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Inspection Summary


Overall summary & rating

Good

Updated 31 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Links Medical Practice on 24 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 a system in place for reporting and recording significant events.
  • Risks to patients were assessed and 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.
  • 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.

There were areas of practice where the provider should make improvements:

  • Ensure that the chaperone processes are in line with guidelines and that staff have been trained and undertake a risk assessment to ascertain if DBS checks are required for all staff who undertake this role.
  • Ensure that proof of good character are taken prior to employing new staff.
  • Ensure yearly appraisals are performed for all practice staff.
  • Ensure that the practice reviews the feedback from national GP patient survey to identify and act on further areas that can be improved.
  • Review the complaints procedure to ensure it contains all the relevant information for patients and that complaints are responded in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 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.
  • Lessons were shared to make sure 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 systems, processes and practices in place to keep patients safe and safeguarded from abuse. However the chaperoning processes are not in line with guidelines.
  • Risks to patients were assessed and managed.
  • The practice shared quality alerts with the local hospital and local Clinical Commissioning Group (CCG) to enable services to be improved for all.

Effective

Good

Updated 31 May 2016

The practice is rated as good 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; however not all practice staff had yearly appraisals.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 31 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice in-line with others for some 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 31 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.
  • 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.
  • The practice provided a phlebotomy service at the practice to encourage older patients who may have difficulty in getting to the hospital.
  • The practice nurses ran minor illness clinics to manage patients with simple issues.
  • The patients had access to a duty doctor throughout the opening hours who triaged and saw patients as required.

Well-led

Good

Updated 31 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.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 31 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 national Quality and Outcomes Framework (QOF) data showed that 78% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 87% which was above the CCG average of 78% and slightly below the national average of 88%.
  • The national Quality and Outcomes Framework (QOF) data showed that 73% of patients with asthma in the register had an annual review, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 75%.
  • Longer appointments and home visits were available for people with complex long term conditions when needed.
  • All patients with long-term conditions 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 31 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 urgent care and 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.
  • The practice’s uptake for the cervical screening programme was 79%, which was below the CCG average of 84% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered weekly midwifery clinics at the surgery.
  • The practice offered sexual health clinics.

Older people

Good

Updated 31 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 provided a phlebotomy service at the practice for the benefit of older patients who may have difficulty in getting to the hospital.
  • The GPs visited two nursing homes and one residential home on a regular basis, supporting the needs of the residents.

Working age people (including those recently retired and students)

Good

Updated 31 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. Around 5000 patients had registered for online access.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 May 2016

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

  • The number of patients with dementia who had received annual reviews was 88% which was above the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.
  • 87% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • 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 31 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. These patients were flagged in their clinical system.
  • The practice offered appointments for all newly registered looked after children with a named GP and had an alert set up on the computer system.
  • The practice offered longer appointments for patients with a learning disability; all the patients with learning disability had received a health check in the last year.
  • 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.
  • 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.