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High Street Medical Practice - Winsford Good

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Street Medical Practice - Winsford on 4 November 2015. Overall the practice is rated as good.

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

  • 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 that overall they were involved in decisions about their care and treatment.

  • There were systems in place to reduce risks to patient safety for example, infection control procedures.

  • Patients found it easy to make an appointment with a named GP and there was good continuity of care. Urgent appointments were available the same day.

  • The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

  • There was a clear leadership and structure and staff understood their roles and responsibilities. The practice proactively sought feedback from patients and acted upon it.

  • Complaints were investigated and responded to appropriately.

  • The practice learned from events and complaints and used this learning to drive improvements.

  • The practice made good use of audits and the results of these were used to improve outcomes for patients.

The areas where the provider should make improvement are:

  • Ensure the policy and procedure for managing significant events is followed at all times. The practice should also consider putting checks in place to ensure that any learning from significant events has been embedded into staff practice

  • Extend the training record to include all clinical and non clinical staff groups.

We saw one area of outstanding practice:

The GP lead for mental health had recognised that physical health could be poor for patients with enduring mental health conditions. The practice provided primary care to people living in a psychiatric unit and the practice had tailored care towards these patients by ensuring they received health screening and information about their health conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 January 2016

The practice is rated as good for providing safe services. The practice had systems, processes and practices in place to keep people safe and safeguard them from abuse. Infection control practices were carried out appropriately. Tests were carried out on the premises and on equipment on a regular basis. Staff were clearly aware of their responsibilities to report safeguarding and information to support them to do this was widely available throughout the practice. There was a system in place for recording, reporting and investigating significant events. The practice had recognised that not all events which could be regarded as ‘significant’ had been recorded as significant events. However, they were able to provide assurances that all events had been investigated and responded to appropriately. While, lessons learned as a result of investigations of significant events were shared across the practice to ensure improvements were made, the provider did not carry out checks to ensure improvements had become fully embedded into practice. Systems for managing medicines were robust and the practice was equipped with a supply of medicines to support people in a medical emergency.

Effective

Good

Updated 7 January 2016

The practice is rated as good for providing effective services. Data showed that outcomes for patients were at or above average for the locality. For example, a higher than average number of patients who had diabetes had undergone checks on their health. Clinical staff assessed patient’s needs and delivered care in line with current evidence based guidance. Staff felt well supported and they had the skills, knowledge and experience to deliver effective care and treatment. Clinical audits were carried out which resulted in improved outcomes for patients. The audits had a clear focus and purpose. Staff worked on a multidisciplinary basis to support patients who had more complex needs and we were provided with some good examples of the positive impact of this for patients. The practice worked in conjunction with other practices in the area to improve outcomes for patients. This was particularly evident in how the practice supported patients living in residential care homes.

Caring

Good

Updated 7 January 2016

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care. For example, for giving them enough time, listening to them, explaining tests and treatments, involving them in decisions and treating them with care and concern. Information for patients about the services available to them was easy to understand and accessible. The practice had a lead person for carers and was signed up to the Carers Trust. A designated notice board was provided for carers and drop in sessions were provided for carers to receive advice and guidance. Carers were offered health checks and immunisations.   

Responsive

Good

Updated 7 January 2016

The practice is rated as good for providing responsive services. The practice reviewed the needs of the local population and worked in collaboration with partner agencies to improve outcomes for patients. Clinical staff attended regular multi-disciplinary meetings to review the needs of patients and plan for meeting patient’s needs. Patients said they found it easy to make an appointment with a named GP and that there was good continuity of care. The appointments system was well managed and urgent appointments were available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Complaints had been investigated and responded to appropriately.

Well-led

Good

Updated 7 January 2016

The practice is rated as good for being well-led. There was a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their roles and responsibilities and lines of accountability. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures in place to govern activity and regular governance meetings were held. The partners encouraged a culture of openness and honesty. The practice proactively sought feedback from patients and acted upon it. The patient participation group was active and involved in current and anticipated initiatives. There was a strong focus on continuous learning, development and improvement linked to patient outcomes.

Checks on specific services

People with long term conditions

Good

Updated 7 January 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. Data showed that people with diabetes were overall above the national average for having appropriate health checks. Care plans had been developed for patients with long term conditions such as asthma, epilepsy and rheumatoid arthritis. Longer appointments and home visits were available when needed. Patients with a long term condition had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care and treatment.

Families, children and young people

Good

Updated 7 January 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, alerts on medical records identified children at risk.

Regular meetings were held with a health visitor linked to the practice to share information or concerns. This linked in with an ‘early intervention’ strategy whereby children who presented at any level of risk were highlighted by the practice and information shared with relevant professionals. Appointments were available outside of school hours and children were always given appointments at short notice. The premises were suitable for children and babies and baby changing facilities were provided. The practice supported children with special needs to attend appointments that suited their needs. A system had been set up whereby carers could be contacted on their mobile number to alert them that their child’s appointment was ready and they could then have direct access to the surgery. Child immunisation rates were in line with average rates and on the spot immunisation appointments were available to encourage uptake. Pre-conception planning was in place for women of child bearing age who had medical conditions such as epilepsy or diabetes. The practice provided a ‘one stop shop’ for six week baby checks and post natal checks to be carried out simultaneously.

Older people

Good

Updated 7 January 2016

The practice is rated as good for the care of older people. The practice offered proactive and personalised care and treatment to meet the needs of the older people in its population. Home visits and urgent appointments were provided for those with enhanced needs. The appointments system included a ‘Rapid Response’ to ensure frail patients who were at risk of an unplanned admission to hospital were seen quickly and early in the day. Patients at risk of an unplanned hospital admission had been offered an appointment to develop a care plan to help them manage their health conditions. The practice maintained a record of people who were elderly and vulnerable and worked on a multi-disciplinary basis to meet people’s needs. GPs carried out a weekly visit to a local nursing home to assess and review patient’s needs. The practice also met on a monthly basis with neighbouring practices to review the care and treatment provided to people living in residential care homes. This included carrying out an analysis of events across the care homes and setting objectives to improve the quality of care and treatment provided to patients.

Working age people (including those recently retired and students)

Good

Updated 7 January 2016

The practice is rated as good for the care of working-age people

(including those recently retired and students)

. The needs of this population group had been identified and the practice had adjusted the services it offered to ensure the service was accessible, flexible and offered continuity of care. Late appointments were available four days per week until 7pm. Telephone consultations were also available every day. The practice was proactive in offering online services, enabling people to book appointments on line, view their records and order repeat prescriptions. A full range of health promotion and screening that reflects the needs for this age group was available to patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 86.2% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. One GP was the lead for mental health within the practice and within the Clinical Commissioning Group (CCG). The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out regular visits to a local residential care home and care planning was carried out for patients with dementia. The practice provided primary care to patients living in a psychiatric unit and we heard examples of the positive impact this had on patient care. The practice was aware of people who were subject to restrictions under the Mental Health Act. Patients experiencing poor mental health were provided with information about how to access support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 7 January 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. Longer appointments were available for people with a learning disability. Annual health checks were provided for people with a learning disability. Arrangements were made for travelling families to be seen on an opportunistic basis for immunisations, vaccinations and screening. The practice worked with multi-disciplinary teams in the case management of vulnerable people. Vulnerable patients had been provided with advice and support about how to access a range of support groups and voluntary organisations. Staff had been provided with training in domestic abuse. 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.