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Inspection Summary


Overall summary & rating

Good

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swallowfield Medical Practice on 8 June 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 reporting and recording significant events.
  • 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.
  • 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.
  • There was a clear leadership structure and staff felt 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.

The areas where the provider should make improvement are:

  • Consider the location of emergency medicines.

  • Ensure all high risk actions regarding legionella are completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 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 3 August 2016

The practice is rated as good 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.

  • 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 3 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.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, one of the practice nurses had seen a patient safety alert relating to equipment used for delivering injectable medicines. Although the equipment was not the practice responsibility, the nurse ran a search to find patients who were using the equipment and rang them to ensure they were aware of the alert and to enquire with the provider of the equipment if they required a replacement.

  • 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.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 3 August 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice had been chosen as a pilot site for a community navigator who worked closely with patients of the practice to offer them additional sources of help and support from external and voluntary agencies.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, feedback about GP appointments led to an increase of nursing hours and introduction of a nurse led minor illness clinic to alleviate pressure on the duty doctor.

  • Patients can access appointments and services in a way and at a time that suits them. For example, patients could telephone the practice at any time during a 24 hour period and book an appointment using the automated appointments line.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 3 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 actively involved in the practice and had initiated many changes in patient improvement programmes.

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

Checks on specific services

People with long term conditions

Good

Updated 3 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.

  • One of the GP partners had an interest in cardiology (heart health) and had successfully introduced 24 hour blood pressure and electrocardiogram (ECG – a recording of the electrical activity of the heart) monitoring. This reduced patients need to go to hospital for diagnosis of some coronary conditions.

  • The practice had commenced a ‘house of care’ model for diabetes care and had achieved positive outcomes. (

    The house of care takes a whole system approach to long term conditions management. It makes the patient central to care).

    The practice was planning to offer the same for patients with chronic lung problems.

  • 76% of patients with diabetes had achieved a target blood level compared to the CCG average of 74% and national average of 78%.

  • 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.

Families, children and young people

Good

Updated 3 August 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.

  • One of the GPs was developing a course for young school children to promote GP services and reduce fear of going to the practice for examinations and vaccines.

  • 87% of females aged 25 to 64 had received a cervical screening test in the preceding five years compared to the CCG average of 84% and national average of 82%.

  • 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 and health visitors.

Older people

Good

Updated 3 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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice offers a voluntary transport service to patients over the age of 65 who require assistance with attending appointments. This initiative is organised in association with the patient participation group.

  • All patients over the age of 75 are contacted by a healthcare assistant within two days of being discharged from hospital. Any concerns are raised with the named GP who arranges a home visit or urgent appointment.

  • The practice looked after patients from one nursing home and one residential home. Both homes received a regular ward round for reviewing all patients and were able to book home visits quickly when urgent care was required.

Working age people (including those recently retired and students)

Good

Updated 3 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.

  • 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 had a self-check blood pressure machine for patients use so patients could take a reading at a time that was convenient for them.

  • The practice newsletter included health education articles and practice information updates for patients who did not attend the practice very often.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 August 2016

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

  • 75% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 78% and national average of 84%. The practice had increased this to 80% in the most recent QOF year (2015/16) and had initiated system alerts to highlight patients attending who could be opportunistically reviewed during a routine appointment.

  • 90% of patients with a diagnosed psychiatric condition had a comprehensive, agreed care plan documented in the record in the preceding 12 months compared to the CCG average of 95% and 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 looked after residents from two nursing homes who assisted patients with dementia. Both the homes were able to access GP home visits in a timely way and felt supported by the practice. Staff told us the named GP would attend when required with very few exceptions and they always treated the patients with dignity and respect.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 3 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.

  • The practice looked after three residential homes for patients with severe learning disabilities. Each home had a named GP who attended regularly for reviews and check-ups.

  • 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 regularly hosted the citizen’s advice bureau and had commenced the services of a community navigator (a volunteer who advises patients on voluntary organisations and sources of help and support).