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Rowhedge and University of Essex Medical Practice Good

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 The Rowhedge and University of Essex Medical Practice on 24 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were:

  • There was an effective arrangement for reporting and recording significant and safety events at the practice.
  • Risks were managed and evaluated to ensure patients and staff members were safe.
  • Care was provided in line with current best practice and evidence based guidance. Staff members had the skills, knowledge, and experience to deliver effective care and treatment.
  • Patients told us they were cared for with concern, dignity, and respect; they also told us they were included in decisions about their care and treatment.
  • Information about practice services and how to complain was available, on notices and the practice website. Learning was seen in meeting minutes, and improvements had been made as a consequence of complaints and concerns.
  • Patients said they able to access appointments with a GP and were provided continuity of care. There were urgent appointments available on the same day.
  • The practice was well equipped to treat their patients and the premises were clean and safe.
  • Staff members said they felt supported by management, and there was a clear leadership structure at the practice. Feedback was sought from staff members and patients, which we saw the practice had considered and acted on.
  • The practice recognised the requirements of the duty of candour in the open and honest way they deal with concerns and complaints.

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 were arrangements for reporting and recording significant and safety events at the practice. The practice held meetings every six months to review events and complaints.

  • Lessons learned were shared and used for training to ensure when incidents and events occurred the actions they had taken were embedded at the practice to improve safety.

  • An open and honest approach to safety was seen at the practice. When anything went wrong patients were provided reasonable support, information, and a written apology. They were told about any actions taken to improve processes and prevent recurrence.

  • The practice had processes and procedures in place to keep patients safe and safeguarded from abuse. There were alerts on patient’s records to highlight to staff their vulnerability and to ensure they were treated appropriately.

  • Risks were monitored and assessed to keep patients, people visiting the practice, and staff member’s safe.

The practice held a recently updated business continuity plan to support staff in case of an emergency event.

Effective

Good

Updated 15 November 2016

The practice is rated as good for providing effective services.

  • The Quality and Outcomes Framework (QOF) data showed patient’s clinical quality outcomes were above local and national practice averages.

  • Staff members delivered care in line with current evidence based clinical guidance.

  • Clinical audits demonstrated patient outcomes were improved and positive changes made to prescribing and treatment.

  • We found that staff members had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of annual appraisals with personal development and training for all staff members.

Staff members worked with other health and social care professionals to meet the range 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 comparable with other local and national practices for aspects of care.

  • The number of carer’s registered at the practice was 45, this equates to 0.3% of the whole practice population.

  • Patients told us they were treated well, with dignity and respect which included being involved in decisions about their care and treatment.

  • Information for patients about the services was available, easy to understand, and accessible at the practice and on their website.

  • There was a hearing loop and translation services available for patients that needed it.

We saw staff members at the practice treated patients with kindness, respect, and maintained patient information confidentiality.

Responsive

Good

Updated 15 November 2016

The practice is rated as good for providing responsive services.

  • Home visits were available for older patients and patients with clinical needs

  • Same day appointments were available for children and for patients with an urgent medical need or problems that required a same day consultation.

  • Longer appointments were available for patients with a learning disability.

  • Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

  • 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 over 70% of the practice population were students that required dedicated services to support not only those leaving home for the first time, but the 40% that were leaving their birth country for the first time.

  • The practice provided integrated patient-centred care for its more traditional practice population and for its university location population. Each September when approximately 2,700 students were enrolled at their university location practice they provided bulk vaccination against ‘Meningitis ACWY’ and measles, mumps and rubella (MMR) when registering them at the practice. This prevented complications caused when a great number of people live and work in close proximity and can spread disease. The practice provided a health presentation for student patients during their first few weeks at the beginning of September in conjunction with the university to give them information needed for self-help to keep them healthy and understand where they can receive primary care treatment when they needed. The practice provided sexual health nurse community clinics at their university practice location to ensure early access to this provision and reduce the risks from sexually transmitted infection

  • The practice had clean, safe facilities and sufficient equipment to meet their patient population needs.

  • Information about how to complain was available both at the practice and on their website.

  • The practice responded quickly when issues, complaints, or safety events were raised, and learning from these was shared with staff members and others working with practice staff and patients.

Patient needs were assessed for their local population and the practice engaged with the NHS England Area Team and the local Clinical Commissioning Group to secure improvements to services when these were identified. Patients told us they found it easy to make an appointment with a named GP and they had continuity of care, with urgent appointments available on the same day.

Well-led

Good

Updated 15 November 2016

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

  • The practice told us their values were to provide: good family medicine, a stable partnership, and care for patients as they would family members, and provided a diverse partnership of different ages, personalities and medical interests.

  • Staff members knew about the practice ethos and their responsibilities in relation to its shared values of openness, fairness, respect, accountability, and suitable work-life balance.

  • There was a clear leadership structure that staff members understood; when we spoke to staff members they told us they felt supported by management at the practice.

  • The practice had a number of policies and procedures to govern both clinical and administrative activity which it reviewed and updated regularly. The practice complied with the requirements of the duty of candour when dealing with significant events in an open and honest manner.

  • We saw that the practice took minutes at clinical and business meetings; there were set agenda items to ensure regular monitoring of important practice systems and issues.

  • We saw a central service strategy to provide good quality care, which included arrangements to monitor and improve service quality and identify and manage risk.

  • The partners encouraged a culture of openness and honesty within their staff members.

  • Notifiable safety incidents were shared with staff members to ensure when appropriate action had been taken it was embedded within the practice procedures.

  • Feedback was sought from staff members and patients, which it used to develop improvements. The practice management team regularly reviewed the results of data produced at the practice and discussed how they could improve service quality.

  • Data was also benchmarked by the practice against local and national results to monitor and understand their own performance.

  • The patient participation group was active and supported the practice. They also worked with local community organisations to improve and support services at 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 15 November 2016

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

  • Specialist nursing staff ran clinics and had lead roles in chronic disease management.

  • Patients considered to be at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available to patients in this population group when needed.

  • All patients in this population group had a named GP and a structured annual review to check their health and medicine needs were being met.

  • Access to consult a North East Essex Diabetic Service (NEEDS) liaison nurse at the practice was available to improve diabetes care to patients

  • For patients with the most complex needs, the named GP worked with local health and care professional specialists to deliver multidisciplinary care.

A GP Care Advisor visited the surgery two days each week to provide social care, financial and benefit advice to support patients with life changing health problems.

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.

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

  • There were arrangements in place to identify and follow up children living in disadvantaged circumstances or were at risk, for example, children and young people who had a high incidence of A&E attendances. The practice also provided primary care for a local four bed adolescent children’s home for looked after children.

  • The GP safeguarding lead at the practice attended the local quarterly safeguarding forums when possible, and provided reports when necessary.

  • Safeguarding was a standard agenda item on the weekly practice business meeting.

  • A GP lead for children and babies, and receptionist work together to identify and contact parents whose children had missed their immunisations. Immunisation rates were higher than local and national practices for all standard childhood immunisations.

  • Contraceptive services, cervical cytology, midwifery services, postnatal checks and baby checks are provided at the practice for patients in this population group.

  • The practice had worked with the local village school for the last three years by inviting children to the practice to talk to them about health care and show them how, a GP practice works.

  • The practice worked with midwives, health visitors and school nurses to provide a quality service to patients.

Parents of children and young people told us they were treated in an age-appropriate way.

Older people

Good

Updated 15 November 2016

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with a greater need.

  • The practice offered follow-up appointments with a GP or nurse practitioner on the telephone when patients in this population group were discharged from hospital.

  • Patients over the age of 75 years old were allocated a named GP. The practice performed a monthly search on their patient record system to identify any patients approaching the age of 75 to offer them age appropriate services.

  • The practice provided primary care to two large care homes for the elderly. An individual care plan had been established for each resident which was managed by their named GP.

  • The nurse practitioner provided telephone triage support for the care homes in the form of dedicated telephone times each morning for improved access. The nurse practitioner also undertook “welcome visits” for all new residents.

  • Home visits for flu vaccinations were provided for house-bound elderly frail patients.

  • The practice sought the views of their patients with life-limiting conditions who were resident in care homes, to ensure they could meet their preferred care needs.

  • At times of bereavement the practice offered support to the family and sent a condolence card.

The practice held a register of patients that were carers and added an alert on the patient record system so that staff members were able to consider their needs when making appointments. The number of carer’s registered at the practice was 45, this equates to 0.3% of the whole practice population. Carers were supported by a designated GP lead for carers. The practice approach to identify carers was using their new patient registration form, having a poster in the waiting room and asking patients to identify themselves as being a carer and on an ad hoc basis during consultations. The practice % was low due to three quarters of their population group being under 25 years of age.

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 practice had modified their services to ensure these were appropriate, accessible, flexible, and met the needs of this population group.

  • Appointments were identified for working patients towards the end of the afternoon/evening surgeries.

  • They were proactive in offering online services that specifically met the needs of this population group for example; their website had an easy to use translate facility.

  • The practice website contained a full range of health information that was specifically tailored to meet the needs of this population group, including support for students to enable them to access the most appropriate service.

  • The practice had a strong link with the university campus to ensure consistent and robust health care messages were given to students.

  • Staff at the practice had received extra training to ensure they could meet the needs of their student patients. For example students experiencing high stress levels at exam times.

  • A specialist nurse practitioner in sexual health services was accessible daily, and two of the GPs were trained in extended contraceptive services to provide implants and inter-uterine device (IUD) fittings. An out-reach service for Sexual Health Screening and treatment at the university location was provided twice a week.

The practice had become proficient in student and foreign student healthcare by balancing ideas and expectations; for example ensuring female GPs for female patients was offered and guidance with regards to accessing healthcare in this country.

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).

  • Mental health performance data reflected that the practice was performing higher than local and national averages. An example was that 91% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, was higher than the local average of 84% and the national average of 84%.

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

  • The practice carried out advanced specific care planning for patients with dementia.

  • Patients experiencing poor mental health were told how to access support groups and voluntary organisations in the practice and on the practice website.

  • The practice had arrangements in place to follow-up patients who had attended accident and emergency where they may be experiencing poor mental health.

  • Staff members understood how to support patients living with mental health needs or dementia. The training received by staff members supported them when communicating with the staff and patients from the two specialised dementia homes receiving primary care services from the practice.

  • The practice offered double appointments to patients suffering from poor mental health. On the records of patients with poor mental health there was an alert to notify staff members of their particular needs.

  • Working with the Alzheimer’s Society the practice held out-reach clinics every two weeks to provide information and support to patients, their friends and family for anyone suffering with dementia.

Care home residents were provided with care plans to ensure their wishes regarding their care and treatment was provided in the manner they preferred.

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.

  • There was a register held at the practice of patients living in vulnerable circumstances these included homeless people, travellers and those with a learning disability. The practice had a register of 32 patients living with a learning disability; each of these patients had been offered a health check annually.

  • Longer appointments were offered to patients living with a learning disability and alerts added to their records informed staff members to their particular needs.

  • Vulnerable patients case management was discussed in regular meetings with healthcare professionals trained to treat patients in this population group.

  • The practice provided information to vulnerable patients about how to contact and access support groups and voluntary organisations.

  • Staff members had received training to recognise signs of abuse in vulnerable adults and children. Staff members were aware of their responsibilities regarding safeguarding concerns and who to contact. The process they used was accessible to all staff members, held current contact details and met local safeguarding guidance.

  • They allocated GP and nurse time each week to speak with the learning disability (LD) care home staff regarding the patients they looked after.

  • Each patient with a learning disability had an individual care plan agreed with the patient and their family or carers. This included information regarding ‘My Care Choices’ (MCC). MCC is a register that allows information sharing with community and out of hour’s services for those patients with a life-limiting condition.

  • The practice provided a direct telephone number for care homes to use to ensure access to clinical guidance was available promptly for patients.

During clinical meetings vulnerable patients were discussed each time along with the feedback from recent safeguarding forums was reviewed.