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Salters Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salters Medical Practice on 28 June 2016. The overall rating for this service is good.

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

  • There was a system in place to raise concerns and report significant events. Staff understood their responsibilities to raise concerns and to report significant events. These were discussed regularly at meetings and were a standing agenda item. Learning was shared with practice staff regularly and with other practices in the locality.

  • Patients’ needs were assessed and care was provided to meet those needs in line with current guidance. Staff had the skills and expertise to deliver effective care and treatment to patients. This was maintained through a programme of continuous development to ensure their skills remained current and up-to-date.

  • Risks to patients were assessed and well managed through practice meetings and collaborative discussions with the multi-disciplinary team. Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Information about safety alerts was reviewed and communicated to staff in a timely fashion.

  • Patients told us GPs and nurses at the practice treated them with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available in the reception area and on the practice website.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included easy access for patients who used wheelchairs.

  • There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on. Staff were committed and motivated to deliver high standards of care and there was evidence of team working throughout the practice.

  • The practice was involved in a Triumvirate Leadership Programme. Three leaders within the practice, a GP, a nurse and a manager made substantial changes to optimise success within the practice by sharing goals, values and mutual respect throughout the team. This was then rolled out to all staff in order to raise the practice profile and improve communication with the patients. Staff told us they had found this training and involvement in the programme beneficial for them as individuals and helped them in their work.

The area where the provider should make improvements are:

  • The practice should continue to look for ways to improve patient experiences of access to appointments.

We saw several areas of outstanding practice including:

  • Following a patient safety alert from NHS England, two GPs from the practice had attended a training course on sepsis. As a result of this, new guidelines had been developed by the practice and shared with staff.

  • The partners had instigated visiting consultants to serve the patients at Salters Medical Practice and patients from other practices. A cardiology consultant attended every two weeks to consult with and support patients and offer advice to the GPs. A Care of the Elderly Consultant attended weekly to see patients and carried out domiciliary visits to those patients who needed them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff were encouraged to report all incidents and events as part of their everyday role and responsibilities. The practice carried out a thorough analysis of significant events and shared learning from these with appropriate staff. Where patients were affected they received a written apology and steps were taken to prevent the same thing happening again. The incident recording form supported the recording of notifiable incidents under 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).
  • Following a patient safety alert from NHS England, two GPs from the practice had attended a training course on sepsis. As a result of this, new guidelines had been developed by the practice and shared with staff.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Staff had received training relevant to their role.
  • Risks to patients were assessed and well managed. There were robust systems in place to manage patient safety alerts, including medicines alerts which were acted upon.
  • Appropriate recruitment procedures were followed to ensure that only suitably qualified staff were employed to work at the practice.

Effective

Good

Updated 15 November 2016

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff received appraisals and had personal development plans in place.
  • A programme of audits and reviews were carried out so that improvements were made to enhance patient care.
  • Data from the Quality and Outcomes Framework (QOF) showed varied results for patient outcomes when compared with the local and national averages. The practice had taken steps to improve patient outcomes and had recruited two new Partners and one new salaried GP.
  • Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared.

Caring

Good

Updated 15 November 2016

The practice is rated as good for providing caring services.

  • Staff were friendly, polite and helpful to patients both attending at the reception desk and on the telephone. We saw that patients’ were treated with dignity and respect.
  • Patients we spoke with and feedback in the comment cards were mostly very complimentary about the practice and commented that they received excellent care from the GPs and the nurses. There were seven additional comments which highlighted some patients were not happy with the appointment system.
  • Results from the National GP Patient Survey published in July 2016 showed that overall the practice achieved results that were in line with local and national rates in relation to patients’ experience and satisfaction scores on consultations with the GP and the nurse. The practice had taken analysed the results and taken steps to improve patients’ experiences that included actively promoting online access and had made more appointments available for patients to book online. They had recruited two new partners and one new salaried GP.
  • Information to help patients understand and access the local services was available.
  • A notice board in the waiting room advertised support for carers. There were 85 carers registered with the practice (1% of the practice population). There was a designated lead for carers who worked closely with the local Carers Action Team to support registered carers and identify additional carers.

Responsive

Good

Updated 15 November 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and the local community in planning how services were provided to meet patients’ needs. Meetings were regularly attended with other practices and partner organisations from the locality so that services could be monitored and improved as required.
  • Patients we spoke with had mixed experiences of making appointments, some positive and some negative. The practice was aware of some of the access issues and had taken steps to improve this.
  • The practice was located in purpose-built premises and had good facilities. It 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 had responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders accordingly.
  • In order to enhance local services for their patients, one of the GP Partners had instigated visiting consultants to serve the patients at Salters Medical Practice and patients from other practices. For example, a cardiology consultant attended every two weeks to consult with and support patients and offer advice to the GPs.

Well-led

Good

Updated 15 November 2016

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

  • There was a clear leadership structure and staff felt supported by management.
  • There was an overarching governance framework which included arrangements to monitor and improve quality and identify risk.
  • There was a clear vision and strategy to provide quality care. Staff shared this vision and told us they worked hard to deliver quality care for all patients.
  • Staff morale was high with a high level of staff satisfaction with evidence of teamwork.
  • The practice encouraged a culture of openness and honesty. High standards were promoted and owned by all practice staff and teams worked together across all roles. Staff told us they were confident they would be supported if they needed to raise any issues or concerns. They said they felt respected, valued and supported by everyone and that they absolutely loved working at the practice.
  • Staff had received inductions, regular performance reviews and attended regular staff meetings and events.
  • The leadership of the practice demonstrated their commitment to ongoing improvement of services for patients and were actively engaged in primary care research.
  • The practice was involved in the Triumvirate Leadership Programme. Three leaders within the practice, a GP, a nurse and a manager made substantial changes to optimise success within the practice by sharing goals, values and mutual respect throughout the team. This was then rolled out to all staff in order to raise the practice profile and improve communication with the patients. Staff told us they had found this training and involvement in the programme beneficial for them as individuals and helped them in their work.
Checks on specific services

People with long term conditions

Good

Updated 15 November 2016

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

  • There were systems in place to monitor patients with chronic diseases. The practice nurses had lead roles in chronic disease management.
  • The practice ensured continuity of care in order to achieve the best outcomes for individual patients. Patients diagnosed with a long term condition had a named GP and a structured regular review to check that their health and medicine needs were being met. Reviews were carried out at least annually if not more often. Holistic appointments were offered so that the number of times patients needed to attend for appointments was reduced. Longer appointments and home visits were available when needed.
  • The GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care for those patients with the most complex needs.

Families, children and young people

Good

Updated 15 November 2016

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

  • There were systems in place to identify and follow up children who were at risk of abuse. Staff had received safeguarding training. They were aware of their responsibilities in protecting children who were at risk of harm.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.
  • Appointments were available outside of school hours and the premises were suitable and accessible for children.
  • Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
  • We saw good examples of joint working with health visitors and district nurses.
  • A number of online services including booking appointments and requesting repeat medicines were also available.
  • Data for 2014/2015 showed the practice was in line with local and national rates for their cervical screening programme.

Older people

Good

Updated 15 November 2016

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

  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia.
  • It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.
  • A care of the elderly consultant attended the practice weekly to see patients and carry out domiciliary visits to those patients who needed them.
  • Health checks were carried out for all patients over the age of 75 years.
  • Support and weekly ward rounds were provided routinely for local care homes for the elderly.

Working age people (including those recently retired and students)

Outstanding

Updated 15 November 2016

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

  • The practice offered extended hours appointments from 6pm to 8pm on Monday evenings and from 9am to 11am on alternate Saturdays for pre-bookable appointments. These appointment times were available for both GPs and nurses.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
  • The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
  • The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Repeat prescriptions could be requested online at any time, which was more convenient for patients.
  • The partners had successfully instigated visiting consultants to serve the patients at Salters Medical Practice and patients from other practices. A cardiology consultant attended every two weeks to consult with and support patients and offer advice to the GPs.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 November 2016

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

  • The practice held a register of patients with poor mental health including those patients with dementia. Staff had received training on how to care for patients’ with mental health needs and dementia.
  • Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The GPs and practice nurses understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
  • The practice supported families in their bereavement and signposted them to support services.
  • Data for 2014/2015 showed the practice achieved results that were comparable with local and national rates for support for patients with poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 15 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. Alternative formats were available for those patients who needed help to access information such as patient leaflets in large text, easy read or alternative fonts. The practice offered longer appointments for patients with a learning disability. They had completed annual health checks for 36 out of 64 patients on their register in the current year prior to the inspection.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They had advised patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff would know that patients may need to be prioritised for appointments or offered longer appointments.
  • Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.
  • The practice treated patients of all ages and provided a range of medical services. The practice told us they had registered homeless people and provided them with treatment and health care according to their needs.