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Jubilee Street Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Street Practice on 19 July 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • There was a clear effective leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice actively engaged with external organisations such as the carer’s society and local schools to engage patients, promote healthy living and promote primary care services.
  • The practice had an effective approach to staff appraisals, which included a system of 360 degree and peer review.
  • There was an open and transparent approach to safety and a comprehensive effective system in place for reporting, recording and sharing learning from significant events both internally and externally with local practices and the Clinical Commissioning Group (CCG).
  • 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 and was shared internally and externally to the practice.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent and non-urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

  • Patients were invited to take part in practice learning time, where they participated in scenario based role reversal role play with clinical and non-clinical staff to improve customer service and patient understanding; this was fed back to the patient participation group, and increased the number of PPG members.

  • A video was provided by carers registered with the practice which informed other carers of the care that they were provided with and about services available to them such as priority access to GP’s referrals into support services and support with letters to external agencies for financial support. Written information was available to direct carers to the various avenues of support available to them.

  • The practiced designed a trigger tool, which had been adopted by Tower Hamlets CCG and identifies patients at risk of deterioration of chronic kidney disease (CKD), which led to 43 patients being coded as having CKD, 10 patients having their medicines changed and four referrals made to the CKD clinic.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 December 2016

The practice is rated as good for providing safe services.

  • There was a comprehensive effective system in place for reporting and recording significant events, staff understood their responsibilities to raise concerns.

  • Lessons learned and action taken as a result of incidents were shared internally and externally with the CCG and local practices to make sure action was taken to improve safety in and outside the practice.

  • The practice took every opportunity to learn from incidents. Learning was based on thorough analysis and investigation.

  • 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 clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • There was a proactive approach to anticipating potential risks to patients in the practice which involved all staff members, risks to patients were well managed.

  • Medicines were well managed, there was emergency equipment including a defibrillator and oxygen.

Effective

Outstanding

Updated 2 December 2016

The practice is rated as outstanding 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.

  • There was a programme of continuous clinical audits, which demonstrated quality improvement.

  • The practice was involved in designing, developing and testing a trigger tool, which had been adopted by Tower Hamlets CCG and identifies patients at risk of deterioration of chronic kidney disease (CKD), which at Jubilee Street Practice led to 43 patients being coded as having CKD, 10 patients having their medicines changed and four referrals made to the CKD clinic.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was a walk in phlebotomy service for patients who were unable to make appointments and who found it difficult to attend clinics outside of the practice.

  • There was evidence of appraisals and personal development plans for all staff as well as 360 degree and peer review.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • Clinical staff met daily over lunch to discuss complex patients and share ideas and learning.

Caring

Good

Updated 2 December 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.

  • The practice employed a translator for patients who did not have English as their first language.

  • 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.

  • The GPs were involved in discussions outside the practice to promote services available to Carers.

Responsive

Good

Updated 2 December 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.

  • 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.

  • 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

Outstanding

Updated 2 December 2016

The practice is rated as outstanding 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.

  • 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 an annual staff survey which showed improvement in staff satisfaction.

  • The practice had robust strategies to support business plans, which reflected the vision of the practice.

  • The practice held regular away days where governance arrangements where governance arrangements were reviewed.

  • There was a strong focus on continuous learning and improvement at all levels, the practice also supported non practice related training.

Checks on specific services

People with long term conditions

Good

Updated 2 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 worked in teams that also included a GP and administration staff member. Patients at risk of hospital admission were identified as a priority.

  • The percentage of patients on the diabetes register who had a record of foot examination and risk classification within the preceding 12 months was 93% compared with a CCG average of 90% and a national average of 88%.

  • Longer appointments and home visits were available when needed.

  • Patients could attend the surgery at any time for a blood test without the need for an appointment.

  • 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

Outstanding

Updated 2 December 2016

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

  • There were effective 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.

  • One of the GPs attended a local primary school where many of their patients attended and met with parents and carers to promote healthy lifestyles and answer questions.

  • The practice was signed up to the local HUB, which provided GP appointments after hours on weekdays and on weekends.

  • 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 practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 79% and the national average of 74%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

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

  • The practice operated a Facebook and twitter account as a means of two way communication with patients.

Older people

Outstanding

Updated 2 December 2016

The practice is rated as outstanding 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.

  • here was a walk in phlebotomy service for patient convenience

  • Patients had a named GP, with a personal business card showing when their GP was available.

  • Unplanned hospital admissions were reduced for patients in care homes by the use of bi-weekly rounds alongside the community team.

Working age people (including those recently retired and students)

Good

Updated 2 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.

  • 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 was signed up to the local HUB, which provided GP appointments after hours on weekdays and on weekends.

  • The practice operated a Facebook and twitter account as a means of two way communication with patients.

  • There was a walk in phlebotomy service for patient convenience.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 December 2016

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

  • 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record in the preceding 12 months was 86% compared with a CCG average of 83% and a 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.

  • Patients were given a personal business card which highlighted the days and times that their GP was available

People whose circumstances may make them vulnerable

Good

Updated 2 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 those with a disability and those with a learning disability.

  • Alerts were on the clinical system to identify these patients to enable them to get priority access to services.

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

  • 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.

  • All staff were provided with domestic abuse awareness training.

  • A benefits advisor held a clinic at the practice on a weekly basis.

  • Patients were given a personal business card which highlighted the days and times that their GP was available.