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Inspection Summary


Overall summary & rating

Good

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tisbury Surgery on 2 March 2016.

Overall the practice is rated as good.

  • 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.

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

  • 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.

    For example, installing a handrail in the corridor.

  • 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.

  • The practice had a clear vision which had quality and safety as its top priority.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

  • The national GP patient survey showed 100% of patients found it easy to get through to this surgery by phone, compared to a national average of 73%.

  • The practice had a longstanding and active patient participation group (PPG) which met at least three times a year and meetings were attended by at least of the GP partners. Members of the PPG had their contact details listed on the practice website so that patients could contact them directly if they wished.

We saw some areas of outstanding practice.

  • They were proactive in communicating with patients. For example, following a recent drug safety alert the practice wrote a personal letter to all patients affected, signed by the GP, giving them further advice about the medicine and inviting them to contact the GP if they wanted to discuss it further.

     

  • The practice management was sensitive to the needs of the service and those working in it and had clear and robust systems in place.  For example the practice had a system for reviewing their policies and procedures which included recording the changes made and the reasons for them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 May 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on thorough analysis and investigation of incidents.

  • When there were safety incidents, patients received reasonable support, truthful information, a verbal and 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 11 May 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.

  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 11 May 2016

The practice is rated as outstanding for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care. For example, 97% of patients said the last GP they saw was good at involving them in decisions about their care, compared to the clinical commissioning group average of 85% and national average of 81%.

  • Feedback from patients about their care and treatment was consistently and strongly 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, reception staff helped patients make outpatients appointments if they had difficulty doing this themselves.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on. For example, following feedback from patients they recently installed automatic front doors to aid disabled access to the building.

     

Responsive

Good

Updated 11 May 2016

The practice is rated as good 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. For example, the practice had developed an initiative with other local practices to improve the care offered to older people. The initiative involved the GPs contacting patients on discharge from hospital to review their conditions and working with the local care coordinator to address any needs.

  • 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. For example, providing a handrail in the corridor between the reception area and consulting rooms.

  • Patients could access appointments and services in a way and at a time that suited them. For example appointments could be made by phone or on line and we heard evidence that same day appointments were always available when required.

  • The practice offered regular carers clinics where patients could have a health check and discuss other issues with a member of the local carers support group.

  • The practice has a carers lead who can signpost carers to other services and has visited other local groups such as the carers café and ‘singing for the brain’ group to explain the help that is available to carers.

  • 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

Good

Updated 11 May 2016

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 this.

  • 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 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.

  • The practice and it had a long-standing and very active patient participation group which influenced practice development.

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

Checks on specific services

People with long term conditions

Good

Updated 11 May 2016

The practice is rated as good for the care of patients 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.

  •  99% of patients on the diabetes register had a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) compared to the national average of 88%.

  • The practice employed a specialist asthma nurse to offer asthma clinics for patients with this condition.

  • 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

Good

Updated 11 May 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • 73% of patient with asthma on the register had an asthma review in the last 12 months (04/2014 to 03/2015), compared to the national average of 75%.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • 79% of women aged 25-64 on the register had a cervical screening test in the preceding five years (04/2014 to 03/2015),

    compared 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.

Older people

Good

Updated 11 May 2016

The practice is rated as good for the care of older patients.

The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice sent a birthday card and health questionnaire to patients on their 75th birthday and if appropriate they were contacted by a nurse or elderly care coordinator when the questionnaire was returned.

  • The local palliative care nurse, district nurses, occupational therapist and care co-ordinator attended monthly practice meetings.

  • The GPs routinely gave their personal phone number to patients on palliative care so if they need help out of hours they did not need to see the out of hours GP who may not know them.

Working age people (including those recently retired and students)

Good

Updated 11 May 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

population groups.

  • 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 appointments on alternate Tuesday and Wednesday evening until 7.45pm and on one Saturday per month from 9am to 11am for working patients who could not attend during normal opening hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 May 2016

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

There were aspects of the practice which were outstanding and related to all population groups.

  • 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months

    (04/2014 to 03/2015), which is comparable to the national average of 84%.

  • 90% of patients with a psychosis had a comprehensive, agreed care plan documented in the preceding 12 months (04/2014 to 03/2015),

    which is comparable to the national average of 88%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients diagnosed 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.

People whose circumstances may make them vulnerable

Good

Updated 11 May 2016

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

 

  • The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams 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.