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Inspection Summary


Overall summary & rating

Good

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

We inspected this service on 19 November 2014 as part of our new comprehensive inspection programme.

The overall rating for this practice is good. We found the practice to be good in safe, effective, caring, responsive and well led areas. We found the practice provided good care for older people, patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health, including dementia.

Our key findings were as follows:

  • Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.
  • Patients’ needs were assessed and care was planned and delivered in line with current legislation. The practice had a strong commitment to the on-going development of skills, competence and knowledge of all staff to achieve good outcomes for patients.
  • Patients felt they were treated with compassion, dignity and respect. They told us that GPs were good at listening to them and gave them enough time.
  • The practice had a well-established and well trained team who had expertise and experience in a wide range of health conditions.
  • There was a transparent and inclusive culture at the practice which encouraged contributions from staff and patients in the development of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 March 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep people safe.

Effective

Good

Updated 19 March 2015

The practice is rated as good for providing effective services. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. We saw records which demonstrated that the practice had achieved one of the highest rates of diagnosis for dementia in the local Clinical Commissioning Group (CCG) area. We found that 80% of people experiencing poor mental health had received an annual physical health check at the time of the inspection and almost all patients with diabetes had received an annual review. The practice had a strong commitment to the on-going development of skills, competence and knowledge of all staff to achieve good outcomes for patients. Staff were encouraged to acquire new skills and share best practice. Staff worked with multidisciplinary teams to ensure improved outcomes for patients.

Caring

Good

Updated 19 March 2015

The practice is rated as good for caring. Patients told us they were treated with dignity and respect at all times and that they considered the practice to be very caring. We observed a patient centred culture and found strong evidence that staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieve this. The practice referred to the Gold Standard Framework in caring for patients nearing the end of their life. This ensured their care was reviewed appropriately and that patients were supported to make decisions about their care and treatment for as long as possible.

Responsive

Good

Updated 19 March 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said there was continuity of care, with urgent appointments available the same day.

Well-led

Good

Updated 19 March 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was involved. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

Older people

Good

Updated 19 March 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people and all patients over the age of 75 had a named GP.

People with long term conditions

Good

Updated 19 March 2015

The practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people 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 19 March 2015

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, looked after children. Most immunisation rates were high for standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors and school nurses.

Working age people (including those recently retired and students)

Good

Updated 19 March 2015

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 for example appointments, as well as a full range of health promotion and screening that reflected the needs of this age group.

People whose circumstances may make them vulnerable

Good

Updated 19 March 2015

The practice is rated as good for the care of people living in vulnerable circumstances. The practice supported patients whose circumstances may make them vulnerable, such as those who were homeless or had a mental health crisis. The practice was located in the centre of Shrewsbury and enabled easy access for vulnerable patients, particularly those who were homeless or drug dependent. Staff told us about how they enabled them to access the practice without fear of stigma or prejudice and treated them in a sensitive and sympathetic manner.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It signposted vulnerable patients 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.

Patients were encouraged to participate in health promotion activities, such as cytology and smoking cessation. The practice had a care co-ordinator who linked patients into existing community networks to improve their wellbeing and prevent isolation and loneliness.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 March 2015

The practice is rated as good for the care of patients experiencing poor mental health (including those with dementia). We found that 80% of patients who experienced poor mental health had received an annual physical health check at the time of the inspection. The practice regularly worked with multi-disciplinary teams in the case management of these patients, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations including MIND. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.