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Horsmans Place Partnership Good Also known as Horsmans Place Surgery

Inspection Summary


Overall summary & rating

Good

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Horsmans Place Partnership on 28 September 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 for reporting and recording significant events, and learning from these was discussed, shared and embedded at the practice.
  • Risks to patients were assessed and well managed, including an infection control audit with identified actions and the date these were achieved.
  • Medicines were well managed and organised within the practice.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had received updates to training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice provided a personal list system for patients, which meant that patients had their own GP who would see them unless they required an emergency appointment.

  • Patients said they were treated with compassion, dignity and respect, and 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, and the practice was open and transparent in responding to these.

  • 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. However, the response to the GP patient survey rated the practice lower than the CCG and national averages for being able to get through on the telephone to make an appointment. The practice had an action plan to address this.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. It had been refurbished to increase accessibility for patients with reduced mobility and for those with babies and small children.

  • 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.
  • The patient participation group (PPG) was active at the practice and improvements were made as a result of their input, reflecting the patient voice.

The areas where the provider should make improvement are:

  • Continue to address and take action on areas below the local and national average as identified by the GP Patient Survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and staff spoken with were able to give clear examples of changes that had been made in practice.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong 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.

  • The practice had systems, processes and practices to help keep patients safe and safeguarded from abuse, including a designated safeguarding lead GP and appropriate training for all staff members.

  • Risks to patients were assessed and well managed.

  • Infection prevention and control was well managed.

Effective

Good

Updated 14 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • 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.

  • There was evidence of appraisals for staff employed at the practice for over a year.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. For example, multi-disciplinary meetings were held regularly.

Caring

Good

Updated 14 December 2016

The practice is rated as good for providing caring services.

  • Patients’ views gathered at the inspection showed that they felt treated with dignity and respect and involved in decisions about their treatment and care, and we observed that staff treated patients with kindness and respect and maintained confidentiality. However, data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care compared to local and national averages. The practice were aware of this and working with an action plan to make changes according to the results of the patient survey. The patient participation group (PPG) were also aware of this and liaising with the practice to help to make improvements.

  • 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.

Responsive

Good

Updated 14 December 2016

The practice is rated as good for providing responsive services.

  • Services were planned and delivered to take into account the needs of different patient population groups and to help provide flexibility, choice and continuity of care.

  • The practice provided a personal list system for patients, which meant that patients had their own GP and would see them unless they required an emergency appointment.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, but that it could be difficult to access the practice by telephone at peak times.

  • Feedback from patients regarding how easy it was to make an appointment at the practice was varied.

  • Urgent appointments were available the same day and patients could book in advance up to four weeks ahead. There was an on-line appointment booking system.

  • 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 December 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 policies and procedures to govern activity and held regular governance meetings.

  • 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 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

People with long term conditions

Good

Updated 14 December 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.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 95% which was higher than the CGG average of 87% and the England average rate of 88%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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 December 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems 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.

  • The practice aimed to register whole families with the same GP for continuity of care.

  • 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.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years (01/04/2014 to 31/03/2015) was 96% which was higher than the CCG average of 87% and the England average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. There were baby change and breast feeding facilities available.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • One member of the reception team was the designated person to work with young people.

Older people

Good

Updated 14 December 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.

  • Monthly multi-disciplinary meetings were held to discuss the care and treatment needs of complex patients including end of life care.

  • Palliative Care Gold Standards Framework meetings were held monthly.

  • Patients in local residential and nursing homes (approximately 20 patients) had a named GP who was solely responsible for their care and treatment.

  • The practice worked in close liaison with the Dementia Community Team.

Working age people (including those recently retired and students)

Good

Updated 14 December 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, the doors of the practice remained open from 8am until 6.30pm, from Monday to Friday, however, the practice were not currently able to offer extended hours services. Staff told us that this would change when a new partner joined the practice in 2017.
  • A text message reminder service had been introduced.
  • 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 experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2016

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

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 95% which was higher than the CCG average of 86% and the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice 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.
  • 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 14 December 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, travellers and those with a learning disability.
  • The practice was proactive in helping to ensure homeless patients were able to access care and support.
  • The practice offered longer appointments for patients with a learning disability and the nursing team would carry out these appointments within the community where required.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.
  • There was a safeguarding lead GP and all staff spoken with were aware of this and how to report any incident of concern.