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The Abbey Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Abbey Medical Centre on 19 January 2017. Overall the practice is rated as outstanding.

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

  • Staff used an effective system report and investigate significant events and the working culture encouraged openness and honesty to highlight areas for improvement.
  • Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.

  • 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.
  • There was evidence of extensive and consistent multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
  • A comprehensive programme of audits was in place and staff used this to assess quality of care and establish standards against national best practice guidance. The audit programme had demonstrably led to improvements in practice.
  • Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 areas of outstanding practice:

  • GPs had developed a significant range of multidisciplinary services to meet the complex needs of the location population that included young people with brain injuries, patients with needs relating to drug addiction and those under child protection orders. An on-call, responsive and individualised service was provided that included patients who lived in protective or sheltered accommodation.
  • Care for patients with safeguarding needs extended beyond the practice’s immediate responsibility. This included proactive working with schools, key workers, social workers and the police. Children at risk, refugees and homeless patients were offered an on-demand service by a team of staff who adapted the electronic patient records system to improve tracking and who undertook regular training with specialist teams to be able to deliver such services safely.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 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 although there was room for improvement in the consistency of this.
  • Staff worked in an environment that encouraged self-reflection and had a low threshold for identifying risk. This meant staff reported near-misses or incidents that had been avoided so that the team could learn from each other’s experiences and implement strategies to reduce risk.
  • 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 and staff could evidence how they adhered to the principles of the duty of candour.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • A named GP was the lead for child protection and demonstrated an extensive programme and track record of support and multi-agency working.
  • All staff had recent Disclosure and Barring Service clearance.
  • Risks to patients were assessed and well managed including in relation to medicines management and action taken as a result of national safety alerts.
  • The practice had an up to date health and safety policy and emergency policies and equipment were regularly tested.

Effective

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar to or better than the national average. Exception reporting rates were comparable to, or better than, the national average in 19 clinical domains and significantly better than the national average in two clinical domains.
  • Staff assessed needs and delivered care in line with current evidence based guidance and there was a structured system in place to ensure updates were tracked and applied to practice policies. All relevant staff had access to this system and could demonstrate how it impacted their work.
  • Clinical audits demonstrated a consistent drive to establish and improve quality of care and patient outcomes. Audits were focused on the needs of the local population and trainee doctors were actively involved in them as part of their professional development.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment because they had access to on-going clinical training.
  • There was consistent evidence of effective appraisals and personal development plans and structured support and mentorship for new and trainee staff.
  • There was significant focus on education provision, including weekly protected teaching time, peer consultations and structured bi-monthly tutorials for trainee doctors.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs, including those with mental health needs and substance addiction. This followed a successful mental health pilot scheme that resulted in on-site mental health support being provided on a regular basis from a community psychiatrist, psychologist and mental health nurse.
  • The practice worked with geriatricians, nursing and community support teams to provide care to patients who lived in nursing and residential homes. A GP frailty lead was in post and supported led health assessments, home visits and coordinated care.
  • Multidisciplinary meetings took place monthly including for frailty, end of life and complex care. There was an established and extensive provision for the care of patients with mental health needs, including those with schizophrenia, personality disorders and needs relating to self-harm, drug use and high-risk sexual behaviour.

Caring

Good

Updated 28 April 2017

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 several aspects of care.
  • Patients reported 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.
  • The practice facilitated access to services that could provide emotional support and guidance to patients from diverse cultural backgrounds and ethnic minority groups.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • There was evidence staff routinely included patients in their own care and adhered to best practice principles in allowing patients to make their own decisions, including unwise decisions.

Responsive

Good

Updated 28 April 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group and other local organisations to secure improvements to services where these were identified. This included in the reduction of prescribing antihypnotic drugs through the provision of more structured multidisciplinary mental health support.
  • Patients said they found it easy to make an urgent appointment and there was continuity of care, with urgent appointments available the same day and a daily duty doctor triage service.
  • 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice provided a number of services for patients including practice nurse home medicine reviews for housebound patients, liaison services with community drug rehabilitation teams and home visits for young people with complex learning disabilities.
  • The practice regularly reviewed how people accessed services and provided a responsive service as a result. This included adapting online software to better support patients who used smartphones and enabling patients to communicate with GPs by e-mail.
  • GPs undertook proactive case reviews where they thought their response to a patient’s medical concern could have been improved. This was a peer-review process that took place with the patient’s consent and enabled GPs to identify strategies to provide the best level of care for specific conditions.

Well-led

Good

Updated 28 April 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 supported by management. The practice had up to date policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework that 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 proactively sought feedback from staff and patients, which it acted on. The patient representative group was proactive and produced an annual action plan, which we saw was used to improve patient experience.
  • The practice demonstrated a commitment to the health and wellbeing of its staff and had supported them professionally and personally during a period of significant and unpredictable change.
Checks on specific services

People with long term conditions

Good

Updated 28 April 2017

The practice is rated as good for providing services to people with long-term conditions.

  • Individual GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • A GP contacted patients who attended hospital unexpectedly to support them in managing their condition.
  • Performance for diabetes related indicators was better than the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 87% compared to the CCG average of 76% and the national averages of 78%. The percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 87% compared with the CCG average of 82% and national average of 80%. Longer appointments and home visits were available when needed.
  • A GP lead was in post for patients with complex care and worked with a wide multidisciplinary team to provide individualised care, including out of hours through a local federation.
  • A range of services were offered on-site, including phlebotomy, spirometry and electrocardiograms.

Families, children and young people

Good

Updated 28 April 2017

The practice is rated as good for providing services to families, children and young people.

  • There were systems in place to identify and support children living in disadvantaged circumstances. This included those who were at risk such as children and young people who had a high number of emergency hospital attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations and comparable to local and national averages.
  • The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 72% and the national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies including a dedicated children’s waiting area.
  • The practice provided specialised care and support for children with needs relating to autism.
  • The practice had established relationships with local schools to provide care, including school visits for health checks, to bridge a gap in care due to a shortage of local school nurses.
  • A GP was the dedicated child protection lead and worked closely with health visitors to provide care and support. The GP also worked with alcohol and drug counsellors and mental health specialists to support young people with complex needs.
  • The practice offered new born baby checks, antenatal and postnatal care and sexual health screening.

Older people

Good

Updated 28 April 2017

The practice is rated as good for providing services to older people.

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

  • A GP frailty lead was in post and provided targeted care and reviews for patients with a well-coordinated multidisciplinary team.
  • A planned care lead was in post who offered extended appointments for patients and worked with a care navigator to support patients over the age of 60.
  • Staff worked with community rehabilitation therapists, dietetics, phlebotomy and community nursing teams to provided individualised, coordinated care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice invited all patients over 75 years old to attend an annual health assessment that included a blood test, medicine review and advice regarding diet and lifestyle.
  • Staff offered dementia screening and referrals to a memory clinic as well as assessments using a frailty pathway. This helped to ensure patients received care that met their changing needs.
  • The practice provided a dedicated service to 140 patients in nearby residential and nursing homes. Each patient had a named GP and the homes had direct mobile telephone access to them. A named receptionist provided single point of contact access to the practice and appointments.

Working age people (including those recently retired and students)

Good

Updated 28 April 2017

The practice is rated as good for providing services to 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 range of health promotion and screening that reflected the needs of this age group, including in relation to alcohol consumption and recreational drug use.
  • The practice offered extended hours to support those patients that could not attend appointments during standard working hours and facilitated e-mail communication between GPs and patients.
  • The patient participation group was actively promoting recruitment to this age group to improve their representation at practice development meetings.
  • GPs offered telephone consultants and email communication and facilitated patient access to an online psychology service.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2017

The practice is rated as good for providing services to people experiencing poor mental health (including people with dementia).

  • 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%. The practice had exception reported 4% compared to the national average of 7%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had a designated dementia support lead who was responsible for overseeing the treatment of all diagnosed patients.
  • The practice carried out advance care planning for patients with dementia.
  • 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 had participated in a pilot scheme to improve access for patients to mental health services in the practice. This had resulted in regular access to drug and alcohol counsellors, a community psychiatrist, mental health nurses and a psychologist.

People whose circumstances may make them vulnerable

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for providing services to people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, those over 75 years of age living alone, those with a learning disability and patients with refugee status.
  • 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.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations, including those providing services to specific cultural groups.
  • 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 demonstrated a proactive approach to engaging other agencies for urgent support.
  • Patients who were considered vulnerable were given same day priority appointments.
  • The practice maintained registers of patients who were known to suffer domestic violence or had experienced female genital mutilation. These patients were offered access to urgent appointments.
  • GPs worked with social workers to provide dedicated support to patients living in emergency or sheltered housing as well as people with refugee status and those who were homeless.