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Inspection Summary


Overall summary & rating

Good

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Warrengate Medical Centre on 1 March 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, recording and taking remedial action in relation to 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 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.
  • Patients said they found it easy to make an appointment with a named GP and that 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 May 2016

The practice is rated as good for providing safe services.

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

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.

  • The practice maintained an effective working relationship with other safeguarding partners such as health visitors.

Effective

Outstanding

Updated 17 May 2016

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • The practice was proactive in encouraging and supporting patients to attend the national screening programmes for cervical, breast and bowel cancer. This had resulted in significant increases in uptake since 2014, 22% for cervical screening, 48% for breast screening and 83% for bowel screening.

  • The practice delivered an avoiding unplanned admissions service which provided proactive care management and support for those patients who were at high risk of an unplanned hospital admission or had recently been discharged from hospital.

Caring

Good

Updated 17 May 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. ,

  • 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.

Responsive

Good

Updated 17 May 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 secure improvements to services where these were identified. For example, the practice participated in a local extended hours/out of hours service, which was organised across the local network. Patients could call the service on weekdays 6.30pm to 8pm and on weekends and bank holidays 9am to 3pm. Calls were triaged and an appointment made with a doctor should this be necessary. Three partners from the practice actively took part in this service.

  • The practice provided a shared care diabetes clinic for patients which was led by a diabetic consultant and a practice 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 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 evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 May 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 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 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 knowing about 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 had given valuable support to 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 17 May 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.

  • The practice provided a shared care diabetes clinic for patients which was led by a diabetic consultant and a practice nurse.
  • Longer appointments and home visits were available for those patients who needed them.

  • Patients had structured six monthly or annual reviews to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with health and care professionals to deliver a multidisciplinary package of care.

  • The practice held regular DESMOND training sessions for patients (Diabetes Education and Self Management for Ongoing and Newly Diagnosed - a course for people with type 2 diabetes that helps people to identify their own health risks and to set their own goals).

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

  • National and local Immunisation targets were consistently achieved for all standard childhood immunisations.

  • Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The health visitor attended the monthly practice meeting and was able to discuss safeguarding issues directly with clinical staff.

  • The patient participation group had a representative for young people.

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; this included a named GP for those over 75 years old.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. In addition the practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and who were at risk of an unplanned hospital admission.

  • The practice held an annual abdominal aortic aneurysm clinic for patients in conjunction with Leeds Teaching Hospitals NHS Trust.

  • The practice had participated in the West Riding Nursing and Residential Home pilot scheme and had continued to be part of the now mainstreamed service as part of the Wakefield Vanguard Connecting Care programme. As part of the programme the practice provided clinical sessions at a nearby nursing home during which patient health needs were met and care plans were reviewed. Since introduction there was an 87% increase in the number of care plans developed for residents.

  • The practice hosted a monthly patient led arthritis drop-in session, where patients could obtain advice and information on the condition.

  • The practice encouraged and supported older people to participate in national screening programmes including those in relation to bowel and breast cancer. This had resulted in significant increases in uptake.

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. For example, the practice offered telephone appointments and extended hours on a Monday and Tuesday evenings. In addition the practice

  • The practice was proactive in encouraging and supporting patients to attend thenational screening programmes for cervical, breast and bowel cancer. This had resulted in significant increases in uptake since 2013 - 22% for cervical screening, 48% for breast screening and 83% for bowel screening.

  • The practice had a social media account, where people could access health advice.

  • 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, this included online booking of appointments and repeat prescriptions.

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).

  • Performance for mental health related indicators was better than the national average. For example, 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months compared to a national average of 88%.

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

  • The practice was dementia friendly, staff had received dementia awareness training and the signage in the practice and the clock in the reception area was designed to be easier to understand and comprehend.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • All dementia patients were placed on the avoiding unplanned admissions scheme and received advanced care planning.

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 those with a learning disability and used this to plan reviews.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice was registered under the Wakefield Safer Places Scheme. This was a voluntary scheme which assisted vulnerable people to feel safer and more confident when travelling independently away from the home environment.

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

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations, this included local carers groups and dementia support groups.

  • 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.

  • Staff had received training in British Sign Language.