You are here

Whitnash Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Holtby & Martin (also known locally as Whitnash Medical Centre) on 27 September 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 received training to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • Feedback from patients about their care was consistently positive. 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.

  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 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 discussed and shared within the practice and with other agencies to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, clear 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 14 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) 2014/15 showed patient outcomes were in line with regional and national averages.

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

  • Clinical audits demonstrated quality improvement.

  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 December 2016

The practice is rated as good for providing caring services.

Data from the National GP Patient Survey published during July 2016 showed patients rated the practice higher than others for almost all aspects of care. For example:

  • 96% of patients said the last GP they saw or spoke to was good at giving them enough time compared with the Clinical Commissioning Group (CCG) average of 91% and the national average of 87%.

  • 100% of patients said they had confidence and trust in the last nurse they saw or spoke to

    compared with the CCG average of 91% and the national average of 86%.

  • Feedback from patients about their care and treatment was consistently positive.

  • 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. For example nursing staff had attended the practice on their days off to see patients they were concerned about when the patients could only visit on those days.

  • Information for patients about the services available was easy to understand, was accessible and was distributed in a variety of ways. For example the practice had for many years provided a regular article in the local community newspaper to promote the services available at the practice and to support health awareness.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

One of the PPG members with knowledge of dementia had, with the practice’s support, run a dementia education evening at the practice to provide an insight into the condition. This event was promoted in the community magazine and staff and patients told us it had been a real success.

Responsive

Good

Updated 14 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of the local population and engaged with the NHS England Area Team and the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example the practice offered extended hours clinics at evenings and weekends for patients who could not attend during normal opening hours, and extended appointments were available for those needing them.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was discussed and shared with staff and other stakeholders.

Well-led

Good

Updated 14 December 2016

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

  • The practice had clear values and a strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the values and strategy and their responsibilities in relation to them.

  • 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 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.

  • The practice proactively sought feedback from staff and patients, which it acted on. There was an established Patient Participation Group (PPG).

  • There was a focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 14 December 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.

  • Chronic disease reviews were carried out by nursing staff at the practice or patients’ homes.

  • 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.

  • The named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care for patients with complex needs.

Families, children and young people

Good

Updated 14 December 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 accident and emergency attendances. Immunisation rates were high for all standard childhood immunisations.

  • GPs performed child health surveillance and post-natal checks and a midwife attended the practice weekly to see patients.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Performance for cervical screening indicators was in line with Clinical Commissioning Group (CCG) and national averages. For example the percentage of women aged 25-64 who attended for a cervical screening test in the last five years was 84% compared with CCG and national averages of 83% and 82% respectively.

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

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

Older people

Good

Updated 14 December 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 participated in a local over 75s project offering different levels of reviews working in collaboration with Age UK. The practice offered health checks to all patients aged over 75 in the last 12 months and over 80% of the patients in this age group received these.

  • The practice directed older people to appropriate support services.

  • All patients aged over 75 had a named GP.

Working age people (including those recently retired and students)

Good

Updated 14 December 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.

  • The practice offered online appointment booking and the facility to request repeat prescriptions online.

  • Appointments were offered to accommodate those unable to attend during normal working hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2016

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

  • Performance for mental health related indicators was in line with the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the last 12 months was 92% compared with CCG and national averages of 93% and 88% respectively.

  • The practice had carried out health checks for all patients registered as having a mental health condition in the last 12 months (42 patients).

  • 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.

  • 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.

  • One of the PPG members with knowledge of dementia had, with the practice’s support, run a dementia education evening at the practice to provide an insight into the condition.

People whose circumstances may make them vulnerable

Good

Updated 14 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice had up-to-date registers of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • The practice had traveller families registered as patients and offered to register their postal address at the surgery to help them to access hospital care. Practice staff tried to ensure they had current mobile telephone numbers for these patients.

  • The practice had 21 patients registered as having a learning disability and had completed health checks for all of these patients in the last 12 months. The practice offered longer appointments for patients with a learning disability.

  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 65 patients as carers, which represented 1% of the total practice population.

  • Carers were identified and supported as part of the annual reviews provided 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.

  • One of the PPG members with knowledge of dementia had, with the practice’s support, run a dementia education evening at the practice to provide an insight into the condition. This event was promoted in the community magazine and staff and patients told us it had been a real success.