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Inspection Summary


Overall summary & rating

Good

Updated 12 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Empingham Medical Centre on 15 September 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • This practice was not an outlier for any QOF (or other national) clinical targets. It achieved 99.3% of the total QOF target in 2014, which was 1.6% points above CCG Average and 5.8% above national average.

  • 95% of people who responded to the July 2015 national patient survey said the GP was good at listening to them compared to the CCG average of 91% and national average of 89%.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they did not find it easy to make an appointment with a named GP. Urgent appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about services and how to complain was available and easy to understand.
  • 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 (PPG).

  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw two areas of outstanding practice:

  • The practice had increased the flexibility of access to appointments and could demonstrate the impact of this by reduced use of the GP out of hour’s service and Accident and Emergency. The practice had very positive patient survey results for July 2015.
  • The practice had a Carer’s Champion. This is a member of staff who supports carer’s and acts as a key contact for carer information for the GP practice where they work. They aim to improve the carer’s quality of life and help them to continue in their caring role. They can also help ensure that the carer’s voice is heard when the person they care for is having their needs assessed or met. Carer Champions will also help improve local services by feeding back what they learn from supporting carer’s.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

  • Have a system in place to ensure audit cycles have been completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 November 2015

The practice is rated as good for providing safe services. Arrangements were in place to safeguard adults and children from abuse. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The practice used every opportunity to learn from internal and external incidents, to support improvement. Information about safety was highly valued and was used to promote learning and improvement.

Information about safety was recorded, monitored, appropriately reviewed and addressed. Most risks to patients were assessed and well managed.

Effective

Good

Updated 12 November 2015

The practice is rated as good for providing effective services. Data showed that the practice was performing highly when compared to neighbouring practices in the Clinical Commissioning Group. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

There was some evidence of completed clinical audit cycles which were driving improvement in performance to improve patient outcomes.

Caring

Good

Updated 12 November 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others for almost all aspects of care. Feedback from patients about their care and treatment was consistently and strongly positive 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 12 November 2015

The practice is rated as good for providing responsive services. It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG). The PPG is a group of patients who have volunteered to represent patients’ views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care.

Feedback from patients reported that access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually 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.

Well-led

Good

Updated 12 November 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active. The PPG is a group of patients who have volunteered to represent patients’ views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 12 November 2015

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. The practice took part in admission avoidance and worked in partnership with the integrated care co-ordinator from a local council and community services from a secondary care trust. 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 medication 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 12 November 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 for the standard childhood immunisations were comparable to CCG/national averages. The practice operated its own recall system for families, children and young people. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 12 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were higher than both the CCG and national averages for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice had a named nominated GP for patients 75 plus and also took part in the admission avoidance scheme.

Working age people (including those recently retired and students)

Good

Updated 12 November 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 100% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. 88% of people who had dementia had received an annual physical health check.

The practice had a Carer’s Champion. This was a member of staff who supports carer’s and acts as a key contact for carer information for the GP practice where they work.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 12 November 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 those with a learning disability. 83% of people with a learning disability had received an annual health check. It also offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It 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.