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Inspection Summary


Overall summary & rating

Good

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lindley Group Practice on 25 October 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
  • There was good access to clinicians and patients said they generally found it easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested. In addition to appointments, the practice provided an open access clinic three mornings a week.
  • The practice staff had a good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands. The practice continually audited patient demand for appointments. Locums were used occasionally to meet increased demand.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice sought views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and engagement with patients and their local community.
  • Risks to patients were assessed and well managed.
  • The practice had an organised approach to working systems and processes. There was a signatory sheet for all policies to evidence that staff had seen them.
  • There were effective safeguarding systems in place to protect patients and staff from abuse.
  • The practice promoted a culture of openness and honesty. All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.
  • There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive. There was evidence of an inclusive team approach to providing services and care for patients.
  • Staff had a ‘mini-meeting’ every working day to discuss any issues or concerns within the practice
  • Staff said they were proud to work at the practice and felt they delivered good quality service and care to patients.
  • The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 November 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed
  • There were systems in place for reporting and recording significant events. There was evidence of investigation, actions taken to improve safety in the practice and shared learning with staff.
  • There was a nominated GP lead and deputy lead for safeguarding children and adults. Embedded systems and processes were in place to keep patients and staff safeguarded from abuse. We saw there was safeguarding information and contact details available for staff.
  • There was evidence of engagement with other health and social care professionals regarding safeguarding concerns of adults and children.
  • There were processes in place for safe management of medicines and the practice was supported by a local Clinical Commissioning Group (CCG) pharmacist.
  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.
  • There were regular checks and risk assessments undertaken, which included those relating to health and safety, such as infection prevention and control.

Effective

Good

Updated 25 November 2016

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the need of patients and delivered care in line with local pathways and national guidance.
  • The practice was supported by the local CCG pharmacy team to ensure effective prescribing was undertaken.
  • We saw evidence of appraisals and up to date training for staff.
  • There was evidence of working with other health and social care professionals, such as the mental health team, to meet the range and complexity of patients’ needs.
  • Clinical audits were carried out which could demonstrate quality improvement.
  • End of life care was delivered in a compassionate and coordinated way.
  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally in line with local and national averages.

Caring

Good

Updated 25 November 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice comparable to other practices for the majority of questions regarding the provision of care. Comments we received from patients on the day of inspection were very positive about their care.
  • We observed that staff treated patients with kindness, dignity, respect and compassion. Patients’ comments aligned with those observations.
  • Although the practice had a large patient population, there was a good understanding of the needs of their patients. It was apparent when talking with both clinical and administrative staff during the inspection there was a genuine warm and supportive ethos within the practice. Comments made by patients supported this view, often citing them as being a ‘family practice’.
  • There was a variety of health information available for patients, relevant to the practice population, in formats they could understand.
  • The practice maintained a register of those patients who were identified as a carer and offered additional support as needed.

Responsive

Good

Updated 25 November 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Greater Huddersfield Clinical Commissioning Group (CCG) and other local practices to review the needs of their population.
  • The practice had good facilities and was equipped to treat patients and meet their needs. However, the practice identified there were some issues regarding the building and capacity.
  • National GP patient survey responses and comments made by patients indicated appointments were available when needed.
  • The practice offered pre-bookable, same day and online appointments. They also provided extended hours appointments in the week and an open access clinic three mornings a week.
  • All patients requiring urgent care were seen on the same day as requested.
  • Home visits and longer appointments were available for patients who were deemed to need them, for example housebound patients or those with complex conditions.
  • The practice could evidence being responsive to demands on the appointment system. They audited demand and capacity and also booked locums when there were anticipated pressures in the appointment system.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.

Well-led

Good

Updated 25 November 2016

The practice is rated as good for being well-led.

  • There was a clear leadership structure and a vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There were safe and effective governance arrangements. These included the identification of risk, with policies and systems in place to minimise risk.
  • The practice had an organised approach to working systems and processes.
  • Policies were available to all staff as a paper copy, as not all policies were currently accessible via the practice computer system. There was a signatory sheet for all policies to evidence staff had seen them.
  • The provider complied with the requirements of the duty of candour. There were systems in place for reporting notifiable safety incidents and sharing information with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from patients through engagement with patients and their patient reference group.
  • The practice promoted a culture of openness and honesty. Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. There was a daily ‘mini-meeting’ where all staff attended, to discuss any issues or concerns within the practice
  • There was evidence of an inclusive team approach to providing services and care for patients.
  • Staff said they were proud to work at the practice and felt they delivered good, quality service and care to patients.
Checks on specific services

People with long term conditions

Good

Updated 25 November 2016

The practice is rated as good for the care of people with long term conditions.

  • The GPs and practice nurse both supported the management of long term conditions. Annual or six monthly reviews were undertaken to check patients’ health care and treatment needs were being met. There was an effective system for the follow-up of non-compliant patients.
  • The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
  • Clinicians liaised with the community matron regarding care, treatment and support of these patients, particularly those which were housebound.
  • There were effective systems in place to support the recall of these patients for influenza and pneumococcal vaccinations.
  • Pre-diabetes checks and chronic obstructive pulmonary disease screening were undertaken with those patients who were deemed most at risk of developing these conditions.
  • 94% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 91%, national average 90%).
  • 69% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG average 78%, national average 75%).
  • 98% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 87%, national average 90%).
  • The practice provided a musculoskeletal clinic once a week.

Families, children and young people

Good

Updated 25 November 2016

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

  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Same day access was available for all children who required medical attention.
  • Childhood immunisations were offered in line with the public health immunisation programme.
  • Sexual health, contraceptive and cervical screening services were provided at the practice, which included coil fitting and implants.
  • The practice promoted cancer screening programmes. For example, 87% of eligible patients had undergone cervical screening (CCG average 85%, national average 82%).

Older people

Good

Updated 25 November 2016

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

  • Proactive, responsive care was provided to meet the needs of the older people in its population.
  • They offered rapid access appointments to those patients with enhanced needs and those who could not access the surgery due to ill health or frailty.
  • Medication reviews were undertaken every six months.
  • Registers of patients who were aged 75 and above and also the frail elderly were in place to ensure timely care and support were provided.
  • The practice worked closely with other health and social care professionals, such as the district nursing team, to ensure housebound patients received the care and support they needed.
  • The practice liaised several times a week with local nursing homes, where they had registered patients who resided there.
  • At 77%, the uptake rate for influenza immunisation in the over 65s was higher than the CCG target of 75%.

Working age people (including those recently retired and students)

Good

Updated 25 November 2016

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

  • The needs of these patients 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 provided extended hours appointments from 7.30am on weekdays, online booking of appointments and ordering of prescriptions.
  • There was an open access clinic three mornings per week.
  • During influenza vaccination season, the practice offered Saturday morning flu clinics.
  • The practice offered a range of health promotion and screening that reflected the needs for this age group.
  • Travel health advice and NHS travel vaccinations were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 November 2016

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

  • The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
  • Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
  • 77% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 85%, national average 84%).
  • 74% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had received a review of their care in the preceding 12 months (CCG 90%, national 88%).
  • Patients who were at risk of developing dementia were screened and support provided as necessary.
  • Staff had received dementia friendly training and could demonstrate a good understanding of how to support patients with dementia or mental health needs.

People whose circumstances may make them vulnerable

Good

Updated 25 November 2016

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

  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
  • We saw there was information available on how patients could access various local support groups and voluntary organisations.
  • The practice had a register of patients who had a learning disability. There was a named nurse who supported the delivery of annual health reviews of those patients.