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Drs Lavin, Findlay, Remedios and Thompson Good Also known as Whiteacres Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Lavin, Findlay, Remedios and Thompson on 16 March 2016. Overall the practice is rated as good.

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

  • Patients in Malvern had voted Drs Lavin, Findlay, Remedios and Thompson the best practice in town, according to an article in the 19 February 2016 edition of The Malvern Gazette.
  • Patients said that the GPs and nurses were very caring and respectful and that they were always involved in decisions about their treatment options.
  • The practice team was experienced to deal with a variety of health conditions.
  • The practice had clear systems in place to ensure the safety of the practice and monitor the level of care and treatment delivered to patients.
  • Risks to patients were assessed and well managed.
  • The practice was one of five local practices to take part in a pilot scheme whereby a local GP was available to review any patient in a care home from 10am to 2pm during the weekend.
  • Information about services and how to complain was available and easy to understand. The practice replied to complaints in a timely manner.
  • Patients said they found it easy to make an appointment with a named GP and that 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.
  • 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.

We saw one area of outstanding practice:

  • A practice nurse had set up a Swim Inspiration scheme, in order to encourage patients to get fit and lose weight. Weekly sessions were held for patients with conditions such as obesity, arthritis, Hypertension, Parkinson’s, Huntington’s and Learning Disability. Instructors regularly had between 20 and 30 patients attending.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 May 2016

The practice is rated as good for providing safe services.

  • Staff knew how to raise concerns and report incidents and near misses. Significant events were thoroughly investigated and lessons shared to ensure that action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, 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 clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Staff were aware of their responsibilities to raise concerns and knew how to report incidents and near misses.

  • The practice assessed risks to patients and had clear systems in place for managing risks such as medical emergencies, infection control and fire safety.

Effective

Good

Updated 11 May 2016

The practice is rated as good for providing effective services.

  • 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 these guidelines were positively influencing and improving practice and outcomes for patients.

  • Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes were at or above average for the locality and compared to the national average. For example, the number of patients with poor mental health who had their care plan reviewed in the last 12 months was 92%, which was 12% above the Clinical Commissioning Group average and 12% above the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits were carried out on a regular basis and results used to improve standards of care.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They received training appropriate to their roles.

  • Appraisals and personal development plans were carried out for all staff.

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

Caring

Good

Updated 11 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice higher than others for almost all aspects of care. For example, 91% of patients said that GPs were good at involving them in decisions about their care, which was 6% higher than the local Clinical Commissioning Group (CCG) average and 9% above the national average.

  • Patients told us that they were always treated with compassion, dignity and respect. Feedback from patients and comment cards confirmed that patients felt involved in decisions about their care and treatment options. Results from the Friends and Family Test showed that 100% of patients would recommend the practice to friends and family.

  • We observed a strong patient-centred culture.

  • Views of external stakeholders were very positive and aligned with our findings. For example, managers of local care homes all emphasised the excellent service provided by the practice and said that GPs went the extra mile to help patients.

  • The practice kept a file of ‘Happy Letters’ from patients and relatives who praised the high level of care.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality. We noted that patients respected the privacy sign by the reception desk, and stood back until it was their turn. A radio also helped to preserve patients’ confidentiality when they spoke with receptionists.

Responsive

Good

Updated 11 May 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs. For example, diabetic clinics were held with the Diabetic Specialist Nurse six times a year.

  • 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.

  • Patients emphasized that it was easy to make an appointment. Urgent appointments were always available on the same day. Patients who rang before 10am were guaranteed an appointment the same day.

  • The practice operated an on call GP system, whereby a GP had no booked appointments that day, but was responsible for all home visits and tasks such as signing prescriptions, so home visits were carried out early in the day.

  • Patients told us that they appreciated the continuity of care.

  • The practice was located in purpose-built premises and had good facilities. It 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 as appropriate.

Well-led

Good

Updated 11 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 these were accessible to staff.

  • 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 practice 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. There was a virtual Patient Participation Group (PPG), which contributed to patient surveys.

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

People with long term conditions

Good

Updated 11 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.

  • Longer appointments and home visits were available when needed.

  • Some patients had alerts on their records to remind receptionists that they needed a longer appointment.

  • 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 nursing team provided lifestyle advice (smoking cessation, weight loss) and the NHS Health Checks.

  • Patients had access to the Swim Inspiration programme, which provided the opportunity to swim once a week, thus helping patients to keep fitter and healthier.

  • Achievement data from the Quality and Outcome Framework (QOF) for 2014/15 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 91%, which was 5% above the CCG average and 7% above the national average.

  • Data showed that 78% of patients with asthma had their care reviewed in the last 12 months, which was in line with CCG and national averages.

Families, children and young people

Good

Updated 11 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 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. One comment card specifically mentioned that the clinical staff made children feel very relaxed when they attended for appointments and immunisations.

  • There was a children’s area and children’s books available in reception.

  • Children who were seen in the morning and were ill were offered an emergency appointment later on the same day with the on call doctor to ensure that they were improving.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Patients who rang or came to the practice before 10am wanting an appointment would be offered an appointment that day. If patients contacted the practice after 10am, they would be seen in the afternoon emergency surgery if the issue could not wait until the next day.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 11 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 operated an on call doctor system, whereby visits were carried out early in the day, thus preventing unnecessary hospital admissions and reducing the number of patients who might otherwise have presented at accident and emergency (A&E).

  • GPs could refer patients to the Minor Injuries Unit at Malvern Community Hospital for X-rays to eliminate or confirm fractures, thus avoiding an A&E attendance.

  • The usual GP would visit housebound patients on his or her visiting day if they needed a routine review.

  • A GP visited patients in care homes once a week, providing continuity of care and helping to reduce duplicate investigations and inappropriate referrals.

  • The practice was one of five local practices to take part in a pilot scheme whereby a local GP was available to review any patient in a care home from 10am to 2pm during the weekend. The practice took part in the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission. The practice’s emergency admission rate for over 75 year old patients for 2014/15 was 269 per 1000 patients, and had fallen to 173 per 1000 in 2015/16, which was lower than the Clinical Commissioning Group (CCG) average of 246 per 1000 patients.


Working age people (including those recently retired and students)

Good

Updated 11 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 reflected the needs for this age group.

  • Bookable telephone appointments were available to provide flexibility.

  • NHS Health Checks were offered by the nursing team, who also gave advice on smoking cessation, weight loss and exercise.

  • Cervical screening uptake was 79%, which was in line with CCG and national averages.

  • A range of contraceptive services was available at the practice, including coils and implants.

  • Patients could register with the online booking service to book routine GP appointments and order repeat prescriptions at a time that was convenient for them.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 May 2016

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

  • 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with the CCG and national averages.

  • The practice had the highest dementia prevalence in South Worcestershire.

  • Two managers of local care homes with whom we spoke told us that the GPs would carry out weekly ward rounds and that nothing was too much trouble for them.

  • Patients with dementia and their carers could be referred to Age UK for wellness checks. The checks had helped to signpost carers to support services.

  • Data from the Quality and Outcome Framework (QOF) 2014/15 showed that the practice achieved 99.8% for the mental health indicators, which was 5% above the CCG average and 7% above the national average. The exception reporting rates for the underlying indicators were either in line with or below CCG and national averages. For example, the exception reporting rate for patients with poor mental health who had a comprehensive care plan review completed within the last 12 months was 10% below both the CCG average and national average.

  • 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 11 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 those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The manager of a local care home for patients with a learning disability told us that the GPs provided a very good service and showed great understanding of patients. A comment card referred specifically to the respect that GPs showed towards vulnerable patients.

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

  • The practice maintained a register for patients who needed palliative care. Home visits and same day appointments were available for these patients, who often had complex conditions. Evidence of the high standard of palliative care was clearly demonstrated by the number of letters in the ‘Happy Letters’ file.

  • GPs proactively booked follow up appointments with the usual GP for palliative care patients, patients with complex needs and the most frail patients, thus ensuring continuity of care.

  • Regular multi-disciplinary meetings were held during which treatment for patients on the palliative care register were discussed.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff had received training and 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.

  • Information about domestic abuse and sexual violence was displayed in the reception area.