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Radford Medical Practice - Kaur Good

Inspection Summary


Overall summary & rating

Good

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Radford Medical Practice – Kaur on 9 May 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 managing significant events. Learning was shared with staff and action was taken to improve the service.

  • Risks to patients were assessed and well managed. This included medicines management, recruitment checks on staff and procedures for dealing with medical emergencies.
  • 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.
  • 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 implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient participation group.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • There was a demonstrated commitment to continuous learning and improvement to patient outcomes by all staff. For example, the practice participated in research studies and was accredited as a teaching practice for medical students. Practice staff had also developed information for carers of patients with dementia and for parents of children aged under five years with eczema as part of patient education.

The areas where the provider should make improvement are:

  • Ensure review dates are documented on the significant event forms to enable staff to monitor all agreed actions are completed.
  • Review arrangements to make sure care plans for patients are robust and contain up to date information including for people aged 75 and over.
  • Continue to identify carers proactively and improve their care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 June 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.

  • There was an effective system in place for reporting, recording and investigating significant events. Lessons were shared to ensure action was taken to improve safety in the practice.

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

  • When things went wrong patients received reasonable support,and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had systems and processes in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed. This included checks related to health and safety, fire and the premises.

  • Systems were in place to enable staff to respond to a medical emergency. This included access to emergency equipment, medicines and the business continuity plan.

Effective

Good

Updated 22 June 2016

The practice is rated as good for providing effective services.

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

  • Data from the Quality and Outcomes Framework (QOF) showed most patient outcomes were comparable to the local and national averages.

  • The practice had strengthened its recall system for patients with chronic diseases to ensure regular monitoring and improved outcomes.

  • The practice carried out clinical audits which they used to improve patient 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

  • Health promotion was highlighted through patient education and the practice offered a range of screening programmes and health checks.

Caring

Good

Updated 22 June 2016

The practice is rated as good for providing caring services.

  • Feedback from patients about their care and treatment was strongly positive. Patients felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect.

  • Patients confirmed involvement in decisions about their care and treatment; and we reviewed a sample of care plans which confirmed this.

  • The January 2016 national GP patient survey results showed patients rated the practice higher than others for some aspects of care. For example:

  • 94% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG and national averages of 85%.

  • We saw that staff treated patients in a friendly and respectful way, and maintained patient and information confidentiality.

  • Information for patients about the services available was accessible in different languages and easy to understand. This included information on self-help groups and bereavement.

  • The practice identified carers and provided relevant support to improve their care. This included health checks, carer’s assessments and referrals to external agencies for support.

Responsive

Good

Updated 22 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 provide relevant services and secure improvements where these were identified.

  • The practice worked in liaison with other health and social care professionals to ensure patients’ with long term conditions received additional care and treatment when needed. This included the diabetes specialist nurse and the falls and bones nurse.

  • 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 January 2016 national GP patient survey results showed 100% of respondents found the last appointment they got was convenient and this was above the local and national averages of 92%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included access to interpreting services and facilities for people with disabilities or impairments.

  • 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 22 June 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and business plan to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • The overarching governance framework supported the delivery of good quality care. This included arrangements to monitor and improve patient outcomes, and to mitigate identified risks.

  • The provider was aware of and complied with the requirements of the duty of candour and effective systems were in place to report notifiable safety incidents and to ensure appropriate action was taken.

  • The practice had an engaged patient participation group which influenced practice developments.

  • There was a clear leadership structure and staff felt supported by management.

  • The practice proactively sought feedback from staff which it acted on. Staff told us they felt

    empowered to make suggestions and to drive improvement within the practice.

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

Checks on specific services

People with long term conditions

Good

Updated 22 June 2016

The practice is rated as good for the care of people with long-term conditions.

  • Nationally reported data showed patient outcomes for long term conditions such as coronary heart disease and chronic kidney disease were comparable to local and national averages.

  • The practice had strengthened its monitoring system for recalling patients for annual health checks to improve outcomes for patients.

  • Nursing staff had lead roles in chronic disease management and the nurse practitioner was trained to start patients on insulin treatment. The community diabetes nurse attended the practice every six weeks to see patients with complex needs and those who needed additional support.

  • Patients at risk of hospital admission were identified as a priority and contact was made after they had attended accident and emergency or were discharged from hospital. Their care was also reviewed at monthly multi-disciplinary meetings.

  • 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.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 22 June 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 those at risk of abuse. For example, regular multidisciplinary meetings were held with the health visitor to discuss children on the child protection register as well as families requiring additional support.

  • A weekly baby clinic was held and immunisation rates for most standard childhood immunisations were comparable to the local average.

  • 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. For example, the practice was accredited as a “young people friendly” service in line with the You’re Welcome quality criteria. This criterion provides a set of standards for delivering friendly health services for 14-19 year-olds in England.

  • Young people aged 13 to 24 could access a free and confidential service in respect of sexual health screening, free contraception, pregnancy testing and general advice regarding health.

  • Same day appointments were offered to children under five years if acutely unwell and appointments were available outside of school hours.

  • A variety of useful information on managing common childhood illnesses for under 5 year olds was available on the practice website. One of the GP partners had also produced a leaflet on management of childhood eczema which had been posted out to relevant parents.

  • The practice had baby changing facilities and nappies and wipes were available at the reception.

Older people

Good

Updated 22 June 2016

The practice is rated as good for the care of older people.

Approximately 4% of the practice population were aged 75 years and over. 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 signed up to a local enhanced service referred to as “ensured tailored care for vulnerable and older people”. All patients aged 75 and over had care plans in place, with a named GP and care co-ordinator. We found these care plans could be improved to ensure they were completed comprehensively and personalised.

  • The care of older people at risk of hospital admission was discussed at monthly multi-disciplinary meetings. Benchmarking data for the local area showed the practice had the second lowest number of accident and emergency attendances for patients aged 65 years and over, as at February 2016.

  • A range of health checks were provided, and flu and pneumococcal vaccinations were offered to patients.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to local and national averages.

  • The falls and bones specialist nurse undertook three monthly visits to proactively identify and offer appropriate care to patients at risk of falling and sustaining fractures. There were no patients with a confirmed diagnosis of osteoporosis that met the Quality and Outcomes criteria.

Working age people (including those recently retired and students)

Good

Updated 22 June 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 and text messaging services for appointments.

  • A full range of health promotion and screening that reflects the needs for this age group was offered. For example, cancer screening, NHS health checks and a family planning service.

  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 68%, which was marginally lower than the CCG average of 74% and national average of 73.5%.

  • The practice offered a phlebotomy clinic and treatment room services such as wound care and dressings to its own patients.

  • The nurses offered a full-day telephone triage service which was accessible to working age patients.

  • Patients who moved outside the practice’s catchment area could remain registered with the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 June 2016

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

  • The practice had a register of 17 patients with dementia. The salaried GP had produced an information pack for these patients and their carers, and this had been sent out to them. All carers of patients with dementia were offered a carer’s assessment.

The 2014/15 published data showed:

  • 83.9% of patients diagnosed with dementia had their care reviewed in a face to face meeting within the last 12 months which was in line with the local average of 83.6% and the national average of 88.3%.

  • 78.8% of patients with a mental health condition had a documented care plan in the last 12 months which was comparable to the CCG average of 85.4% and the national average of 89.5%.

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

  • Follow-up arrangements were in place for patients experiencing poor mental health that had attended accident and emergency, or required specialist mental health support. For example, 40 referrals had been made to psychiatric services between April 2014 and March 2015; and 11 of these were for students.

  • Longer appointments were offered including flexible appointments for patients requiring regular blood test monitoring.

  • The practice had produced a leaflet listing the available psychological therapy services for patients and information relating to various support groups and voluntary organisations was available to patients.

People whose circumstances may make them vulnerable

Good

Updated 22 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. An annual meeting was held with the learning disabilities health facilitator to review the care of people with learning disabilities All 13 patients on the learning disability register had received an annual health check and care plans were in place.

  • The practice offered longer appointments for patients with a learning disability and people requiring an interpreter for consultations with GPs and nurses.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. This included the care of patients receiving end of life care.

  • 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 reporting to relevant agencies.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice had a carer’s lead staff member and a number of referrals had been made to the local carers’ support service.