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Inspection Summary


Overall summary & rating

Outstanding

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hindon Surgery on 9 August 2016.

Overall the practice is rated as outstanding.

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

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice was instrumental in establishing an Elderly Care Facilitator service in the locality. One of their roles was to send a birthday card and questionnaire to patients aged 75 and over on their birthday to help identify patients at increased risk.

  •  

    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.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

  • The practice had identified 131 patients as carers (6% of the practice list) and had been awarded a gold plus award for caring for carers by a local charity working in partnership with the local authority.

  • The practice had an ethos of providing a one stop surgery to reduce patients’ visits to the surgery and to reduce the need for patients to visit hospital. They worked to remove all barriers and encourage service uptake.

    For example, following patient feedback and discussions with the Patients Participation Group the practice had introduced eight ‘never full’ surgeries per week. The practice was committed to offering same day access to a GP if this was what the patient wanted and this was confirmed by feedback from patients which was consistently highly positive. Data from the national GP patient survey showed patients rated the practice as the best performing practice in the local clinical commissioning group  area. For example, 100% of patients described the overall experience of this GP practice as good compared to the national average of 85%. This was supported by the latest data available from the Family and Friends test which showed that 100% of the patients responding to said they would recommend this practice to their friends and family.

     The areas where the provider should make improvement are:

 

  • Ensure they adequately assess the risks inherent in the building, such as the security of consulting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 October 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.

  • Most risks to patients were assessed and well managed. However the risk assessments did not adequately reflect some of the security risks inherent in the building, such as the potential for an unauthorised person to enter the consulting rooms which opened onto the foyer.

  • The practice put additional information on labels and repeat prescription forms to improve patient safety, to encourage patients to take responsibility for their condition and to share other health information. For example, we saw a label on some tablets dispensed by the practice which said, “take half in the evening to help prevent migraine”.

  • 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 .

Effective

Good

Updated 4 October 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices nationally. For example, 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (4/2014 to 3/2015) compared to the CCG average of 88% and national average of 84%.

  • The practice had low numbers of people being admitted to hospital as an emergency. Six patients per thousand had an emergency admission for ambulatory care sensitive (ACS) conditions (from 04/2014 to 03/2015 inclusive) compared to the clinical commissioning group of average of 13 and national average of 15 per thousand patients. (ACS conditions are a group of diverse health conditions that can often be managed with timely and effective treatment in a primary care setting without hospitalisation. The rates of admission for these conditions are a common marker of success for health systems.)

  • The practice actively encouraged its patients to attend national screening programmes for bowel and breast cancer. They encouraged uptake of the screening programmes by a communication strategy which included; writing up to three personal letters from the GP to all patients who did not attend for a screening test, articles in local village newsletters and advice on repeat prescription forms. We saw that the letters to patients included background information and the pros and cons of the screening.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice.

Caring

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for providing caring services.

Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. This data showed they were the best performing practice in Wiltshire and the fourth best nationally. For example:

  • 100% of patients found it easy to get through to this practice by phone compared to the national average of 73%.

  • 99% of patients were able to get an appointment to see or speak to someone the last time they tried compared to the national average of 76%.

  • 100% of patients described the overall experience of this GP practice as good compared to the national average of 85%.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on. For example, following feedback from patients the practice had changed their appointment system to include eight ‘never full’ surgeries a week for which no appointment was required and went on until all patients had been seen.

  • The practice prioritised supporting patients on end of life care. We were told that one of the GPs gave their  personal phone number to patients who were identified as being in need of  end of life care and in the last two years over 70% of patient deaths had been in a place of their choosing. (The majority of patients prefer to die at home.)

  • Views of external stakeholders were very positive and aligned with our findings.

 

The practice had identified 131 patients as carers (6% of the practice list). The practice offered carers clinics where carers could be seen by a GP, a health trainer and an advisor who was able to give advice and support on a range of issues such as benefits and finances. The practice had been awarded a gold plus award for caring for carers by a local charity working in partnership with the local authority.

Responsive

Outstanding

Updated 4 October 2016

The practice is rated as outstanding 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 patients’ needs. For example, the practice was instrumental in establishing an Elderly Care Facilitator service in the locality. One of their roles was to send a birthday card and questionnaire to patients aged 75 and over on their birthday to help identify patients at increased risk.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice had introduced eight ‘never full’ surgeries per week as a result of patient feedback. These were surgeries for which no appointment was necessary. The practice was committed to offering same day access to a GP if this was what the patient wanted and this was confirmed by feedback from patients. Patients could still book appointments for the usual daily surgeries and on the day of our inspection the next bookable appointment with a GP was the next day.

  • The practice aim was to offer a one-stop-shop approach where patients had easy access to GPs who would deal with whatever issues they brought to the surgery.

  • The GP phoned patients on their discharge from hospital or if the patient had received emergency care elsewhere and made arrangements for a home visit or a surgery appointment as appropriate. 

Well-led

Outstanding

Updated 4 October 2016

The practice is rated as outstanding 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.

  • 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.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • High standards were promoted and owned by all practice staff and the team 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 had clear and longstanding commitment to the development of ideas and innovations that improved the quality of care they provided. We saw examples of innovations developed by the practice that had subsequently been adopted by other practices. The practice had won numerous awards for their development work.

    For example, their information leaflets about how to get the best out of a hospital referral, which won a British United Provident Association award and adding extra information to repeat prescription forms.

  • They also supported development in allied services, such as the ambulance service, by giving them feedback and we saw evidence that this was well received.

  • The practice held two team ‘away-days’ each year to focus on learning and service development.

Checks on specific services

People with long term conditions

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for the care of people with long-term conditions.

  • The practice offered six monthly health checks for patients with long term conditions.

  • 90% of patients with diabetes on the register had their last blood test result within the target range in the last 12 months (04/2014 to 03/2015) compared to the clinical commissioning group average of 83% and national average of 81%.

  • Longer appointments and home visits were available when needed.

  • All patients had a named GP and a structured annual 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 an ethos of providing a one stop surgery to reduce patients’ visits to surgery and to reduce the need for patients to visit hospital.

  • The practice had low number of people being admitted to hospital as an emergency. Six patients per thousand had an emergency admission for ambulatory care sensitive (ACS) conditions (04/2014 to 03/2015) compared to the clinical commissioning group of average of 13 and national average of 15 per thousand patients. (ACS

    conditions are a group of diverse health conditions that can often be managed with timely and effective treatment in a primary care setting without hospitalisation. The rates of admission for these conditions are a common marker of success for health systems.)

Families, children and young people

Outstanding

Updated 4 October 2016

The practice is rated as outstanding 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.

  • The practice had a policy of the GP phoning to speak to parents of all children seen by medical services outside the practice such as A&E and NHS 111 services.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw spoke to patients who confirmed this.

  • The practice’s uptake for the cervical screening programme was 81%, which was higher than the CCG average of 77% and the national average of 74%.

  • The practice’s uptake or bowel cancer screening programme was 69% which was higher than the CCG average of 63% and the national average of 55%.

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

  • New parents were sent a card that included the patient registration form to complete and a provisional date for the post-natal check. New mothers were telephoned or seen by a GP soon after delivery in addition to midwife and health visitor visits.

  • We saw positive examples of joint working with midwives, health visitors and school nurses. For example the practice had recently decided to work more closely with local primary schools to help increase the uptake of child immunisation.

  • Immunisation rates were high for all standard childhood immunisations. 

Older people

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for the care of older people.

  • 14.5% of the practice register were over 75 years of age and had been identified as a priority.

  • The practice sent a birthday card and questionnaire to patients aged 75 and over on their birthday to help identify patients at increased risk.

  • They offered admission avoidance appointments to patients identified as being at risk.

  • 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 conducted weekly visits to one nursing home in the area.

  • The practice used every opportunity to encourage patients to take advantage of preventative measures, such as flu vaccination, which they offered  and delivered opportunistically during appointments made for other reasons.

  • They prioritised supporting patients on end of life care and in the last two years over 70% of patient deaths had been in a place of patients’ choosing. (The majority of patients prefer to die at home.)

Working age people (including those recently retired and students)

Outstanding

Updated 4 October 2016

The practice is rated as outstanding 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 reflected the needs for this age group. 33% of the patient list had signed up for on-line services.

  • The practice offered extended hours surgeries between 6:30pm and 7pm on Mondays and Wednesdays for patients who worked and found  it difficult to attend during normal working hours. Between September and April they also offered an extended hours surgery on Friday evenings between 6.30pm and 7pm. These were in addition to the ‘Never Full’ surgeries which ran from 5pm on Monday, Wednesday and Friday evenings.

  • The practice offered two weekend flu clinics in October, which was  advertised on repeat prescription forms, in articles in the village newsletter and on their website.

  • Last year the practice identified those patients aged 40 – 74 who had not taken up the invitation for a health check in the past two years and a nurse telephoned these patients. Many of these subsequently attended a health check increasing the practice uptake from about 50% to 75% of patients identified for the checks.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 4 October 2016

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

  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the clinical commissioning group average of 88% and national average of 84%.

  • 100% of patients with a psychosis had a comprehensive agreed care plan documented in their record (from 04/2014 to 03/2015 inclusive) compared to the clinical commissioning group average of 93% and 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 4 October 2016

The practice is rated as outstanding for the care of people who 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.

  • 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.

  • The practice nurse undertook regular home visits for people who were vulnerable and housebound.