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Inspection Summary


Overall summary & rating

Good

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kildonan House on 19 September 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.
  • All staff employed by the practice had received an enhanced check with the Disclosure and Barring Service.
  • 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.

  • The practice had recruited two part time pharmacists who carried out regular medication reviews to ensure safe and evidence based prescribing which included the reduction of inappropriate poly-pharmacy.

  • 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 practice was fully committed to staff training.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had a clear vision which was owned by all the staff team.

We saw one area of outstanding practice:

  • The practice monitored patient demand throughout each day and added appointments as needed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 November 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.
  • All staff employed by the practice had received an enhanced check with the Disclosure and Barring Service. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • One of the partners was an examiner for the Royal College of General Practitioners who gave feedback to the practice to ensure that everyone in the practice was working in accordance with up to date guidelines.

Effective

Good

Updated 15 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar to the CCG and national averages.
  • 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 15 November 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.
  • The practice had a carers lead who worked closely with the CCG to ensure that carers received knowledge and support available

Responsive

Good

Updated 15 November 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 a call back service where patients that needed telephone advice would be contacted by a GP, nurse or pharmacist, whoever was appropriate to the patient and their request. The practice aimed to call back within the hour.
  • The practice monitored patient demand throughout each day and added appointments as needed.
  • The GPs had a rota system where one GP was the duty doctor for the day, available between 8am and 6.30pm Monday to Friday dealing with telephone advice and all enquiries from patients, staff and the trainee doctors.
  • Another GP was the visiting doctor for the day, allowing visits to be scheduled throughout the day for patients that had requested them.
  • 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 15 November 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.
  • The practice had a mission statement which had clear aims and objectives, of which, staff we spoke to knew and understood.
  • 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 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 15 November 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.
  • 91% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the national average of 88%.
  • 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.
  • The practice had a clinical lead and an admistration lead for each long term condition.
  • Telephone consultations were offered, with the specialist GP or nurse, for patients with a long term condition that required them.
  • A diabetes consultant visited the practice annually to discuss individual and difficult cases with the clinical team.

Families, children and young people

Good

Updated 15 November 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.
  • 80% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was similar to the 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, health visitors and school nurses.
  • The practice offered a combined clinic to provide a one stop service for post natal checks, baby checks and first vaccinations.
  • Family planning and sexual health advice appointments were offered. Female patients wanting the contraceptive coil were referred to another practice for this.

Older people

Good

Updated 15 November 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. Care plans were offered to all patients over the age of 75 years.
  • All patients over the age of 75 had a named GP and for those patients with the most complex needs, the named GP worked with the relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had a dedicated member of staff who was the lead for carers. The in house lead worked closely with the CCG lead and ensured that carers were offered support and knowledge and were able to signpost them to other support services.
  • The practice carried out regular medication reviews and worked with their newly recruited pharmacists to ensure safe and evidence based prescribing.
  • All elderly patients were offered dementia screening.

Working age people (including those recently retired and students)

Good

Updated 15 November 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.
  • Appointments were offered every lunchtime and every Saturday morning for patients that could not attend during normal working hours.
  • Telephone appointments were available with the duty doctor between 8am and 6.30pm for patients who required them.
  • A drop in clinic was held for confidential chlamydia screening.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 November 2016

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

  • 76% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.
  • 99% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which is higher than the 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 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.
  • The receptionists were trained and effective at identifying possible mental health problems and alerting the GPs.
  • 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 15 November 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 and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • 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.