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Inspection Summary


Overall summary & rating

Good

Updated 27 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bredon Hill Surgery on 18 February 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 and recording significant events.
  • Risks to patients were assessed and well managed with the exception of fire safety arrangements, which needed reviewing.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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.

The area where the provider should make improvement is:

  • Review fire safety arrangements to ensure that they are suitable to protect people from the risk of fire and carry out regular fire drills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 April 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Significant events were analysed at monthly team meetings. Learning was based on thorough analysis and investigation.
  • Information about safety was highly valued and was used to promote learning and improvement.
  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. The one exception was the Fire Risk Assessment, which had been carried out in August 2014 and needed to be reviewed to ensure that it was still suitable for the practice. When unintended or unexpected safety incidents occurred, patients were given reasonable support, information, a verbal and written apology. They were 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 patients safe and safeguarded from abuse. Risks to patients were assessed and well managed.

Effective

Good

Updated 27 April 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits were carried out on a regular basis and results used to improve standards of care.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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 patients’ needs.

Caring

Good

Updated 27 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice as either average or slightly higher than others for almost all aspects of care.
  • Patients told us that they were treated with kindness, dignity and respect and that they were involved in decisions about their care and treatment.
  • We observed a strong patient-centred culture.
  • Views of external stakeholders were very positive and aligned with our findings. For example, the manager of the local care home where some of the practice’s patients lived emphasised the high level of support and care shown by GPs.
  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Patient information about the services offered by the practice was easy to understand and accessible. 

Responsive

Good

Updated 27 April 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations in planning how services were provided to ensure that they met patients’ needs. For example, a practice nurse worked with a Diabetic Specialist Nurse from Worcester Diabetic Centre to provide clinics for diabetic patients.
  • The practice made changes to the way it delivered services as a result of feedback from patients and from the Patient Participation Group.
  • Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked online and urgent appointments were available on the same day.
  • The practice was in purpose-built premises and had good facilities. It was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders as appropriate.
  • Patients praised the continuity of care.

Well-led

Good

Updated 27 April 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 this.
  • There was a clear leadership structure and staff felt supported by the management team. The practice had a number of 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 in place for knowing about 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 27 April 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.
  • Diabetes care had improved significantly since a GP and practice nurse had undertaken specialised training. Clinics were held every two months for more complicated cases and the system for annual reviews was much more robust.
  • The Quality and Outcome Framework (QOF) data for 2014/15 showed variable data for some long term conditions, for example diabetes and osteoporosis. However, recent data from the practice’s clinical computer system proved that effective action had been taken to address the underlying issues, because this trend had reversed for 2015/16 and the practice was on target to achieve better results.
  • 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.
  • The nursing team provided lifestyle support (smoking cessation, weight loss) and the NHS Health Checks.
  • Data from the QOF achievement for 2014/15 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 82%, which was in line with the local and the national averages.
  • Data showed that 64% of patients with asthma had had their care reviewed in the last 12 months, which was 11% below the national average. However, the clinical prevalence for the asthma indicators was 6%, which was in line with the CCG and the national averages.
  • Members of the practice clinical team had undertaken additional training in long term care. For example, a GP and a nurse had specialised in diabetes care.
  • The dispensary provided a home delivery service for patients who were housebound.

Families, children and young people

Good

Updated 27 April 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 (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • The practice had a policy whereby a GP would phone the parent or guardian of a child who did not attend for a GP appointment.
  • 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.
  • Cervical screening uptake was 86%, which was in line with the local and the national averages.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Children under the age of five were given priority appointments.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 27 April 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.
  • The practice held a register for patients who required palliative care. Home visits and same day appointments were provided for these patients, who often had multiple conditions.
  • Regular multi-disciplinary meetings were held during which treatment for patients on the palliative care register was discussed.
  • The practice participated in the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission. The emergency admission rate for over 75 years for 2014/15 was 172 per 1000 patients, which was lower than the Clinical Commissioning Group (CCG) average of 246 per 1000 patients.

Working age people (including those recently retired and students)

Good

Updated 27 April 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.
  • Bookable telephone consultations were offered to provide more flexibility.
  • The practice participated in the extended hours pilot, set up with funds from the Prime Minister’s Challenge Fund, at Evesham Community Hospital (open from 6.30pm to 9pm on weekdays).
  • NHS Health Checks were offered by the nursing team, who gave advice on smoking cessation, weight loss and exercise.
  • A range of contraceptive services were available at the practice (including coils and implants).
  • Online booking enabled patients to book routine appointments with a GP at a time which was convenient to them.
  • Repeat prescriptions could be requested online, instead of having to ring the practice, thus saving time for patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 April 2016

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

  • 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with local and national averages.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • A Community Mental Health Team (Gateway) worker reviewed patients at the practice in a weekly clinic.
  • Patients could self-refer to courses for anxiety, stress management, improving self-confidence and sleep management.
  • 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 experienced 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 27 April 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.
  • The practice offered longer appointments for patients with a learning disability.
  • We received very positive feedback from the residential care home manager with whom we spoke.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Four staff members had received dementia friendly training.
  • Staff had received training and 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. The practice had a policy whereby the usual GP would follow up on any member of a vulnerable family who did not attend an appointment.
  • Information about domestic abuse and sexual violence was displayed in the reception area.