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Cricket Green Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cricket Green Medical Practice on 18 December 2015.

Overall the practice is rated as good

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. 

  • Feedback from patients about their care was consistently and strongly positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. The local multi-disciplinary team attended the practice’s monthly educational meetings in order that patients needs could be discussed. They had a strong relationship with their Patient Participation Group (PPG) and sought their views on all aspects of the running of the practice that impacted patients.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients and from the patient participation group.

  • All staff had been trained as “health champions”, which provided them with insight into difficulties encountered by patients, and enabled them to confidently participate in health promotion initiatives. Positive feedback was received from patients about the improvement to the service they received from reception staff following this training.

  • 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.

  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and staff had the opportunity to contribute during an away-day.

  • The practice had received the gold standard Investors in People award in December 2013, which recognised the success of its leadership approach.

We saw several areas of outstanding practice including:

  • In response to feedback about the availability of appointments, the practice had introduced a new system whereby all consultations with adult patients were initially conducted by phone with a GP. During the consultation the GP would either resolve the patient’s issue or arrange for them to be seen in person with an appropriate member of staff. The practice had analysed the impact of the new system and had found that it resulted in a significant increase in appointment availability. Patient feedback about the system was also very positive.

  • All staff, including non-clinical staff, had been trained in health promotion, which enabled them to become involved in initiatives such as promoting COPD screening for smokers. This training also increased the awareness amongst non-clinical staff of difficulties encountered by certain patient groups, and we were told by the Patient Participation Group that they, and the patients they had spoken to about the service, had noticed an improvement in the way that staff interacted with patients since having this training.

  • The practice had introduced a comprehensive appraisal system for all staff (including GPs), which included a 360º feedback exercise.

However, there was one area of practice where the provider should make improvements:

  • The practice should consider having all portable appliances tested by a qualified electrician, and should it decide that this is unnecessary, ensure that it has a comprehensive risk assessment and mitigation plan for this decision.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 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 are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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 people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 17 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • 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.

  • All staff (including non-clinical staff) were trained as “health champions”, which ensured they had the skills and confidence to distribute health promotion literature and tests to patients.

  • There was strong evidence of appraisals and personal development plans for all staff. All staff, including GPs, participated in the practice’s internal appraisal system, which included 360˚ feedback.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 17 March 2016

The practice is rated as good for providing caring services.

  • Data showed that 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.

  • Staff treated patients with kindness and respect, and maintained their confidentiality.

Responsive

Good

Updated 17 March 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 people’s needs. For example, they held a practice open day where they invited representatives from local charities and services. They also regularly liaised with community pharmacists, and scheduled meeting with the local multidisciplinary (including the mental health team, district nurses, palliative care team and social services) into their monthly education meeting.

  • The practice used innovative approaches to provide integrated person-centred care. For example, patients with learning disabilities were reviewed annually and these reviews are available in the patient’s home if required.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients and from the patient participation group (PPG). For example, the practice sought PPG feedback on proposed new policies and processes that would affect patients.

  • People could access appointments and services at a time that suited them. The practice’s policy of conducting all adult appointments by phone initially meant that many patients could consult with a doctor from home or work. The practice also provided both evening and Saturday morning appointments.

  • 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

Outstanding

Updated 17 March 2016

The practice is rated as outstanding for being well-led.

  • It had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders such as the PPG and was regularly reviewed and discussed with staff during away days.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • The practice carried out proactive succession planning.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. The Practice had achieved the Investors in People gold award.

  • The practice gathered feedback from patients, and it had a very active patient participation group which influenced practice development. For example, the PPG were involved in reviewing and providing feedback on all draft policies which affected the delivery of patient care.

Checks on specific services

People with long term conditions

Outstanding

Updated 17 March 2016

The practice is rated as outstanding 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’s overall performance in relation to long-term conditions was largely comparable to, and in some cases significantly higher than, CCG and national averages. For example, QOF achievement for hypertension indicators was 100% (CCG average was 97% and national average was 98%), for asthma the practice achieved 96% overall (compared with 100% CCG average and 97% national average), and for osteoporosis the practice achieved 100% (compared to CCG average of 83% and national average of 81%).

  • The practice’s overall performance in relation to diabetes indicators was higher than both CCG and national averages at 92% of the total QOF points available, compared with an average of 86% locally and 89% nationally. In particular, the number of diabetic patients who had a blood pressure reading of 140/80 mmHg or less in the preceding 12 months was 90% (CCG average was 76% and national average was 78%); the number who had received influenza immunisation was 99% (CCG average 90%, national average 94%); and the number with a record of a foot examination and risk classification in the preceding 12 months was 91% (CCG average 89%, national average 88%).

  • 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 medicines 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.

  • Administrative staff had been trained as “health champions”, and were actively involved in promoting testing for chronic diseases such as Chronic Obstructive Pulminory Disease (COPD).

Families, children and young people

Good

Updated 17 March 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. A paediatric clinic was run daily.

  • Cervical screening uptake at the practice was higher than the national average at 91% compared with 82% nationally.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Appointments for children by-passed the telephone consultation system and were always booked as face to face consultations.

  • We saw good examples of joint working with midwives and health visitors.

Older people

Good

Updated 17 March 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.

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

  • One of the partners had a dedicated day each week to concentrate on services for those over the age of 75, which included performing annual health checks, which were delivered during a home visit for those who were housebound.

Working age people (including those recently retired and students)

Outstanding

Updated 17 March 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students).

  • The practice’s telephone consultation system allowed patients to consult with a doctor without having to take time off from work, and meant that any subsequent face to face consultation that was required would be booked with the most appropriate member of clinical staff, which avoided appointments needing to be re-booked.

  • The practice offered a range of appointments outside of normal working hours, including appointments on Saturday mornings with both GPs and nurses.

  • The practice offered a range of services that patients would often need to access via a hospital or clinic, for example, they provide HIV testing on the premises and testing for deep vein thrombosis (DVT).

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2016

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

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

  • It 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.

  • It 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 people with mental health needs and dementia.

  • 77% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to a CCG and national average of 84%.

  • 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their notes, compared to a CCG average of 92% and national average of 88%.

People whose circumstances may make them vulnerable

Good

Updated 17 March 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 those at risk of abusing their prescribed medicines.

  • Annual health checks were carried out for people with learning disabilities, and these could take place in the patient’s home if requested.

  • It offered longer appointments for people with a learning disability.

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

  • It had told 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.