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Archived: Great Staughton Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Great Staughton Surgery on 16 January 2016. Overall the practice is rated as good. They are rated as outstanding for providing services to people whose circumstances may make them vulnerable.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • 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.
  • Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice higher than others for all areas of care. For example, 97% of patients said that the last GP they saw or spoke to was good at treating them with care and concern, in comparison to a local and national average of 85%.
  • 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.
  • Patients said they found it easy to make an appointment with a GP and that there was continuity of care. Data from the National GP Patient Survey published in July 2016 showed that 100% of patients surveyed found it easy to get through to the practice by phone.
  • 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 well 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.

We saw several areas of outstanding practice:

  • The practice had created specialist ‘bereavement packs’ to give to patients who had experienced a recent bereavement. These included practical information and guidance on who to contact for emotional support. This had been shared with other practices in the area who had commenced the same service.
  • Teenagers were invited for a formal review when they were 16 to complete their immunisation schedule and as an opportunity to provide health promotion information, such as diet, exercise, substance misuse and sexual health.
  • The practice recognised the lack of public transport for patients to get to the practice, and had organised a volunteer led transport scheme. We received positive feedback about this service. The success of this service and the improvement it made to access was also reflected in national and local benchmarking figures, which showed that the practice had one of the lowest rates in the country for both emergency admissions to hospital and accident and emergency attendances, despite caring for a largely older population in a rural setting.

However, the provider should:

  • Maximise the functionality of the computer system in order to consistently code patient groups and produce accurate performance data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff had a good understanding of significant events, and recorded a wide range of incidences, including cancer diagnoses, patient deaths, safeguarding concerns, changes to services, near misses and compliments.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, detailed 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. For example, there was a clear protocol in place to follow up children who did not attend hospital appointments.
  • Risks to patients were comprehensively assessed and well managed.
  • Arrangements were in place to respond to emergencies and major incidents.

Effective

Good

Updated 13 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with local and national averages in most areas, but below averages in others.
  • 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 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.
  • National and local benchmarking figures showed that the practice had one of the lowest rates in the country for both emergency admissions to hospital and accident and emergency attendances, despite caring for a largely older population in a rural setting.

Caring

Good

Updated 13 February 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed patients rated the practice higher than others for all aspects of care. For example, 97% of patients said the last GP they saw or spoke to was good at involving them in decisions about their care, compared to the local and national average of 82%.
  • Feedback from patients about their care was consistently positive. 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.
  • The practice had created specialist ‘bereavement packs’ to give to patients who had experienced a recent bereavement. These included practical information and guidance on who to contact for emotional support. This had been shared with other practices in the area who had commenced the same service.
  • The practice was proactive in providing support for patients with caring responsibilities. The practice had identified 69 patients as carers (2% of the practice list). Written information was available to direct carers to the various avenues of support available to them.

Responsive

Good

Updated 13 February 2017

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 (CCG) to secure improvements to services where these were identified. For example, the practice worked with the CCG to set up an anticoagulation service, meaning that patients could receive care closer to home. Furthermore, the practice had commenced a hearing aid battery exchange service so that patients did not have to travel to the hospital for this service.
  • Patients said they found it easy to make an appointment with a GP and that there was continuity of care. Urgent appointments were available on the same day.
  • Data from the National GP Patient Survey published in July 2016 showed that 100% of patients surveyed were able to get an appointment at a convenient time, compared to the local average of 94% and the national average of 92%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice recognised the lack of public transport for patients to get to the practice, and had organised a volunteer led transport scheme. We received positive feedback about this service.
  • 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 13 February 2017

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.
  • Staff at the practice were engaged with local healthcare services and worked within the wider health community. For example, a GP at the practice was a director of the West Cambridgeshire GP Federation steering group, a network of practices who worked at scale.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity.
  • 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 and the practice produced a regular newsletter.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 13 February 2017

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 used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 72%, which was below the local and national average of 89%. Exception reporting for diabetes related indicators was 9%, which was lower than the local average of 13% and the national average of 12% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We discussed the recent QOF data with the clinicians at the practice who agreed that there was scope to improve the recording of clinical codes used on the IT system. For example, we saw evidence that patient reviews had been carried out, but the clinical coding had not been completed effectively and therefore did not reward the practice with the work undertaken.

  • A community diabetic specialist nurse and dietician held regular clinics at the practice. Furthermore, the practice participated in an annual virtual diabetic clinic with a consultant diabetologist from a local hospital, where complex cases were discussed.
  • Longer appointments and home visits were available when needed. Practice nurses carried out regular chronic illness home visits.
  • Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
  • The practice held a designated clinic for patients with more than one long term condition. This was to provide holistic care and reduce the need for multiple appointments.
  • 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 13 February 2017

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 A&E attendances. There was a clear protocol in place to follow up children who did not attend hospital appointments.
  • Immunisation rates were in line with the national average for all standard childhood immunisations.
  • Teenagers were invited for a formal review when they were 16 to complete their immunisation schedule and as an opportunity to provide health promotion information, such as diet, exercise, substance misuse and sexual health.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 78%, which was slightly below the local and national average of 82%. Exception reporting for this QOF indicator was 1%, which was lower than the local average of 9% and national average of 7%
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered a full range of contraception services and chlamydia screening.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 13 February 2017

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
  • The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
  • The practice looked after patients living in local care homes and clinical staff undertook regular visits. Representatives from local care homes regularly attended multidisciplinary team meetings held at the practice.
  • Influenza vaccination clinics were held at the local village hall, and were attended by community support groups who provided information and signposting on a range of topics.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Working age people (including those recently retired and students)

Good

Updated 13 February 2017

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 where possible.
  • 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.
  • Extended hours appointments were available between 7.30am and 8am on Thursdays.
  • Telephone appointments with a GP were available throughout the day.
  • Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes.
  • The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 February 2017

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

  • 97% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local average of 87% and the national average of 84%. Exception reporting for this QOF indicator was 3%, which was lower than the local average of 8% and the national average of 7%
  • 70% of patients experiencing poor mental health had a comprehensive care plan, which was below the local average of 90% and the national average of 89%. Exception reporting for this QOF indicator was 0%, which was lower than the local average of 15% and the national average of 13%.
  • 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.
  • Staff had received training in the Mental Capacity Act (2005). Furthermore, all staff had received training from the Alzheimer’s Society to become ‘Dementia Friends’.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, such as drug and alcohol addiction support groups.
  • 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.

People whose circumstances may make them vulnerable

Outstanding

Updated 13 February 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability. 5 out of 10 patients on the practice learning disability register had received an annual health check since April 2016. Further invites recalling these patients in for an appointment had been sent out to patients who had not responded to the first invite.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held regular multidisciplinary team meetings.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice recognised the lack of public transport for patients to get to the practice, and had organised a volunteer led transport scheme.

  • The practice was proactive in providing support for patients with caring responsibilities. The practice had identified 69 patients as carers (2% of the practice list).
  • The practice was engaged with the local carers support group, which provided guidance, support and respite for carers. The practice nurse had been appointed as the practice Carers Champion, and provided a signposting service to local community care providers.
  • The practice had created specialist ‘bereavement packs’ to give to patients who had experienced a recent bereavement. These included practical information and guidance on who to contact for emotional support. This had been shared with other practices in the area who had commenced the same service.

  • 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.