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Archived: Cropredy Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JA Wright and Dr B Tucker, more commonly known as Cropredy Surgery in Oxfordshire on 24 November 2016. 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.

  • 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.

  • An understanding of the clinical performance and patient satisfaction of the practice was maintained. The practice had reviewed clinical performance and implemented actions to improve. The practice was seeking to improve already high levels of patient satisfaction.

  • Feedback from patients relating to access to services and the quality of care was significantly higher when compared with local and national averages. This was collaborated by written and verbal feedback collected during the inspection.

  • 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.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice actively reviewed complaints and how they are managed and responded to and made improvements as a result.

  • Cropredy Surgery had a clear vision to deliver high quality, patient-centred care and promote good outcomes for patients. The practice had developed clear aims and objectives. These reflected the principle that patients came first, underpinned by a philosophy of providing safe and personalised high quality general practice care.

The area where the provider should make improvement is:

  • Continue to review patient outcomes to ensure that patients receive appropriate care and treatment. This would include a review of the system in place to promote completion of dementia care plans in order to increase patient uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 January 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. Learning was based on a thorough analysis and investigation.

  • 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.

  • National patient safety and medicine alerts were disseminated within the practice in a formal way and there was a system to record that these had been appropriately dealt with.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. The practice maintained effective working relationships with other safeguarding partners such as health visitors and district nurses.

  • There were systems in place to protect patients from the risks associated with medicines management.
  • The practice demonstrated a thorough approach to staff training in management of emergencies; this included community training in the use of the village Automatic External Defibrillator. Records were kept and analysis was undertaken to ensure that risks to patients were reduced and learning was encouraged and shared.

Effective

Good

Updated 13 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar when compared to the local and national averages. In 2015/16, the practice had achieved 97% of points (the local CCG was 98% and national average was 99%).

  • The most recent published exception reporting was higher when compared to the CCG and national averages. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects. The practice had identified the increased levels of exception reporting as an area for improvement and formulated action plans to reduce exception reporting.

  • Our findings 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.

  • Clinical audits demonstrated quality improvement.

  • There was a programme of staff appraisals and evidence of performance monitoring, identification of personal or professional development.

  • The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence and staff we spoke with told us they are supported to acquire new skills and share best practice.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. For example, strong alliances with the psychiatrist and community mental health team.

Caring

Outstanding

Updated 13 January 2017

The practice is rated as outstanding for providing caring services.

  • We observed patients were respected and valued as individuals, whilst being empowered as partners in their care.

  • Verbal and written feedback about the about the way staff treated people and their families was continually and overwhelmingly positive.

  • Data from the latest national GP patient survey (published in July 2016) showed that patients rated the practice highly for all of aspects of care.

  • 92% of patients said the last GP they saw or spoke to was good at involving them in decisions about their care. This was higher when compared to the local clinical commissioning group (CCG) average (84%) and national average (82%).

  • 97% of patients who say the last nurse they saw was good at treating them with care and concern. This was higher when compared to the local CCG (92%) and national average (91%).

  • Information for patients about the services available was easy to understand and accessible.
  • We saw there was a strong, visible, person-centred culture. Relationships between patients, those close to them and Cropredy Surgery staff was caring, supportive and highly valued. 

Responsive

Good

Updated 13 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Oxfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, a prescription delivery service was provided by a driver employed by the practice, and this provided an opportunity for any concerns about patient wellbeing to be fed back to the practice.

  • The practice had good accessible facilities and was well equipped to treat patients and meet their needs.

  • Data collected via the national GP patient survey reported patients found access was excellent. For example, 97% of patients said they found it easy to get through to the practice by telephone, CCG average was 84% and national average was 73%.

  • Furthermore, 91% of patients described their experience of making an appointment as good. This was higher when compared to the CCG average (80%) and national average (73%).

  • All of the verbal and written feedback received on the day of the inspection, was positive about access and highlighted excellent access to appointments.
  • 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.

Well-led

Good

Updated 13 January 2017

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

  • The practice had a clear vision with quality and safety as their top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. Staff we spoke with were clear about the vision and their responsibilities in relation to it.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. We noted that the practice undertook staff satisfaction surveys, results of which were analysed and shared to ensure learning and improvement.

  • The practice gathered feedback from patients, there was an active patient participation group (PPG) which influenced practice development.

  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • There was a strong focus on continuous learning and improvement at all levels. This included proactively reviewing already high levels of patient satisfaction.

Checks on specific services

People with long term conditions

Good

Updated 13 January 2017

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

  • The number of patients registered at Cropredy Surgery with a long-standing health condition was higher than local and national averages. For example, 58% of patients had a long-standing health condition, this was higher than the local CCG average (50%) and national average (54%). This could result in an increased demand for GP services

  • Performance for diabetes related indicators showed Cropredy Surgery had achieved 97% of targets which was similar when compared to the CCG average (95%) and higher when compared to the national average (90%).

  • Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (98%) and higher when compared to the national average (96%).

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 13 January 2017

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 higher when compared with local averages and national averages 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’s uptake for the cervical screening programme was 84%, which was similar when compared to the CCG average (83%) and the national average (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 and health visitors.

Older people

Good

Updated 13 January 2017

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 people in its population. Older people at risk of isolation within a rural community were identified and discussed at meetings including multi-disciplinary meetings to address any additional support required.

  • Cropredy Surgery was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice identified if patients were also carers; information about support groups was available in the waiting areas.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were higher when compared with local and national averages. For example, Cropredy Surgery performance for osteoporosis (osteoporosis is a condition that weakens bones, making them fragile and more likely to break) indicators was higher than both the local and national averages. The practice had achieved 100% of targets which was higher when compared to the CCG average (97%) and the national average (88%).

Working age people (including those recently retired and students)

Good

Updated 13 January 2017

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.

  • Services were flexible, provided choice and ensured continuity of care for example, telephone and email consultations were available for patients who chose to use this service.

  • There was a range of appointments including early morning and evening appointments. These appointments were specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments. Following patient feedback, the practice had amended the times of nurse clinics to increase appointments for this group of patients.
  • Online access was promoted within the practice and 51% of the practice population had registered for online access. The practice had utilised online access for over 10 years and was highlighted as a beacon site for online access. On-line booking for appointments and ordering repeat prescription was available for patients’ convenience. The practice website was well designed, clear and simple to use featuring regularly updated information.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 January 2017

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

  • The practice offered flexible hour long appointments at the end of usual surgery times for patients with complex mental and physical needs.

  • 92% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was similar when compared to the CCG average (91%) and the national average (89%).

  • 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower when compared to the local CCG average (87%) and the national average (84%).

  • 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia. Additional training in recognising and supporting people with dementia had been arranged for December 2016.

People whose circumstances may make them vulnerable

Outstanding

Updated 13 January 2017

The practice is rated as outstanding 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, canal community, those with caring commitments and those with a learning disability.

  • Cropredy Surgery was actively involved in a research project for domestic abuse. Core areas of this project were training and education, clinical enquiry, care pathways and an enhanced referral pathway to specialist domestic violence services. Initially aimed at women who were experiencing domestic violence this also provides information and signposting for male victims and for perpetrators.

  • This service enabled a responsive and personal service for the supply of medicines, including the delivery of medicines to vulnerable, frail and housebound patients. This provided an opportunity for any concerns about patient wellbeing to be fed back to the practice.

  • The practice offered longer appointments for patients whose circumstances may make them vulnerable.

  • In November 2016, the practice patient population list was 3,650. The practice had identified 83 patients, who were also a carer; this amounted to 2.2% of the practice list.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.