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Wordsley Green Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 8 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wordsley Green Health Centre on 10 January 2017. 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.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Risks to patients were assessed and well managed. However, we saw that the practice had not obtained references for a GP who was previously a registrar at the practice and had only one reference for a non-clinical member of staff.
  • 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 raised with the practice.
  • Patients said they found it easy to make an appointment and that the last time they got an appointment it was convenient. We saw that urgent appointments were available the same day. Data showed that 94% of patients found the receptionists at the surgery helpful.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. All staff received annual basic life support training and there were emergency medicines available in the treatment room. We were told that staff took part in regular ‘skill drills’ which were mock emergencies that staff responded to.
  • 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.
  • We saw that information and orientation packs were available for locums and GP registrars. Locum workloads were reviewed before the practitioner left the practice and they would sign to confirm they had completed all tasks, including referrals.

We saw one area of outstanding practice:

  • We saw that safeguarding was a priority for the practice and the systems and processes for keeping people safe were comprehensive and embedded within the team. For example, the GPs reviewed the notes of all newly registered children within 24 hours of their registration. This had identified safeguarding issues which were acted upon. We saw evidence that when patients at the practice were struggling with health or social care issues the practice would ‘think family’ and review how other members of the family were also affected. The practice also held six weekly safeguarding meetings with a number of relevant professionals and held a log of all safeguarding issues which were regularly reviewed.

The areas where the provider should make improvement are:

  • The partners should formalise the process for supporting salaried GPs and ensure that they are offered regular, documented appraisals.

  • The practice should continue to attempt to obtain two references for each newly recruited member of staff in line with the practice policy.

  • The practice should implement an effective system to monitor and manage prescriptions which are not collected from reception by patients who have requested them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 February 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 personal apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Safeguarding was a priority for the practice and the clearly defined systems and processes for keeping people safe and safeguarded from abuse were comprehensive and embedded within the team.
  • Risks to patients were assessed and well managed. However, the practice had not obtained references for a GP who was previously a registrar at the practice and had been unable to obtain more than one reference for a non-clinical member of staff. All other checks to ensure the safe recruitment of staff were in place and staff were supported and monitored throughout their probationary period.
  • Prescription stationery was securely stored and there was a clear system in place to track and monitor the use of prescription pads used for home visits and for prescription stationery in printers. However, during our inspection we found that the practice did not follow an effective system to monitor and manage any uncollected prescriptions. The practice said they would implement a system for this.

Effective

Good

Updated 8 February 2017

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. For example, the practice had achieved 100% of the points available. However exception reporting was 13% which is higher than the national average of 10 %. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. For example, a regular audit was carried out into the care of patients who had recently died. The purpose of the audit was to review the care of the person and to review if care and treatment was appropriate or could be improved upon.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for the majority of staff.
  • Staff worked closely with a wide range of other health care professionals to understand and meet the range and complexity of patients’ needs, including school nurses and mental health professionals.
  • The practice had implemented a patient centred ‘one stop’ approach to the review of long term conditions. Patients with several health issues would be reviewed in one single appointment tailored to meet individual patient needs. This allowed a review of multiple issues to take place at the same time without the need for patients to attend further appointments.

Caring

Good

Updated 8 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as comparable to other for most aspects of care. For example, 84% of patients said that the last time they saw or spoke to a GP they were good at treating them with care and concern, which was the same as the clinical commissioning group (CCG) average and comparable to the national average of 85%.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • There was a wide range of information for patients about the services available which was easy to understand and accessible. Patient information boards were informative and relevant to the patient group.
  • We saw staff treated patients in with kindness and respect, and maintained patient and information confidentiality.
  • We saw evidence that when patients at the practice were struggling with health or social care issues the practice would ‘think family’ and review how other members of the family were also affected. We were told of referrals that had been made to additional agencies to assist individuals and their families to manage in times of need.

Responsive

Good

Updated 8 February 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 Dudley CCG to secure improvements to services where these were identified. The practice had implemented and managed a community gynaecology and community vasectomy service at the surgery for a number of years. This was highly valued by patients.
  • Patients said they found it easy to make an appointment 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. The practice had considered and implemented the NHS England Accessible Information Standard to ensure that patients with additional needs received information in a format that they could understand and received appropriate support to help them to communicate.
  • 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 shared with staff and other stakeholders.
  • We saw that medical emergencies which occurred in the practice on the day of our inspection were managed in a calm, responsive and caring manner.

Well-led

Good

Updated 8 February 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 very supported by the partners, GPs and practice manager who were described as approachable and caring. Several staff said they were proud to work at the practice.
  • 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 through e-mail and regular meetings to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was well established and worked closely with the staff to improve the environment and sharing of information regarding the services that were available to patients.
  • There was a strong focus on development, continuous learning and improvement at all levels. A number of staff were undertaking additional vocational training courses and the GPs supported GP trainees (fully qualified doctors in training to become GP’s).
  • All staff with the exception of salaried GPs had regular, documented appraisals. Salaried GPs underwent annual medical appraisals and regular undocumented discussions with the partners. The practice said they would carry out regular documented appraisals for all staff in future.
  • We saw that information and orientation packs were available for locums and GP trainees. Locum workloads were reviewed before the practitioner left the practice and they would sign to confirm they had completed all tasks, including referrals.

Checks on specific services

People with long term conditions

Good

Updated 8 February 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.
  • Outcomes for patients with diabetes were comparable to CCG and national averages. For example 92% of patients on the diabetes register, had a record of a foot examination and a risk classification within the preceding 12 months compared to the CCG average of 91% and the national average of 88%.
  • The practice had adopted the local CCG long term conditions (LTC) framework and template for reviewing patients with LTC. The practice had implemented a patient centred ‘one stop’ approach to the review of LTC where patients with several health issues would be reviewed in one single appointment tailored to meet individual patient needs.
  • We received data from the CCG which demonstrated how the practice was performing across areas of the local framework; the data presented showed that generally the practice was within the expected threshold for each indicator, although some results were low. We were told that this was monitored by a partner at the practice; however, full annual results were not available.
  • Longer appointments were available when needed. Home visits were offered for acutely unwell, housebound and complex patients by both GPs and the nurse practitioner.
  • All these patients had a named GP and a structured review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP and advanced practitioner worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 8 February 2017

The practice is rated as good for the care of families, children and young people.

  • There were comprehensive 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. For example, the practice had a Teenagers Confidentiality policy which aimed to support young people in their right to exercise choice of medical treatment.
  • Data from the quality and outcomes framework (QOF) showed that the percentage of women aged 25 or over whose notes record that a cervical screening test has been performed in the preceding 5 years was 80%, compared to the CCG average of 78% and the national average of 81%.
  • Appointments with GPs and nursing staff were available outside of school hours and the premises were suitable for children and babies.
  • We saw excellent examples of how children and vulnerable people were kept safe at the practice. GPs at the practice reviewed the notes of all newly registered children within 24 hours of their registration. This had identified safeguarding issues which were reviewed and acted upon. The practice held comprehensive six weekly safeguarding meetings with a number of relevant professionals including midwives, health visitors and school nurses and kept a log of all issues which were causing concern.
  • The practice offered contraceptive and family planning services. A community gynaecology clinic and a community vasectomy clinic had been established by clinicians at the practice which could be accessed by all patients registered within the CCG.

Older people

Good

Updated 8 February 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 people in its population.
  • The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable and in some cases better than CCG and national averages. For example, 96% of patients diagnosed with heart failure and atrial fibrillation had their risk of stroke assessed (CCG average 90%, national average 94%). Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate.
  • We saw evidence of care plans for older people and advance care planning was also encouraged for patients with palliative care needs.

Working age people (including those recently retired and students)

Good

Updated 8 February 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. Patients could see GPs and nursing staff during extended hours clinics.
  • 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. Data showed that 27% of patients had signed up for on line services and SMS text messages were sent to remind patients of their appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 February 2017

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

  • Data showed that 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 82% and the England average of 84%.
  • Outcomes for patients with mental health issues were comparable to, or better than, CCG and national averages. For example, 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record. (CCG average 69%, national average 89%).
  • 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. Nursing staff used a dementia screening tool and template to identify patients at risk.
  • 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. Patients could be referred to a mental health professional situated within the same building.

People whose circumstances may make them vulnerable

Good

Updated 8 February 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 homeless people, travellers and those with a learning disability. The local traveller population would be contacted by telephone to remind them of reviews and appointments and immunisations and reviews were offered opportunistically, if necessary, when they attended the surgery.
  • The practice offered longer appointments for patients with a learning disability. These patients were sent easy read letters and an easy read health document was completed at review appointments. 100% of patients with a learning disability had attended their annual review.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. Patients who were identified as at risk of an unplanned admission would be contacted within 48 hours of their discharge from hospital and a visit undertaken if appropriate.
  • The practice offered a ‘bypass telephone number’ to the care homes they supported, district nurses and paramedics to enable those who urgently needed care timely access to the surgery.
  • The practice informed vulnerable patients, including carers, how to access various support groups and voluntary organisations.
  • Staff had attended additional in house training and were very aware of how to recognise signs of abuse in vulnerable adults and children. Staff were well supported by a GP with a specialist interest in safeguarding and were knowledgeable regarding their responsibilities when sharing information, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.