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Rowden Medical Partnership Outstanding Also known as Rowden Surgery

Inspection Summary


Overall summary & rating

Outstanding

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rowden Medical Partnership on 29 September 2016. Overall the practice is rated as outstanding.

  • Our key findings across all the areas we inspected were as follows:
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the initiation of complex care clinics.
  • Information about safety was highly valued and was used to promote learning and improvement. For example the system developed by the practice to monitor patients on high risk medicines.
  • Feedback from patients about their care was consistently positive.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the implementation of an early home visiting service.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The partners recognised staff for their areas of expertise and demonstrated a willingness to learn and improve systems suggested by staff and there was a strong focus on staff development.
  • The practice was a teaching and training practice and had been selected to provide training and mentoring for GP registrars who required additional support.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

  • People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP, the pharmacist and the care coordinator to ensure patients received a comprehensive holistic review that met all health and social care needs .
  • Patients with a care plan in place were given access to a dedicated urgent telephone line between 8am and 10am. Each day a GP was available to visit these patients between 9am and 10am. The purpose of this was to ensure that patients could be assessed and a management plan commenced early in the day, to help prevent unnecessary hospital admission . We saw a number of examples where patients had benefitted from this service.
  • The practice had developed a system where all patients on high risk medicines were given written information, in a wallet sized card. Greater understanding had resulted in patients working in partnership with the practice and taking greater responsibility and ownership to ensure monitoring regimes were followed.
  • The practices information technology administrator supported patients, who required it, on an individual basis or demonstration sessions during flu clinics, to gain access to online services which provided greater flexibility and convenience to access appointments and had increased the numbers of patients utilising on line services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 November 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 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.
  • Information about safety was highly valued and was used to promote learning and improvement.
  • The practice had developed a system where all patients on high risk medicines were given written information, in a wallet sized card. Greater understanding had resulted in patients working in partnership with the practice and taking greater responsibility and ownership to ensure monitoring regimes were followed.
  • 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 23 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • The practice participated in national research programmes which patients had benefitted from.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice was a teaching and training practice and provided placements for GP registrars, nursing and medical students. The practice had been selected to provide training and mentoring for GP registrars who required additional support.
  • 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 23 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for consultations with GP’s and nurses.
  • 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 employed a care coordinator who supported carers to access the services they needed.

Responsive

Outstanding

Updated 23 November 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice had engaged with the clinical commissioning group to deliver an earlier home visiting service. The purpose of this was to ensure that patients could be assessed and a management plan commenced early in the day, to help prevent unnecessary hospital admission.
  • There were innovative approaches to providing integrated patient-centred care. People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP, the pharmacist and the care coordinator to ensure patients received a comprehensive holistic review that met all health and social care needs.
  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met those needs. For example, the practice employed a practice pharmacist to support optimal medicines management for patients. The practice also employed a care coordinator to enhance integrated care delivery by liaising with other health and social care professionals to help to support and coordinate the care of vulnerable patients who had complex needs.
  • Continuity of care was central to ethos of the practice and was achieved by operating a system of personalised list with the GPs.
  • 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. The patient participation group worked in partnership with the practice to implement extended hours surgeries which would best meet patient needs.
  • Patients can access appointments and services in a way and at a time that suits them. The practices information technology administrator supported patients, who required it, on an individual basis or demonstration sessions during flu clinics, to gain access to online services which provided greater flexibility and convenience to access appointments.
  • All patients who held care plans were given the number of a dedicated phone line during 8am and 10am to ensure they were seen as early in the day as possible.
  • The practice was a young person friendly practice and delivered the ‘No Worries’ service, a confidential sexual health service for all young people aged 13-24.
  • 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.

Well-led

Outstanding

Updated 23 November 2016

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

  • The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The strategy and supporting objectives were stretching, challenging and innovative, while remaining achievable. The practice leadership and culture was used to drive and improve the delivery of high quality person centred care. The practice sought opportunities to deliver tailored care in the local community and improve health outcomes for patients. For example the initiation of a complex needs clinic that met all health and social care needs for a patient during a single attendance at the surgery

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. This included arrangements to monitor and improve quality and identify risk. Governance and performance management arrangements were proactively reviewed and reflected best practice. The practice management had evaluated information and data from a variety of sources to inform decision making that would deliver high quality care.
  • 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 partners in the practice prioritised safe, high quality and compassionate care. The partners were visible and it was clear that there was an open culture within in the practice. There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • The practice proactively sought feedback from staff and patients, which it acted on. The partners recognised staff for their areas of expertise and demonstrated a willingness to learn and improve systems suggested by staff.
  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

Older people

Outstanding

Updated 23 November 2016

The practice is rated as outstanding 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 employed a care coordinator to enhance integrated care delivery, by liaising with other health and social care professionals, to help support and coordinate the care of older patients who had complex needs.
  • The practice employed a practice pharmacist who worked with older patients who needed additional support to understand medicine regimes and to enhance compliance.
  • A clinic to review older patients with complex needs had been initiated to ensure a comprehensive review that met all health and social care needs was delivered.

People with long term conditions

Outstanding

Updated 23 November 2016

The practice is rated as outstanding 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. Nursing staff had undertaken specialist diplomas in chronic disease to ensure high quality care was delivered to patients.
  • The practice delivered an earlier home visiting service to ensure patients with deteriorating health, could be assessed and a management plan commenced early in the day, to help prevent unnecessary hospital admission.
  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was within target range (2014/15) was 85% compared to a local average of 80% and a national average 78%.
  • 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.

Families, children and young people

Outstanding

Updated 23 November 2016

The practice is rated as outstanding 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 was a young person friendly practice and delivered the ‘No Worries’ service, a confidential sexual health service for all young people aged 13-24.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (2014/15 ) was 83% compared to a local average of 85% and a 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.
  • GPs were always involved in child immunisation clinics which allowed for immediate decisions to be taken regarding unscheduled immunisations for poor attenders and for the children of a refugee family that were registered with the practice.

Working age people (including those recently retired and students)

Outstanding

Updated 23 November 2016

The practice is rated as outstanding 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.
  • Extended hours surgeries were offered for patients to be able to attend outside of working hours.

People whose circumstances may make them vulnerable

Outstanding

Updated 23 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and 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.
  • All patients with a care plan in place had access to an early morning dedicated telephone line to ensure these patients could be visited early in the day, to potentially prevent a hospital admission.
  • The practice care coordinator supported vulnerable patients to gain access to appropriate social care packages.
  • 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.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 23 November 2016

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

  • 91% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was better than the local average of 88% and the national average of 84%.
  • The percentage of patients with a serious mental health illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014/15) was 97% compared to a local average of 93% and a national average of 88%.
  • 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.
  • The practice held an in house memory assessment clinic.