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Inspection Summary


Overall summary & rating

Good

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an inspection of Wycliffe Surgery on 4 October 2016. This review was performed to check on the progress of actions taken following an inspection we made in April 2016. Following the inspection in April 2016 the provider sent us an action plan which detailed the steps they would take to meet their breach of regulation. During our latest inspection on 4 October 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published in January 2015. This can be done by selecting the 'all reports' link for Wycliffe Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

The practice had improved the governance systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. This included the introduction of improved:

  • Systems to manage and monitor infection control procedures, including infection control audits, disposal of water used to wash leg ulcers and booking infection control training.
  • Processes to monitor and keep an overview of significant events and complaints.
  • Assessment of the risk of non-clinical staff generating prescriptions following changes in medicines for patients discharged from hospital.
  • Systems to evidence that all nurses were currently on the Nursing and Midwifery Council register
  • Monitoring to ensure all staff received annual appraisals.

The provider had also implemented changes to identify and support more carers within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 October 2016

This domain was not inspected on this visit.

Effective

Good

Updated 14 October 2016

This domain was not inspected on this visit.

Caring

Good

Updated 14 October 2016

This domain was not inspected on this visit.

Responsive

Good

Updated 14 October 2016

This domain was not inspected on this visit.

Well-led

Good

Updated 14 October 2016

Since the inspection in April 2016 the practice had improved the governance systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. This included the introduction of improved:

  • Systems to manage and monitor infection control procedures, including infection control audits, disposal of water used to wash leg ulcers and booking infection control training.

  • Processes to monitor and keep an overview of significant events and complaints.

  • Assessment of the risk of non-clinical staff generating prescriptions following changes in medicines for patients discharged from hospital.

  • Systems to evidence that all nurses were currently on the Nursing and Midwifery Council register

  • Monitoring to ensure all staff received annual appraisals.

The provider had also implemented changes to identify and support more carers within the practice.

Checks on specific services

People with long term conditions

Good

Updated 17 May 2016

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

  • The two practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients with chronic obstructive pulmonary disease (COPD), asthma or diabetes were aware that they could telephone and talk to the relevant nurse for advice and get quick access to rescue pack medicines for their COPD.
  • 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.
  • Staff monitored blood levels for patients on certain high risk medicines. For example, blood thinning medicines.
  • One of the health care assistants had an extended role of wound management which meant the practice could be more responsive to patient needs. A named member of staff looked after patients who were at increased risk of hospital admission. Staff were alerted by a message on the patient’s record, highlighting if they were at risk and needed closer monitoring. These patients were reviewed every 3 months.
  • The practice worked with outside agencies to improve wellbeing in patients. For example staff encouraged patients to attend the expert patient program run by the Plymouth Guild. The practice had hosted some of these sessions at the practice. The practice also hosted the diabetic education group.
  • Health checks for carers of patients with long term conditions were provided at the practice.
  • Practice staff were able to access the expertise of a community matron for long term conditions through the district nursing hub referral service.
  • Staff offered smoking cessation advice clinics and assessed and referred patients to weight management clinics when needed.
  • Practice staff respond to new guidelines regarding long term conditions and discussed any changes with patients.

Families, children and young people

Good

Updated 17 May 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • 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. The practice demonstrated a responsive and safe approach to all children under five years. The policy ensured that children were seen on the same day, which parents found reassuring.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • There was a designated area for children in the waiting area and facilities for baby changing. Rooms were available for mothers who wanted to breast feed in private.
  • Patients had access to full range of contraception services and offered screening for sexually transmitted infections such as chlamydia.

Older people

Good

Updated 17 May 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 had a register of patients at increased risk of unplanned hospital admission. This was currently 91 patients which reflected approximately 2% of the adult population, many of whom are elderly. These patients had on the day access to medical assessment and were reviewed pro-actively on a 3 monthly basis as described above.
  • The practice offered flu, shingles and pneumococcal vaccinations to the relevant patients in this group.
  • The practice had hearing loops in building and the building was accessible for patients with limited mobility and anyone using a wheelchair.

Working age people (including those recently retired and students)

Good

Updated 17 May 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.
  • Early morning appointments on Wednesdays were available for working people and telephone consultations were offered for patients who could not get away from work for a follow up consultation.
  • Patients could access the on line systems to book appointments and request repeat prescriptions, which they were then able to collect from the pharmacy of their choice.
  • Health promotion clinics were offered. These included smoking cessation clinics and cardiovascular assessments.
  • Patients could access pre bookable appointments up to eight weeks in advance. On the day appointments were available for each GP, nurse and a duty doctor.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 May 2016

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

  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the local and national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Patients were screened for dementia using a nationally recognised assessment tool and were referred to the memory clinic and Alzheimer’s support group in Plymouth for further support.
  • 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 with mental illness were invited to have a physical health review every year and were supporting people well. Data from 2014/15 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan, documented in their record was 97.67% compared to a national average of 88.47%.
  • Patients with depression, anxiety, self-esteem or anger issues were encouraged to access a local library books on prescription resource. This was a national scheme which helped patients manage their mental wellbeing using cognitive behavioural therapy-based self-help books, all written by experts. They were also advised about various websites that people could use for example, the mind gym or living life to the full.
  • There was an external counsellor who saw patients in the surgery on a weekly basis.

People whose circumstances may make them vulnerable

Good

Updated 17 May 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.
  • Patients with a learning disability were invited to an annual health check. 46% of patients at the practice with a learning disability had a health check so far this year.
  • 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.
  • The practice had a substantial number of asylum seeker patients whose first language was not English. Longer appointments were offered for these patients. Staff used translation services to help with communication.
  • Patients were referred to the Asylum seeker mental health service as needed.
  • There was disabled access to all areas of the building. There was a passenger lift, accessible toilets and parking facilities.
  • Practice staff prescribed controlled medicine substitutes for patients with substance misuse problems and worked effectively with the local drug and alcohol team. These patients were encouraged to attend for a review with the GP every three to six months.
  • GPs were aware that some patients could be at increased risk of having and developing long term complications resulting from Hepatitis B infection. Information had been added to the new patient questionnaire offering screening for this infection.