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Archived: Pinfold Surgery Good Also known as Dr Bance & Partners

Inspection Summary


Overall summary & rating

Good

Updated 14 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bance and Partners on 31 March 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, recording and taking remedial action in relation to 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.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and 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 one area of outstanding practice:

  • The practice had identified the needs of diabetic patients and since 2013 had employed a dedicated diabetes specialist nurse.This allowed the practice to deliver diabetic services up to level four which included insulin initiation.In addition, a diabetic consultant attended the practice to review patients. This prevented the need for diabetic patients to attend secondary care unnecessarily. Patient satisfaction with the service was high and in the latest practice survey 97% of patients rated the care received as either excellent or good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 June 2016

The practice is rated as good for providing safe services.

  • There was a nominated lead and systems were in place for reporting and recording significant events. Lessons were shared to ensure action was taken to improve safety in the practice. All staff were encouraged and supported to record any incidents using the practice reporting system.

  • There was a nominated lead for safeguarding children and adults. Systems were in place to keep patients and staff safeguarded from abuse.

  • There were processes in place for safe medicines management.

  • When things went wrong we were told 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.

  • Risks to patients were assessed and well managed.

Effective

Outstanding

Updated 14 June 2016

The practice is rated as outstanding for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the need of patients and delivered care in line with current evidence based guidance. The practice had in place an effective system of disseminating guidance and alerts and ensuring implementation.

  • Weekly clinical meetings were held to discuss patient care and complex cases.

  • Staff worked with other health and social care professionals, such as, district nursing and health visiting teams, to meet the range and complexity of patients’ needs.

  • Clinical audits were undertaken and could demonstrate quality improvement.

  • The practice had a proactive approach to staff training and development.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to both local and national figures.

  • There were care plans in place for patients considered at risk of an unplanned admission or attendance to A&E, such as patients with a long term condition. At the time of inspection the practice had reviewed 72% of all care plans (this equated to over 2,000 care plans) and exceeded the local target of 65%. The practice could demonstrate a reduction in admissions linked to this work.

  • The practice had developed consent processes for patients who received minor surgery and steroid injections and had coded and used pop-up alerts on screen to identify patients subject to a Deprivation of Liberty Safeguard (DoLS) assessment.

  • The practice had developed a monthly staff newsletter which was used to keep staff informed of key information across the three surgeries which comprised the practice.

Caring

Good

Updated 14 June 2016

The practice is rated as good for providing caring services.

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

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

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

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

  • There were private rooms available for mothers who were breastfeeding.

  • All surgeries, Pinfold, Elizabeth Court and Castleford Health Centre had wheelchairs available on demand for patients who had mobility problems.

  • The practice was registered under the Wakefield Safer Places Scheme. This was a voluntary scheme which assisted vulnerable people to feel safer and more confident when travelling independently away from their homes by offering then places of safety and support should this be required.

Responsive

Good

Updated 14 June 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. For example;

    • The practice had identified the needs of diabetic patients and since 2013 had employed a dedicated diabetes specialist nurse able to deliver diabetic services up to level four which included insulin and GLP-1 initiation (GLP. In addition, a diabetic consultant attended the practice to review patients. Patient satisfaction with the diabetic service was high and in the latest practice survey 97% of patients rated the care received as either excellent or good.

    • The practice organised and hosted specialist clinics which included health trainers, audiology, physiotherapy, cognitive behavioural therapy, prostate cancer and abdominal aortic aneurysm screening.

    • The Castleford Health Centre branch surgery worked closely with a local hostel for homeless people to offer access to medical services.

  • Patients said they found it easy to make an appointment with a named GP and 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; this included having good access for people with a disability.

  • 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 and other stakeholders.

Well-led

Good

Updated 14 June 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. Staff were clear about the vision and their responsibilities in relation to it.

  • 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.

  • The practice had a strong ethos of staff training and development which included acting as a training practice and developing a successful apprenticeship programme.

  • 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 had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

Older people

Good

Updated 14 June 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. We were told elderly patients were given additional time and help to book their appointments if they were perceived to be struggling with the booking system.

  • The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and who were at risk of an unplanned hospital admission.

  • The practice had recently joined the Wakefield Vanguard Connecting Care programme, part of  which involved the practice providing regular clinical support to 11 nearby residential and nursing homes. The support included meeting individual patient health needs and the development and review of care plans. At the time of inspection the practice was providing services to 151 care home residents, of these residents 84% had active care plans in place.

People with long term conditions

Outstanding

Updated 14 June 2016

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.

  • Since 2013 the practice had employed a dedicated diabetes specialist nurse.This allowed the practice to deliver diabetic services up to level four which included insulin and GLP-1 initiation (GLP-1 is a class of injected drugs for the treatment of type 2 diabetes). In addition, a diabetic consultant attended the practice to review patients. This prevented the need for diabetic patients to attend secondary care unnecessarily. Patient satisfaction with the service was high and in the latest practice survey 97% of patients rated the care received as either excellent of good.

  • 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the last 12 months, compared to 94% locally and 90% nationally.

  • The practice hosted other specialist/enhanced clinics which included physiotherapy, heath trainer advice and prostate cancer screening.

  • All patients on long term condition registers were invited for structured reviews on at least an annual basis. During these reviews patients had bespoke care plans developed for them and received advice on how to manage the condition.

  • The practice offered e-consultations with secondary care specialist consultants. This meant a reduction in the need for patients to visit secondary care providers, and also meant they received more timely advice and treatment than would be otherwise the case.

  • Longer appointments and home visits were available when needed.

  • For those patients 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 14 June 2016

  • 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.

  • We were told 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 81%, which was comparable to CCG and national averages.

    The practice had a policy of always following up cervical screening non-responders.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Additionally, extended appointments were available Monday to Friday for new born six to eight week baby checks at any of the practice locations.

  • The safeguarding lead GP had weekly meetings with the health visitor team at the Castleford Health Centre branch surgery.

  • Sexual health and contraceptive and cervical screening services were provided at the practice.

Working age people (including those recently retired and students)

Good

Updated 14 June 2016

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

  • Students and young people aged 17 years and above were able to access an enhanced service catch up programme for MMR and Meningitis C vaccinations (MMR

    vaccine is an immunisation vaccine against measles, mumps, and rubella)

    .

  • 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, the practice provided telephone consultations during the day to patients who may otherwise not be able to attend.

  • 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 whose circumstances may make them vulnerable

Good

Updated 14 June 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 and the frail elderly.

  • Castleford Health Centre branch surgery worked closely with a local homelessness hostel to deliver healthcare services to residents.

  • The practice offered longer appointments for patients with a learning disability and for those whose conditions would benefit from a longer consultation period.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice met with other health and social care professionals including palliative care nurses on a monthly basis to discuss individual cases and update care plans.

  • The practice informed 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 June 2016

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

  • The practice has a high dementia diagnosis rate of 84% and at the time of inspection had 153 patients on its dementia register.

  • 79% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months; this was comparable to the CCG and national average.

  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months which had been agreed between individuals, their family and/or carers as appropriate. This was 2% above the CCG average and 4% above the national average.

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice informed patients experiencing poor mental health how to access various support groups and voluntary organisations. In addition the practice worked with a local provider to offer weekly Improving Access to Psychological Therapies (IAPT) sessions either by referral or self-referral. (IAPT is a programme of talking therapy treatments recommended by the National Institute for Health and Clinical Excellence (NICE) which supports frontline mental health services in treating depression and anxiety disorders).

  • Staff had an understanding of how to support patients with mental health needs and dementia.

  • The practice was registered under the Wakefield Safer Places Scheme. This was a voluntary scheme which assisted vulnerable people to feel safer and more confident when in the community and away from home settings.