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Inspection Summary


Overall summary & rating

Outstanding

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Staffa Health on 17 September 2015. Staffa Health provides services from a main surgery at Tibshelf and three branch surgeries at Pilsley, Stonebroom and Holmewood. Overall the practice is rated as outstanding.

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

  • The practice had robust arrangements in place to deal with information about safety. Staff were aware of their responsibilities to report incidents and concerns and knew how to do this. Information about safety was thoroughly documented and monitored. The practice had systems in place to maximise learning from significant events and incidents.
  • Risks to patients were assessed and well managed across the four practice sites. Staff could access information about health and safety online or via the staff health and safety noticeboard.
  • The practice demonstrated the use of best practice guidance to assess patients’ needs and plan their care. Staff had received relevant role specific training and further training needs were identified through an appraisal system and a training needs analysis.

  • Feedback from patients was positive about the practice. Patients told us they were treated with dignity and respect and supported to make decisions about their care and treatment.
  • The practice had developed clear and accessible processes to encourage patient feedback. Information on changes made as a result of patient feedback was shared with patients on noticeboards in the waiting area. The practice encouraged feedback from patients.
  • Feedback from patients demonstrated that there was good access to the practice. Pre-booked appointments were available up to five weeks in advance with urgent appointments available on the same day. Patients could access appointments at any of the four sites.
  • The practice had good facilities and was well equipped to meet the needs of patients.
  • There was a very clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice:

  • In response to high rates of emergency admissions linked to falls, the practice had introduced the Otago Falls Prevention programme. This had a positive impact on the practice patients and we saw evidence to demonstrate a decrease in the number of falls related admissions to hospital.

  • The practice employed a care coordinator and a health needs support worker to ensure that multidisciplinary care their patients received was integrated and well-coordinated. This ensured an effective link between health services, social care services and the voluntary sector.
  • The practice continuously improved the way it delivered services by proactively identifying learning from a range of sources. Sources included patient feedback, complaints, significant events and a rolling programme of audit.

  • The practice ensured learning from significant events and complaints was maximised and shared with all staff. The practice had introduced a quarterly lessons learned newsletter for staff.

  • The practice had a clear vision which was shared with staff and patients; we saw that this vision was reflected in the practice’s plans for the future and was central to the care provided to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 December 2015

The practice is rated as good for providing safe services. The practice had robust systems in place to manage information about safety. Staff were aware of, and fulfilled, their responsibilities to raise concerns and report incidents and near misses. The practice ensured that learning was identified and shared with staff. To ensure that opportunities for sharing learning were maximised the practice had introduced a lessons learned newsletter which was circulated to all staff. For example the newsletter shared learning with staff regarding a significant event involving a vaccination. The newsletter highlighted a new practice protocol in respect of this issue.

The practice had systems and processes in place to deal with emergencies and had a robust business continuity plan.

Risks to patients and staff were assessed and very well managed. A comprehensive range of information about health and safety was easily accessible to staff.

Effective

Good

Updated 24 December 2015

The practice is rated as good for providing effective services. Information we reviewed showed that outcomes for patients were in line with the locality. Staff had access to local and national guidelines and used these routinely to plan and deliver patient care.

Staff had received relevant role specific training and further training was planned as required. The practice undertook an annual training needs survey in addition to staff appraisals.

We saw evidence of effective multidisciplinary working with external organisations. For example, the practice employed a care coordinator who worked within a wider community support team to ensure their patients had the appropriate care in place following discharge from hospital.

We saw evidence that the practice was using clinical audit to drive improvements. For example, the practice had audited the prescribing of anticoagulants to patients diagnosed with atrial fibrillation.

Caring

Good

Updated 24 December 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. For example, 85% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 83% and national average of 85%.

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

The practice provided a wide range of information about services which was easy to understand and accessible. We observed that staff treated patients with kindness and respect.

Responsive

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for providing responsive services. We saw that the practice had reviewed the needs of its population and initiated positive service improvements that were over and above its contractual obligations. This included the implementation of an exercise programme to prevent falls in older people which had resulted in a demonstrable reduction in admissions to hospital following falls.

The practice employed a health needs support worker and a care coordinator to improve the integration of care received by their patients.

It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG). For example the PPG has suggested improvements to the chairs in the waiting area which the practice had acted upon.

Patients told us it was generally easy to get an appointment with a GP of choice; there was continuity of care and urgent appointments available on the same day. Patients could access appointments at any of the four branches of the practice.

Information about how to complain and provide feedback was widely available and well publicised. The practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders. Changes made as a result of feedback were shared with patients via posters in the waiting area.

Well-led

Outstanding

Updated 24 December 2015

The practice is rated as outstanding 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 and the partners.

The practice had policies and procedures to govern activity and had a rolling programme of meetings to ensure their clinical governance requirements were met. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and engaged externally with other PPGs within the locality.

Staff had received comprehensive inductions, regular performance reviews and attended staff meetings and events. Staff were encouraged to make suggestions for improvements within the practice, including how the practice could deliver improved patient care.

Checks on specific services

People with long term conditions

Outstanding

Updated 24 December 2015

The practice is rated as outstanding 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 that their health and medication needs were being met. The practice was moving towards a system of integrated ‘one stop’ appointments for patients with multiple long term conditions and was adopting a care planning approach.

The practice had additional expertise in diabetes and one the GPs was a CCG lead in this area. The practice was one of the early providers of insulin initiation in primary care.

For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice employed a care co-ordinator who was a member of a wider community support team. The team met weekly to discuss patients who had been discharged from hospital or were at risk of admission.

Families, children and young people

Outstanding

Updated 24 December 2015

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 at risk, for example, children and young people who had a high number of A&E attendances. Staff were able to give examples of how they liaised with the health visiting team if they had concerns about a child. The practice held quarterly reviews of safeguarding issues

Immunisation rates were relatively high for all standard childhood immunisations and in line with rates across the CCG. The practice had mechanisms in place to follow up on children who did not attend for immunisations.

Appointments were available outside of school hours. The practice had aspirations to reintroduce a ‘drop-in’ clinic for teenagers at a nearby school. This had produced good outcomes but closed when the school relocated to new premises.

Older people

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example 79.2% of patients with rheumatoid arthritis had received a face to face review in the last 12 months. 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 through a duty doctor system and rapid access appointments for those with enhanced needs.

The practice had dedicated nurse clinicians who provided structured care to local care homes to reduce the need for requests for urgent visits. The practice employed a health needs support worker to assist with the integration of care for elderly patients and those with multiple conditions who also faced social issues.

The practice provided a local falls prevention programme for older people identified as being at risk of falling. The service was provided by their own staff and had achieved good outcomes in reducing the number of admissions to hospital as a result of a fall.

Working age people (including those recently retired and students)

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for the care of working-age people (including those recently retired and students).

The practice offered extended hours surgeries until 8.00pm two evenings per week in addition to opening on Saturday mornings from 7.00am until 12.00pm. A healthcare assistant was available on Saturday mornings to enable patients to access health checks.

The practice had a comprehensive website and patients could make prescription requests and book appointments online.

The practice was proactive in offering health promotion and screening clinics that reflected the needs of this population group. The practice hosted a number of services to benefit the needs of this population group including a wellbeing worker and weight management services.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multidisciplinary teams in the management of people experiencing poor mental health, including those with dementia. It carried out advanced care planning for patients with dementia. The practice hosted services to facilitate the needs of patients within this population group. For example the practice hosted talking therapy and a clinical psychiatrist used rooms within the practice to see practice patients.

Practice staff had recently undergone Dementia Awareness Training.

The practice had told patients experiencing poor mental health about how to access appropriate 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.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 December 2015

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

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice employed a care coordinator to ensure that the needs of vulnerable patients were well managed in the community. The care coordinator and health needs support worker signposted patients to appropriate services in the community.

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