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Inspection Summary


Overall summary & rating

Good

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Coastal Medical Group on 04/11/2015. 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 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.
  • Risks to patients were assessed and well managed.
  • 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 they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they sometimes found it difficult to make an appointment in advance with a named GP but there was continuity of care, with urgent and some non-urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice was currently taking part in an initiative offering patient’s access to a GP from 8am untll 8pm as part of a Prime Ministers Funding Initiative.
  • 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 some areas of outstanding practice:

  • The use of ‘Florence’ a simple tele-health service to advise and assist patients to manage their own conditions with arm’s length support from professional should a change in their condition be detected.
  • The practice had self-funded the employment of two advance nurse practitioners and one trainee advanced nurse practitioner as part of a continuity of care programme. This had allowed patients to have greater access to support in the practice, and had meant that GP’s had more free slots to see patients who required their specific assistance with their needs.
  • The practice had received national recognition for their work with the Gold Standard Framework (care for patients at the end of their lives) and Palliative Care.
  • The practice had a cohesive and effective medicines management team who worked alongside the GP’s for maximum optimisation of patient’s medication and they had managed to save £240,000 in last year through more effective medicine management.
  • The practice had successfully gained approval to offer third year student nurse placements at the practice and were now supporting other practices to achieve this status.
  • The medicine management team monitored patients who were prescribed an increasing dose of medication and contacted them to ensure they were managing their increases in a timely manner.

One area where the provider should make improvement is:

  • Developing an annual audit plan for the practice, this will allow the practice to plan their activity demonstrating a review of care and processes from a strategic level rather than adhoc audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 December 2015

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • 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 there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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 people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 10 December 2015

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or slightly below average for the locality.
  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 10 December 2015

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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • We observed a strong patient-centred culture.
  • Information for patients about the services available was easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Outstanding

Updated 10 December 2015

The practice is rated as outstanding for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice had recently self-funded extra nursing staff to allow GP’s to make available more appointment slots for patients with complex needs.
  • Patients said they sometimes found it difficult to make an advanced appointment with a named GP but there was continuity of care, with urgent and non-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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice was using a tele-health system to monitor their patients with long term conditions.
  • The practice was taking part in an initiative offering patient’s access to a GP from 8am till 8pm as part of a Prime Ministers Funding Initiative.

Well-led

Good

Updated 10 December 2015

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 GP partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient user group was active.
  • The practice carried out proactive succession planning.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Outstanding

Updated 10 December 2015

The practice is rated as oustanding 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.
  • The practice ran ‘duty clinics’ to provide access to nursing expertise for patients who had exacerbation of diabetes and respiratory disease.
  • The practice used ‘Florence’ a simple tele-health service where patients are supported to manage and monitor their ongoing health conditions. Patients enter their vital signs including blood sugar reading and are advised against a protocol of the next steps for their care.
  • Longer appointments and home visits were available when needed.
  • All these patients 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.

Families, children and young people

Good

Updated 10 December 2015

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 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 below the Clinical Commissioning Group and national averages for cervical screening at 69.1% against 75.5% and 76.9% respectively. They also recorded a higher than average exception rate at 8.4%. The practice were aware of this and actively encouraged women to attend for screening and offered screening on an adhoc basis as patients attended for other appointments.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw examples of joint working with midwives, health visitors and district nursing teams.

Older people

Good

Updated 10 December 2015

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.
  • 21% of the practice population was over 65 years of age. Patients on the unplanned admissions register had access to a named clerk for contact at the surgery to assist them in a timely manner with their needs.

Working age people (including those recently retired and students)

Good

Updated 10 December 2015

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 reflects the needs for this age group.
  • The practice was working as part of a Prime Minister Initiative offering eight until eight appointments with GP’s which assisted working age patients to have regular access for their on-going needs.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 December 2015

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

  • 68.2% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • 77.8% of patients with a mental health need had a comprehensive care plan in place.
  • 91.3% of all patients diagnosed with depression underwent a bio-psychosocial assessment on diagnosis and had had a review within 10-35 days after diagnosis. This was above both national and CCG averages.
  • 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 people with mental health needs and dementia. Staff were all being encouraged to undertake dementia friend training.

People whose circumstances may make them vulnerable

Good

Updated 10 December 2015

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 practice offered longer appointments for people with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice had told 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.