hours compared to the CCG average of 78% and the national average of 76%.
  • 92% of patients said they could get through easily to the practice by phone compared to the CCG average of 76% and the national average of 73%.
  • Comment cards said that patients were able to get an appointment and were also able to be seen on the day if required.

  • 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.

  • The practice had a dispensing delivery service for those patients that were unable to attend the practice to collect their prescriptions. This was completed by volunteers once a week.

Well-led

Good

Updated 23 December 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.

  • 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 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 proactively sought feedback from staff and patients, which it acted on.
Checks on specific services

People with long term conditions

Good

Updated 23 December 2016

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

  • One of the GPs had lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The nursing team were trained in long term conditions and the practice worked alongside community specialist nurses such as the community respiratory team.

  • Performance for diabetes related indicators was comparable to CCG and national averages. (96% compared to 92% CCG average and 90% national average).
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 23 December 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 in line with CCG averages for all standard childhood immunisations.

  • 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’s uptake for the cervical screening programme was 84%, which was similar to the CCG average of 80% and the national average of 76%.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 23 December 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 worked at identifying patients at risk of hospital admission to reduce the risk and reduce the amount of unplanned admissions.

  • 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 two bi-weekly sessions at the branch surgeries which had areas of a high elderly population.

  • Dosette boxes and a delivery service for those patients that needed it provided from the dispensary.

  • The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.

Working age people (including those recently retired and students)

Good

Updated 23 December 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 and flexible.

  • Patients could book appointments on line, in person or on the telephone.

  • The practice offered a same day urgent triage and telephone consultations if required.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 December 2016

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

  • 70% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 80% and the national average of 79%.

  • 100% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was higher than the national average of 92%.

  • 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had completed a training session on dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 December 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 those with a learning disability.

  • The branch surgery was within walking distance from one of the learning disability/psychiatric facilities.

  • The practice offered a flexible appointment for these patients to reduce stress if attending the practice.

  • 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.

  • 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.