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Fishponds Family Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fishponds Family Practice on 4 October 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.

  • Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had 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.
  • Fishponds Family Practice received the Customer Service Excellence Award, for demonstrating a high level of commitment to patient care. The practice’s customer care policy is one of several component parts to the award. The care policy focuses on how the practice delivers access to patient services and offers choice wherever possible. The customer care policy is available for patients to read in the practice and on its website.
  • The patient participation group (PPG) were well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness to patients about the practice’ services.
  • The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
  • The practice worked closely with local organisations including a hospice, a dementia charity and a homeless charity.
  • The practice participated in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
  • Staff had lead roles that improved outcomes for patients such as a carer’s lead.
  • The practice was one of seven GP practices that had helped to develop a medical student psychotherapy scheme, for patients who did not have access to specialist mental health services.
  • The practice helped to establish an additional psychotherapy service for patients to be initially assessed before referral to the private or voluntary sector, where they were provided with opportunities for work and art therapies.
  • Patients were able to access a specialist dementia memory nurse. The nurse assessed patients in their own homes, advised on tests and medications and once diagnosed, referred patients to a dementia navigator to help them and their carer access available community support.
  • 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 provider was aware of and complied with the requirements of the Duty of Candour.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw two areas of outstanding practice:

  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. Fishponds Family Practice received the Customer Service Excellence Award in 2010. This government-backed scheme was open to all health sector organisations and awarded where there was a demonstrably high level of commitment to patient care. Fishponds Family Practice was the third GP practice in the country to attain the award since its’ inception in 1991. Following a reassessment in 2015, the practice was re-accredited for this Excellence Award until 2018.
  • The leadership, governance and culture of Fishponds Family Practice are used to drive and improve the delivery of high-quality person-centred care. For the last three years, practice GPs have had fortnightly supervision sessions with a consultant psychotherapist. The sessions were self-funded by the GPs, and focussed on patient empathy and interaction, staff relations, and identifying and working to meet the demands of a GP’s role. The practice produced a paper about the GPs’ experiences of counselling that was published in the British Medical Journal in 2014. When we spoke to the practice, we saw that informal feedback highlighted GPs found the sessions highly beneficial to their professional practice.

We saw one area where the practice should make improvement:

  • The provider should continue to make efforts to identify a greater proportion of carers from its patient list, to better support the population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 January 2017

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.

Effective

Good

Updated 6 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework for April 2015 to March 2016 showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • We saw a programme of clinical audits that included improvements for patient care.
  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • The practice helped to develop a psychotherapy scheme and referred patients to private or voluntary sector psychotherapy services, to help them access mental health services.

  • Patients were able to access a specialist dementia memory nurse.

Caring

Good

Updated 6 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (July 2016) showed patients rated the practice as comparable with other local practices 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 identified patients who were carers and alerted them whenever a local carers group met. This provided an opportunity for carers to gain support and raised awareness of carer’s services locally.
  • Vulnerable patients who did not attend their scheduled appointments were contacted by a practice nurse, to check their welfare.
  • A member of staff acted as a carer’s lead. The carer’s lead had a direct link with the local care forum and referred suitable patients for specialised advice and guidance.

Responsive

Good

Updated 6 January 2017

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 (CCG) to secure improvements to services where these were identified. For example, the practice was participating in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs. The practice had referred 49 patients into the social prescribing scheme in the last 12 months, and we read letters written by patients who revealed how social prescribing had benefitted them in their lives.
  • Patients with a learning disability had care plans and practice leaflets could be made available in large print and Easy Read format, which makes information easier to access for this group.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with regular appointments available the same day.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of patient feedback.
  • 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.
  • The practice worked with other health professionals to minimise unnecessary hospital admissions.
  • Patients were able to access the practice by telephone, and face to face.
  • The practice sent text reminders for appointments.
  • The practice increased the length of individual appointment times for patients with complex medical conditions, and for patients who did not have English as their first language.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
  • The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.
  • The practice increased the length of individual appointment times for patients who did not have English as their first language.
  • Patients were able to access a specialist dementia memory nurse.
  • Patients who did not normally have access to specialist mental health services were able to access a medical student psychotherapy scheme.
  • The practice worked closely with local charities including a local hospice, a Bristol-based dementia charity and a homeless charity. We saw evidence that patients benefitted by being referred more quickly into those services. The practice also invited local charities to attend its monthly palliative care meetings, to discuss the patients on their caseload.
  • The practice helped to establish a psychotherapy service for patients which included opportunities for work and art therapies. Patients were able to access individual face-to-face assessment with an appropriate follow-up package then being arranged for them. This could be anything from group art therapy work to individual counselling lasting up to six months. The scheme was funded by the local CCG and had engaged around 133 patients.
  • The practice hosted a drugs worker from the Bristol Drugs Project at the practice for one day a week in order that patients could have easier access to this service.

Well-led

Good

Updated 6 January 2017

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.
  • 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 provider 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 strong focus on continuous learning and improvement at all levels. For example, the practice GPs had supervision sessions with a consultant psychotherapist, to focus on patient empathy and other development issues. When we spoke to the practice, they told us that patients benefitted more directly because the sessions look at areas affecting GP efficiency and ensuring that they were available to see the patients who were most in need.
  • The practice conducted a detailed annual patient survey to improve feedback. We saw evidence that previous surveys averaged around 300 responses, and that 90% of survey respondents would recommend the practice to friends and family.
  • Practice partners had an away day every six months, to discuss issues such as management structure and partner responsibilities, and the whole practice held an annual away day.
  • The practice has a growing patient list size that includes people seeking asylum and adapted its services accordingly. For example, the practice helped to develop a psychotherapy scheme, for patients who did not have access to specialist mental health services.
Checks on specific services

People with long term conditions

Good

Updated 6 January 2017

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.
  • Performance for patients with long-term conditions compared with national averages. For example, 72% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 76%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
  • 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 routinely offered longer appointments for patients with complex medical needs.

Families, children and young people

Good

Updated 6 January 2017

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. The practice assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 81%, which was comparable 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 worked to provide inclusive services for younger patients, such as hosting the 4YP (for young people) initiative which enabled teenagers to access sexual health care.

Older people

Good

Updated 6 January 2017

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 patients in its population.
  • Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • A carer’s lead worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
  • The practice referred patients to local community health improvement schemes.

Working age people (including those recently retired and students)

Good

Updated 6 January 2017

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.
  • The practice offered extended hours appointments with a GP, nurse or phlebotomist on five mornings a week and four evenings a week.
  • Patients were able to book appointments and order repeat prescriptions online.
  • The practice offered text reminders for appointments.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 January 2017

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

  • 77% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with both the clinical commissioning group (CCG) average of 81% and national average of 78%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 92%, which compared with the national average of 88%.
  • 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.
  • The practice provided injections of slow-release antipsychotic medication for patients at risk of missing their medication, and a phlebotomy service for those patients on medications needing regular blood test reviews.
  • The practice provided a medical student psychotherapy scheme for patients who were not normally able to access specialist mental health services.

  • The practice was proactive in helping patients to access mental health services. The practice helped to develop a further psychotherapy scheme and referred patients to private or voluntary sector psychotherapy services. Patients were able to access individual face-to-face assessment with an appropriate follow-up package then being arranged for them. This could be anything from group art therapy work to individual counselling lasting up to six months. The scheme was funded by the local CCG and had engaged around 133 patients.

  • Patients were able to access a specialist dementia memory nurse.

  • The practice referred 49 patients into a social prescribing scheme in the last 12 months, and we saw evidence that this had benefitted them in their lives.
  • The practice worked closely with local charities including a dementia charity and we saw evidence that patients benefitted by being referred more quickly into those services. The practice also invited local charities to attend its monthly palliative care meetings, to discuss the patients on their caseload.

People whose circumstances may make them vulnerable

Good

Updated 6 January 2017

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 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 was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.