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Dr C Wilcock & Partners Good Also known as Friends Road Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr C Wilcock and Partners on 20 November 2015. 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.
  • Data showed patient outcomes were at or above the local averages.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • 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.

We saw some areas of outstanding practice:

  • The practice recorded and responded to issues patients experienced with other health services. They recorded when other health professionals did not attend booked home visits for their patients. They also reviewed all discharge letters and when these were not completed in full or included incorrect details, they requested the required details from the service and referred their concerns to the CCG to be addressed. These were reviewed as significant events within the practice to ensure patients received appropriate care and treatment.

  • The practice had a long history of providing services to vulnerable patients in the population and demonstrated changes they had made to services to meet the needs of different vulnerable people. For example they provided longer appointments for patients who were refugees and those who required interpreters when they did not have English as their first language. They had systems to sign post refugees to local support services for information and advice. The practice had provided services to local units providing shelter to women and children fleeing domestic violence. The practice was currently providing GP services to a unit providing accommodation to offenders who had just been released from prison.

  • The practice achieved Investors in People in Champion in 1998 and Champion Status which in 2005 and went on to mentor and support 10 other practices in the Investors in People journey to achieve this for themselves.

The areas where the provider should make improvement are:

  • Update emergency medicines to ensure they were able to deal with a range of medical emergencies.

  • Advertise the complaints procedure for patients and display information advising patients that nurses would act as chaperones if required.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 May 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.

  • When there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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 people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 12 May 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were mainly in line or above average for the local area.

  • 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 and there was a skill mix of clinical staff.

  • 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

Good

Updated 12 May 2016

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.

  • Patients said staff respected their dignity and privacy and they were treated with compassion. Patients told us they were involved in decisions about their care and treatment.

  • Information for patients about the services provided was easy to understand and accessible.

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 12 May 2016

The practice is rated as good for providing responsive services.

  • It knew the needs of the local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example they reviewed their appointment system to include GPs contacting patients who request urgent appointments to ensure this was the best way to meet their health need. They had developed patient information leaflets to help patients understand when to attend urgent care and accident and emergency services, to reduce pressure on these local services.

  • Patients said they found it easy to make an appointment with their GP and they received continuity of care. Urgent appointments were available the same day.

  • The practice had suitable facilities and was well equipped to treat patients and meet their needs.

  • While the practice had suitable complaints policies and procedures these were not readily available to patients, although patients we spoke with did not see this as an issue. Evidence showed that the practice responded quickly and appropriately to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 12 May 2016

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

  • The practice had a clear vision with providing high quality and safe services as its priorities. The strategy to deliver this vision was discussed with all staff and this was reviewed and updated when required.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles to meet these standards.

  • Governance and performance management arrangements were reviewed and took account of current models of best practice.

  • The practice carried out proactive succession planning for both clinical and non-clinical staff.

  • There was a high level of staff satisfaction and low staff turnover.

  • The practice gathered feedback from patients using new technology, and it had an active patient participation group which influenced practice development. For example the practice made changes to their appointment system and GP triage in response to patient feedback.

  • The practice displayed strong leadership by mentoring other practices and leading in pilot projects.

Checks on specific services

People with long term conditions

Good

Updated 12 May 2016

The practice is rated as good 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.

  • Nationally reported data showed outcomes for patients with diabetes were in line or above both local and national averages. For example 87% had a flu vaccination, 74% had their cholesterol measured in the last year and 92% had their feet examined in the last year.

  • Longer appointments and home visits were provided when needed.

  • All these patients had a named GP who carried out a structured annual review to check that their health and medicines needs continued to be 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

Good

Updated 12 May 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 accident and emergency attendances.

  • The practice used ‘celebrate and protect’ style birthday cards to remind parents to bring their children for their childhood immunisations. Immunisation rates were in line or just below the local 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.

  • Data showed 81% of women attended for a cervical smear test which was in line with local and national averages.

  • Appointments were available outside of school hours and the premises were suitable for children and babies with sufficient room for pushchairs and a separate waiting area with a range of toys for younger children.

  • The practice liaised with midwives and health visitors to identify children in need and those at risk and there was a system on the patient record to identify these patients. Midwives attended the practice weekly to provide an antenatal clinic.

  • The practice provided services to children who were looked after by the local authority and this was identified on the individual patient record.

  • The practice offered a full range of family planning and sexual health advice.

Older people

Good

Updated 12 May 2016

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

  • Older people made up 24% of the practice registered population. The practice provided a named GP for all patients over 75.

  • The practice offered proactive, personalised care to meet the needs of the 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.

  • The practice provided a service to a nursing home and one of the GPs visited twice each week and in-between when required. They provided end of life care, annual flu vaccinations, carried out regular medicine reviews and reviewed all unplanned admissions to hospital. They also provided services to a number of patients living in shelter housing.

  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

  • The practice worked with other health and social care professionals including falls teams to help reduce the risk of unplanned admissions to hospital.

  • The practice identified they had a high percentage of patients needing nursing and palliative care services. They worked with the palliative care team to ensure these patient’s needs were known and met compassionately and their relatives and carers received extra support when required.

Working age people (including those recently retired and students)

Good

Updated 12 May 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. For example they provided booked appointments from 7.30-8.00am two mornings a week and from 6.30pm-7.00pm every weekday evening. In addition, the GPs provided telephone appointments.

  • 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.

  • The practice website included information about common health conditions and information about local health services.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 May 2016

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

  • Eighty per cent of the 38 people with dementia had had their care reviewed in a face to face meeting in the last 12 months.

  • The practice kept a register of people experiencing poor mental health. Data showed 90% of the 80 patients experiencing poor mental health had a care plan that was reviewed which was above the national average of 86%. Ninety two per cent of these patients had a record of their alcohol consumption above the national average of 89%. They provided longer appointments at times that suited this patient group.

  • The practice regularly worked with multidisciplinary 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 in the local area.

  • It had 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 had completed training in dementia care so they could meet the specific needs of this patient group.

People whose circumstances may make them vulnerable

Good

Updated 12 May 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 homeless people, those with a learning disability and people who used domestic violence services. The practice held a weekly clinic for patients experiencing domestic violence. They had recently started to provide services to a residential unit for ex-offenders.

  • It provided a service to a care home for people with learning disabilities and all these patients received an annual health check. The practice offered longer appointments for people with a learning disability.

  • The practice regularly worked with multidisciplinary teams to provide joined up care and treatment to 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 and were clear about their responsibilities to report concerns and how to contact relevant agencies in and out of office hours.