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City Health Care Partnership CIC - The Wolds Primary Care Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 19 September 2018

This service is rated as Good overall. (Previous

inspection July 2016 – Good. In July 2016 all the population groups were rated good. The population groups were not inspected at this inspection as we only looked at the urgent treatment centre aspect of the service. The previous rating of good still apply).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an unannounced focused inspection at The Wolds Primary Care Practice on 12 and 13 July 2018 in response to concerns that CQC became aware of in relation the to the Urgent Treatment Centre (UTC) aspect of the service.

At this inspection we found:

• The service had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service investigated them and identified lessons and areas for improvement.

• The provider was developing a process for clinically assessing patients within required timescales when they attended the UTC, to enable them to meet the national NHS England Urgent Treatment Centres – Principles and Standards by March 2019.

• Staff had the knowledge, skills and competence to deliver care to patients.

• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated people with compassion, kindness, dignity and respect.

• Patients could access care and treatment for their needs from the service between the NHS England

recommended opening times.

• There was a leadership structure but staff did not feel they could always access support from the

management team.

The areas where the provider should make improvements are:

• Continue to develop the process so patients are clinically assessed in line with NHS England: Urgent

Treatment Centres – Principles and Standards’ by March 2019.

• Implement a system to monitor that access to GP advice is available to nurses/emergency practitioners when required.

• Improve communication and access between staff and the management team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 September 2018

Effective

Good

Updated 19 September 2018

Caring

Good

Updated 19 September 2018

Responsive

Good

Updated 19 September 2018

Well-led

Good

Updated 19 September 2018

Checks on specific services

People with long term conditions

Good

Updated 30 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 86% compared to the local CCG and England average of 88%.

  • Longer appointments and home visits were available when needed.

  • Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 30 November 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 or who failed to attend hospital appointments.

  • Immunisation rates were comparable to or higher than the local CCG area for all standard childhood immunisations. For example, rates for all immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 90% to 100% compared to 94% to 98% for the local CCG area.

  • 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.

  • Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 95% compared to the local CCG average of 85% and the England average of 82%.

  • 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.

    The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

Older people

Good

Updated 30 November 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. Patients over the age of 75 had a named GP.

  • The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans. The practice was participating in the EASY Care Project. The practice would work with social care staff to undertake a needs based assessment of all the practice patients over 75 years of age, those living in care homes and learning disability units. This would identify a summary of the patient’s needs, allowing them to be signposted to appropriate local resources. The information would then be used by the practice to inform patients care plans. It would also help to shape future services in the town.

  • They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Nationally reported data for 2014/2015 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 1.9% above the local CCG average and 2.1% above the England average.

Working age people (including those recently retired and students)

Good

Updated 30 November 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, 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 reflected the needs for this age group.

  • Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

  • Appointments were available on a morning on Saturdays, Sundays and bank holidays with the GP. Saturday morning appointments with the practice nurse were available once a month. Early morning appointments were available during the week with nurses and Health Care Assistants.

  • The practice hosted clinics and services including counselling services and drugs and alcohol misuse.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 November 2016

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

  • Nationally reported data from 2014/2015 showed 91% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local CCG and England average of 84%.

  • The practice carried out advanced care planning for patients with dementia. Staff had completed dementia friends training (a dementia friend is someone who learns more about what it is like to live with dementia and turns that understanding into action).

  • Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 93%. This was above the local CCG average of 91% and the England average of 88%.

  • 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.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 30 November 2016

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

  • The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

  • The practice offered longer appointments for people with a learning disability.

  • Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment.

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

  • The practice 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.

  • Telephone interpretation services were available and information leaflets in different languages were provided when required.