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Inspection Summary


Overall summary & rating

Good

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Practice on 10 June 2016. Overall the practice is rated as good.

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

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services because of feedback from patients and from the patient participation group (PPG).

  • Feedback from patients about their care was consistently positive.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.

  • 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 could make an appointment when they needed one 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.

  • The practice had a clear vision which had quality and safety as its top priority and was regularly reviewed and discussed with staff.

  • Staff were well supported and encouraged to access training to aid their career development. Staff morale was high and staff turnover was low.

We saw an area of outstanding practice including:

  • A GP at the practice had developed an at glance guide to dealing with safeguarding concerns which meant staff could quickly and easily refer to guidance when they had a concern. This had been shared with and adopted by the CCG to disseminate to local practices.

However there were areas of practice where the provider should make improvements:

  • Systems to ensure all policies are regularly reviewed and updated should be strengthened.

  • Ensure practice literature on complaints clearly states which organisation patients can contact for support or who they can contact if they are not satisfied with the outcome of their complaint.

  • Risk assess the level of Disclosure and Barring (DBS) checks for non clinical staff providing a chaperone service and reflect this in the practice policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 August 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 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.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 4 August 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 the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data from the Quality and Outcomes Framework (QOF) showed that the practice was performing well when compared to practices nationally. The practice achieved 100% of the number of points available. Data showed 86% of diabetic patients had well controlled blood sugar levels compared with the CCG average of 83% and national average of 78%. Also 95% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the national average of 88%.

  • Clinical audits demonstrated quality improvement.

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

Caring

Good

Updated 4 August 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.

Responsive

Good

Updated 4 August 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 could make an appointment when they needed one and there was continuity of care, with urgent appointments available the same day. The practice identified which patient satisfaction scores were low and took action to improve these areas of their service.

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

  • Information about how to complain was available and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 August 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.

  • 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

People with long term conditions

Good

Updated 4 August 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 practice was supporting a health care assistant to become an assistant practitioner in order that they could manage patients with some long-term conditions.

  • Patients with a long-term condition had a named GP and a single 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. Regular multi-disciplinary team meetings took place with representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.

  • Longer appointments and home visits were available when needed.

  • A GP partner volunteered as a Diabetes UK clinical champion and advised on NICE quality standards, leading talks on a national level and shared good practice locally. Practice patient satisfaction survey results of diabetic patients in 2015 were very positive and performance for diabetes related indicators were comparable or above the national average. For example, blood measurements for diabetic patients showed that 86% of patients had well controlled blood sugar levels compared with the CCG average of 83% and national average of 78%.

  • Patients were offered an insulin initiation and follow up telephone advice service which was run by a practice nurse and supported by the lead GP. This meant that only the most complex patients needed to be referred to the hospital services for diabetic patients.

  • Clinical staff actively referred appropriate patients and worked collaborately with the local extensivist service, run by the CCG. The Extensivist service is provided by a team of clinicians and non-clinicians skilled in supporting patients with complex needs. This offered patients, over sixty with two or more long term conditions, coordinated health and social care support.

Families, children and young people

Good

Updated 4 August 2016

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

  • Systems were in place to identify and follow up children who were considered at risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multi-disciplinary meetings involving child care professionals such as health visitors and school nurses. We saw positive examples of joint working with midwives, health visitors and school nurses.

  • 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.

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

  • Vaccination rates for 12 month and 24 month old babies and five year old children were above CCG averages. Practice staff proactively contacted families who had failed to attend immunisation appointments and followed up any concerns. The practice operated an in house recall system for childhood immunisations with a designated member of staff co-ordinating invitations and recalls which led to an increase in immunisation rates.

  • A drop in Family planning clinic was available each Thursday from 4.45pm until 6pm.

Older people

Good

Updated 4 August 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. All patients over the age of 75 had a named GP.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.The practice was proactive in offering those older patients who could not attend clinic for Flu vaccinations or health checks this service in their own home.

  • Older patients at risk of hospital admission and in vulnerable circumstances had care plans.

  • The practice worked together with the ‘Rapid Response’ community team, aimed at treating people in their own homes if at risk of needing hospital admission.Social Workers were available for the prompt coordination of any social needs alongside the patients’ health issues.

  • The practice maintained a palliative care register and held monthly meetings attended by a wide multidisciplinary team to enable sharing of information relating to patients to improve Palliative and End of Life care.

  • GPs operated a operated a “buddy” system for palliative care patients, so that there was always someone familiar with the case if a patient became unwell.

Working age people (including those recently retired and students)

Good

Updated 4 August 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.

  • Extended hours surgeries were offered between 6pm and 8.30pm every Monday and Thursday and from 7am every Wednesday for working patients who could not attend during normal opening hours. Appointments were available with GPs, nurses and HCAs and the Mental Health practitioner. Telephone consultations were also available.

  • 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 encouraged online Patient Access for booking appointments, ordering prescriptions, viewing medical records.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 August 2016

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

  • Patients had access to an in-house Advanced Mental Health therapist. Evening appointments were available and patients presenting with new mental health concerns were offered a same day appointment.

  • Data from the Quality and Outcomes Framework (QOF) showed that the practice was performing highly in this area when compared to practices nationally. For example, 95% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the national average of 88%. Exception rate reporting was 8% compared to the CCG average of 19%.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. Staff had begun training to become ‘dementia friends’.

  • 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 promoted and referred patients to ‘The Big White Wall’ a 24/7 online confidential mental health website providing support, counselling and information.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 4 August 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 offered longer appointments for patients with a learning disability and other complex needs.

  • 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.

  • Arrangements were in place to identify and support carers

  • The practice had effective working relationships with multidisciplinary teams in the case management of vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.