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Chilwell Valley and Meadows Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Valley Surgery on 21 October 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be good for providing well-led, effective and responsive services. We found the practice was outstanding for providing safe and caring services. It was also providing good services for all population groups.

  • There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patients’ wellbeing.
  • The practice managed complaints well and took them seriously, information about how to complain was available and easy to understand.
  • Patients told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. They also said that the staff would always allocate time to explain conditions and treatment plans which helped patients understand the care available to them.
  • The practice worked well with other health care services to enable a multi-disciplinary approach in meeting the needs of patients.
  • There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills with good training opportunities.
  • The practice proactively sought feedback from staff and patients, which it acted on. There was an active patient participation group (PPG) which felt involved in the development of the practice.
  • The PPG was proactive in health promotion working with charities to coordinate events to support patients diagnosed with long term conditions such as dementia as well as their carers.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • The practice had a clear vision and informal set of values which were understood by staff. There were clear clinical governance systems in place and regular review of policies.

We saw areas of outstanding practice:

  • The practice staff were open and transparent and fully committed to reporting incidents and near misses. Learning was not only shared within the practice, following a through and open investigation, so staff could work to best practice but also at a national level so learning could be maximised from these events and reduce likelihood of reoccurrence.
  • The practice had an embedded culture and proactive approach to anticipating and managing risks to patients which was recognised as the responsibility of the staff we spoke to.
  • Clinical audits were carried out and all relevant staff were involved to improve care, treatment and people’s outcomes. There had been 19 clinical audits conducted in the last twelve months, seven of these were completed audits where the improvements made were implemented and monitored.
  • The practice provided a level of care over and above what was demanded by their contractual obligations or expected by their patients. The high level of compassion and respect given to patients in need, whether at end of life or during a deterioration of their condition was reflected in comment cards and by talking to patients throughout the inspection. Additional support for patients with dementia was in place to allow access to care and services in a suitable manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Outstanding

Updated 3 March 2016

The practice is rated as outstanding for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Safety was improved as the lessons were taken from these incidents shared amongst staff and used as learning points for improving practice. Suitable systems were in place to ensure appropriate staff were recruited and that staff with the correct skills mix were available to deliver safe patient care.

  • The practice looked for themes in complaints and significant events making changes in policies and procedure to ensure they reflected best practice and to support staff in keeping up to date.

  • The practice used formal systems to assist in learning and development from safety events such as the ‘patient safety toolkit’ developed by the Royal College of General Practitioners and to share the events with other practices to maximise learning using the National Reporting and Learning System.

  • 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

Good

Updated 3 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality, for example the number of diabetics whom had received a blood pressure reading in the preceding twelve months was 84% for the practice compared to a national average of 78%. Staff referred to guidance from the National Institute for Health and Care Excellence and routinely used it to improve patient outcomes with procedures in place to take into account updates.

We found the practice had a culture of learning and development and staff had received training appropriate to their roles.  There was a sense of team work and evidence of support, appraisals and personal development plans for all staff.  Staff worked well with multi-disciplinary teams, external agencies and other health care professionals, this played an important role in the effective planning and delivering of care to patients.

Caring

Outstanding

Updated 3 March 2016

The practice is rated as outstanding for providing caring services.

  • Staff were committed towards providing a high level of care to patients, this was embedded across all staff and the wellbeing of patients was seen as a high priority.

  • The examples of care seen during the inspection were over and above the contractual obligations of the practice and staff put the wellbeing of patients first.For example, GPs provided on call contact numbers to use if extra care was required for patients on end of life care, enabling the GP that understood their wishes to attend out of hours. There were 29 thank you cards the practice had accumulated over the last year from patients and relatives praising the staff for the high level of care and compassion they received.The patient survey showed that patients rated the practice higher than others for almost all aspects of care; for example the percentage of patients who described their overall experience as fairly good or very good was 95% compared to a national average of 85%.

  • Patients we spoke with during the inspection stated how highly they valued the service and care provided by the staff which was also echoed in the comment cards which were overwhelmingly complimentary. Patients commented that staff went the extra mile in caring for them and their health and would give them time and support when required.Words such as ‘excellent’, ‘superb’ and ‘outstanding’ were regularly used when describing the care they and their relatives had received.There were many positive examples to demonstrate how patients’ choices and preferences were valued and acted on.

The care homes the practice served also spoke of the kind nature the GPs had when attending their weekly visits, additional patients would be accommodated at the last minute if the need arose and this provided continuity of care for those patients, they praised the open communication the practice had with them.

Responsive

Good

Updated 3 March 2016

The practice is rated as good for providing responsive services.

  • Patients told us it was generally easy to get an appointment with a GP of choice which provided continuity of care, urgent appointments were available on the day. If no appointments remained a clinician would triage the patient to find the most appropriate. 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders and led to changes in practice.

Well-led

Good

Updated 3 March 2016

The practice is rated as good for being well-led. It had a clear vision and strategy.

  • Staff were clear about the vision and their responsibilities in relation to this. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active.

Checks on specific services

People with long term conditions

Outstanding

Updated 3 March 2016

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people, for example the percentage of patients with chronic obstructive pulmonary disease (COPD) the name for a collection of lung disease, who had a review in the preceding twelve months was 91% compared to a national average of 89%.

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 that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Outstanding

Updated 3 March 2016

The practice is rated as outstanding 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. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. For example a young mother was struggling to breast feed and contacted the surgery in the late afternoon, an appointment was made on the same day and advice and support given by the nursing and midwife team.

Older people

Outstanding

Updated 3 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 the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Patients recently discharged from hospital were followed up and appointments arranged to best suit their needs. We also saw evidence that elderly patients were supported in addition to their health needs. For example they were assisted to replace a car tyre in the car park and, in exceptional circumstances, picked up from their homes when there was inclement weather that meant the patient would otherwise miss an appointment and subsequent treatment in hospital. Older people also receive a Birthday card from the practice as an additional reminder they are there for support if required.

Working age people (including those recently retired and students)

Outstanding

Updated 3 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. 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.  The percentage of women aged 25-65 who had received a cervical screening test in the last five years was 83% compared to a national average of 81%.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 3 March 2016

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

90% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 3 March 2016

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

The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

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