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Inspection Summary


Overall summary & rating

Good

Updated 26 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Linden Medical Group on 6 July 2016. Overall the practice is rated as good.

Our key findings across all of 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 and reviewed and the results shared with staff including lessons learned.

  • Safe arrangements were in place for staff recruitment that protected patients from risks of harm. Staff numbers were regularly reviewed to enable them to meet patients’ needs and plans were in place to increase clinical sessions.

  • There were robust on-going arrangements in place to protect patients and others from unnecessary infections.

  • 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 had been encouraged and planned.

  • Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their treatment.

  • Information about how to make a complaint was readily available and easy to understand. Complaints received were dealt with appropriately and clear explanations given to complainants.

  • The practice had good facilities and was well equipped to assess and treat patients.

  • There was a clear leadership structure and staff told us they felt well supported by senior staff. Management sought feedback from patients which it acted on.

  • The provider was aware of the requirements of the Duty of Candour and we saw where this had been applied concerning a complaint.

We saw an area of outstanding practice:

  • The practice was pro-active in identifying patients who were carers and had registered 3% of the practice population as carers. An additional support mechanism included a designated member of staff who maintained telephone contact with carers. The Northamptonshire Carers Association had given the practice two awards for the work they carried out for carers. Staff had commenced work in identifying young carers aged between five and 17 years. The carers pack included support services that were available for young carers including social activities. The practice website included a wealth of information about carers.

However, there was an area of practice where the provider needs to make improvements.

The provider should;

  • Continue working towards ensuring correct coding is applied for patients with long-term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 September 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated to all relevant staff to support improvement.

  • Information about safety was recorded, monitored appropriately, reviewed and addressed.

  • Risks to patients were assessed and well managed and these were re-visited when circumstances changed.

  • There was an infection control protocol in place and infection control audits were regularly undertaken.

  • There were recruitment policies and procedure in place to ensure patients safety was protected. We found that senior staff had adhered to the policies and procedures.

  • Staffing levels were regularly monitored to ensure there were enough staff to keep people safe.

Effective

Outstanding

Updated 26 September 2016

The practice is rated as outstanding for providing effective services.

  • Staff referred to guidance from National Institute for Health and Care Excellence (NICE) and local guidelines were used routinely.

  • Staff had reviewed the needs of the local population and engaged with the Nene Clinical Commissioning Group (CCG) to secure improvements to patient care and treatment.

  • Patient’s needs were assessed and care was planned and delivered in line with current evidence based practice and legislation.

  • Patients who were at high risk of unplanned hospital admission and those with complex needs had been assessed and weekly meetings held by the Pro-Active (PAC) team. The team consisted of two GPs and a district nurse.

  • Staff had received training appropriate to their role and potential enhanced skills had been recognised and planned for and training put in place.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to provide up to date, appropriate and seamless care for patients.

  • Clinical staff were participating in a pilot by using an assessment tool when patients presented themselves with a cough to determine whether antibiotics were necessary. Another pilot concerned use of a diagnostic tool for patients who had asthma.

  • The standard of clinical audits were detailed, clear and demonstrated on-going improvements in patient care.

  • Nurse practitioners, practice nurses and health care assistants (HCA) held extra meetings to discuss and implement the most appropriate care for patients such as; wound care.

  • Following a search for attendances at A&E of children aged up to five years advice booklets were developed in a range of languages for care of acute illnesses and fevers in children.

  • Annual health awareness events were held with other agencies involved to promote healthy living and identifying patients who needed extra care.

  • Senior staff were working with two other practices to identify ways for improving care of patients with long-term conditions.

Caring

Good

Updated 26 September 2016

The practice is rated as good for providing caring services.

  • Data published January 2016 from the National GP Patient Survey showed that the practice was comparable with local and national averages regarding aspects of care.

  • Patients we spoke with told us they were satisfied with their care and some said it was excellent.

  • Staff ensured that patients’ dignity and privacy were protected and patients we spoke with confirmed this.

  • Patients had their needs explained to them and they told us they were involved with decisions about their treatment.

  • We saw that staff treated patients with kindness and respect and maintained confidentiality.

  • Information for patients about the services available to them was easy to understand and accessible.

Responsive

Good

Updated 26 September 2016

The practice is rated as good for providing responsive services.

  • Most patients told us it was easy to make pre-bookable appointments, some said there was a delay. All patients told us that they could book same day appointments.

  • Staff told us that if patient demand became high GPs converted their weekly administration session to a clinical session.

  • The practice provided enhanced services. For example, avoiding unplanned admissions by carrying out health reviews and the development of individual care plans.

  • Information about how to complain was available and easy to understand.

  • Evidence showed that senior staff responded quickly and appropriately when issues were raised.

  • Learning from complaints was shared with all staff and other stakeholders.

Well-led

Good

Updated 26 September 2016

The practice is rated as good for providing well-led services.

  • Staff were clear about the vision and their responsibilities in relation to this.

  • There was a distinct leadership structure and staff were well supported by management.

  • Meetings were held and information shared to identify areas where improvements could be made.

  • There were policies and procedures to govern activity and these were accessible to all staff.

  • There was a strong focus on continuous learning and improvement at all staff levels.

  • Senior staff actively sought patient feedback about the services they received and where possible made changes to improve them.

  • The Patient Participation Group (PPG) were active and staff responded positively to them when issues were raised or suggestions put forward. A PPG is a group of patients who represent the views of patients and work with practice staff to improvement services and the quality of care.

Checks on specific services

People with long term conditions

Good

Updated 26 September 2016

The practice is rated 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.

  • A diabetes specialist nurse worked at the practice one day per week. They worked alongside practice nurses who managed patients with diabetes and saw patients who had complex needs.

  • Longer appointments and home visits were available when needed.

  • Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

  • Clinical staff worked with health care professionals to deliver a multidisciplinary package of care for patients.

  • Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

  • Clinical staff were participating with a pilot for carrying out an additional test of patients who had asthma. Upon completion the results of this would be shared with other practices.

Families, children and young people

Good

Updated 26 September 2016

The practice is rated 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.

  • Alerts were put onto the electronic record when safeguarding concerns were raised.

  • There was regular liaison and monthly meetings with the health visitor to review those children who were considered to be at risk of harm.

  • All children up to the age of 12 years were triaged and if necessary seen the same day.

  • Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Childhood vaccinations were in line with the local and national averages.

  • A clinical session was held by a GP every Saturday from 8am until 11.30am for patients who had pre-booked an appointment. A practice nurse or health care assistant (HCA) attended the sessions and carried out patient health checks.

Older people

Good

Updated 26 September 2016

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

  • Practice staff offered proactive, personalised care to meet the needs of older patients.

  • Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

  • Home visits were offered to those who were unable to access the practice and patients with enhanced needs had prompt access to appointments.

  • Extended appointments were available to ensure all aspects of their care needs were assessed.

  • A designated GP routinely carried out weekly visits to four care homes to monitor patient’s health needs. GPs would attend at short notice when a patient became unwell.

  • Practice staff worked with other agencies and health providers to provide patient support.

Working age people (including those recently retired and students)

Good

Updated 26 September 2016

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

  • The practice had adjusted its services to accommodate the needs of this population group.

  • Telephone consultations were provided for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

  • Extended hours were provided to improve patient access.

  • Online services were available for booking appointments and ordering repeat prescriptions.

  • The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

  • Patients we spoke with told us that clinical staff routinely provided healthy living advice to promote their well-being.

  • Of eligible female patients 78% had attended for cervical screening. Clinical data told us that breast screening and bowel cancer testing results were in line with local and national averages

People experiencing poor mental health (including people with dementia)

Good

Updated 26 September 2016

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

  • 92% of patients who experienced poor mental health had received a mental and physical health check during 2014-2015 and were involved in developing their care plans.

  • Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

  • GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

  • Referrals to other health professionals were made when necessary.

  • Staff had a good understanding of how to support patients with mental health needs including those with dementia.

People whose circumstances may make them vulnerable

Good

Updated 26 September 2016

The practice is rated 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 who had a learning disability.

  • Invitation letters for health reviews and for cervical screening were available in easy read format to assist patients who had a learning disability in their understanding of their care needs.

  • One GP and a senior nurse practitioner had attended training for care of patients who had a learning disability and carried out their annual health reviews with an extended appointment time.

  • Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

  • There was a clinical lead for managing with vulnerable adults and children.

  • The practice was pro-active in identifying patients who were carers and had registered 3% of the practice population as carers. The Northamptonshire Carers Association had given the practice a bronze award followed by a silver award in January 2016.

  • There was a register to manage end of life care and unplanned admissions to hospital.