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Inspection Summary


Overall summary & rating

Outstanding

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holland Park Surgery on 11 May 2016. Overall the practice is rated as outstanding.

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

  • 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.

  • Throughout our inspection there was a strong theme of positive feedback from staff and patients. Patients said they were treated with compassion, dignity and respect and they felt involved in their care and decisions about their treatment.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had a well-established shared care service which they managed in conjunction with community outreach workers. This allowed the practice to effectively manage physical and psychological problems that may coexist with illicit substance misuse.

  • Feedback from patients about their care was consistently positive.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient participation group. For example to bring more services closer to patients homes the practice listened to feedback and therefore implemented a Anticoagulation clinic (a blood test which tells clinicians how long Warfarin a blood thinning medication is delaying the blood from clotting) and carried out ultrasound and advanced dressings including compression dressings.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and assessed how they were being managed and responded to, improvements were made as a result.
  • The practice was proactive in identifying and managing significant events. For example all significant events were thoroughly investigated and opportunities for learning from internal and external incidents were maximised.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership with robust governance arrangements in place. There was a regular programme of practice meetings and the overarching governance framework supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

The practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. There were clear systemic processes in place and a strong learning culture with development opportunities for all staff. The practice was well organised and made full use of their resources to respond to changing population needs. We saw several areas of outstanding practice for example:

  • The practice attended the yearly canal event in order to promote services available to those who would not normally access health care services. As a result the practice identified a number of people who were not registered with the practice. The practice now registers and supports ‘Liveaboards’ (people living aboard canal boats).

  • The practice holds a yearly Awareness Day which they invite professionals such as the hospice Palliative Care Consultant, local Macmillan Nurse, Pathways4Life (a dementia support worker service for hard to reach groups), life coaches and diabetes UK to raise community awareness of the range of services available. Topics discussed on the day such as end of life care created much interest amongst patients and their carers.

  • The practice had a strong culture of continued professional development and was keen to encourage younger people to take up a career in general practice. For example the practice helped young professionals gain employment and training in a health and social care environment by employing two clinical healthcare support apprentices.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the Patient Participation Group PPG was involved in the registrars and student nurses induction plan, for example they provided talks on topics such as an overview of services from the eyes of patients.

However there were areas of practice where the provider should make improvements. For example:

  • The practice should continue to increase the uptake of health checks for patients aged 40 to 70 and over 75s.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 August 2016

The practice is rated as good for providing safe services.

  • Information about safety was highly valued and was used to promote learning and improvement. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • The practice used every opportunity to learn from internal and external incidents to support improvement. Learning was based on thorough analysis and investigation. The practice used monthly educational meetings to share learning and invited guest speakers to present guideline updates.

  • 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.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Robust infection control procedures were in place and the infection control lead received adequate training to enable her to carry out this role effectively.

  • We observed the premises to be clean and tidy and we saw completed cleaning specifications to demonstrate that the required cleaning had taken place for each area of the practice.

Effective

Outstanding

Updated 24 August 2016

The practice is rated as outstanding for providing effective services.

  • Our findings at inspection 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.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients. The practice used their monthly educational meetings to invite guest speakers to present guideline updates, system developments and information on new incentives.

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes. In addition to audits, clinical reviews were completed across a number of areas at the practice.

  • There was evidence of appraisals and personal development plans for all staff and shared learning was a common theme throughout the practice at all levels.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment and they worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

Caring

Outstanding

Updated 24 August 2016

The practice is rated as outstanding for providing caring services.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the Patient Participation Group PPG was involved in the registrars and student nurses’ induction plan, for example they provided talks on topics such as an overview of services from the eyes of patients. The PPG told us that patients were happy with the service and facilities however the practice continued to seek ways to evolve.

  • Data from the national GP patient survey published in January 2016 showed patients rated the practice higher than others for several aspects of care. There was a strong theme of positive feedback from patients we spoke with on the day of our inspection; this was also evident in completed comment cards.

  • Information for patients about the services available was easy to understand and accessible within the practice and online.

  • We saw staff treated patients with kindness, respect, and maintained patient and information confidentiality.

  • The practice had a very informative carer’s corner situated in the reception area which directed carers to various avenues of external support available.

Responsive

Outstanding

Updated 24 August 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice held a shared care opiate replacement therapy clinic and alcohol addiction therapy sessions with community outreach workers. The practice also worked with Pathways four Life in order to engage with hard to reach patients diagnosed with dementia.

  • 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. For example to bring more services closer to patients home the practice carried out Anticoagulation clinics (a blood test which tells clinicians how long Warfarin a blood thinning medication is delaying the blood from clotting) and did ultrasound and advanced dressings including compression dressings.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • 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; evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice used proactive methods to improve patient outcomes and working with other local providers to share best practice. The practice attended the yearly canal event in order to promote services available to the local community.

Well-led

Outstanding

Updated 24 August 2016

The practice is rated as outstanding 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 a number of policies and procedures to govern activity and held regular governance meetings to review updates.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. Performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • 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 robust systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The patient participation group was very active. They were involved in registrars and student nurse induction plans where they provided talks on topics such as an overview of services from the eyes of patients.

  • There was a strong focus on continuous learning and improvement at all levels, this was demonstrated through a range of internal meetings carried out to improve the quality of service provided.

Checks on specific services

Older people

Outstanding

Updated 24 August 2016

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

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

  • The practice was responsive to the needs of older people, for example they offered support to registered patients who resided in the local care home, home visits and urgent appointments was available for those with enhanced needs.

  • The practice is located in a multipurpose shared building and we saw that they proactively engaged with other health care professionals. For example we saw evidence of excellent working relationships with district nurses and community matron. The practice used the Integrated Care Team for conditions that can be safely managed in the community such as cellulitis and Deep Vein Thrombosis.

  • The practice pharmacist carried out medication checks and held regular meetings with the GPs to discuss patient’s needs.

  • Data provided by the practice showed that 68% of patients aged 75 plus have had their health checks. The practice were pro-actively trying to increase this number, for example we were told that the practice used two apprentice healthcare assistants to help increase the uptake of over 75s health checks. Patients were also invited for checks opportunistically.

  • The practice holds annual awareness days, each year they would have a specific theme. For example end of life care which was attended by the hospice Palliative Care Consultant and the local Macmillan Nurse. We were told the event created much interest amongst patients and their carers and did much to raise awareness of end of life issues in the local community. This was confirmed by some of the patients we spoke to on the day who stated that the practice held very good awareness events.

  • We were told that the practice upcoming awareness day would be attended by a range of services such as Diabetes UK, Walsall Health Trainers and Lifestyle Services, Pathways4Life and St Giles Hospice.

People with long term conditions

Outstanding

Updated 24 August 2016

The practice is rated as outstanding 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. We saw that the practice held bi-monthly unplanned admissions meetings, these were well minuted and there was clear evidence of actions taken to reduce further hospital admissions.

  • Performance for diabetes related indicators was similar to the national average. For example 83% had a specific blood glucose reading of 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%.

  • The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 98%, compared to CCG average of 97% and national average of 94%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Clinical staff were encouraging patients to engage with the Expert Patients Programme (a self-management programme for people living with long-term conditions, which supports them by increasing their confidence, improving their quality of life and helping them manage their condition more effectively).

  • The practice provides a room for the community physiotherapist who runs a weekly clinic at the surgery. 

Families, children and young people

Outstanding

Updated 24 August 2016

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

  • 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 relatively high for all standard childhood immunisations.

  • Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

  • The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.

  • The practice’s uptake for the cervical screening programme was 80%, which was above to the CCG average of 73% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

  • Appointments were available outside of school hours and we observed the premises to be suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses. For example the practice held bi-monthly multidisciplinary sharing and safeguarding meetings.

Working age people (including those recently retired and students)

Outstanding

Updated 24 August 2016

The practice is rated as outstanding 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.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. There were three online appointments per GP session available daily.

  • The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years. Although the uptake was low, for example 20% had their routine health check; we saw that the practice used apprentice health care assistants to help increase the uptake and they were also opportunistically directing patients to apprentice health care assistants

  • We saw that the practice were proactive in offering a full range of health promotion and screening.  The practice had a Facebook and Twitter page to provide updates on their services, the practice provided data which showed that their Facebook page had 100 likes with the largest page reach being 124 people.  We saw that the practice actively engage with the local community, especially those who might otherwise have little contact with health services.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 August 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). The practice provided data which showed that 85% of patients with a LD have had a care plan and medication review in the last 12 months, 96% had a face to face review in the last 12 months.

  • The practice attended the yearly Brownhills Canalside Festival to provide general health advice, blood pressure checks and information to those who would not normally access health care services. As a result the practice identified a number of people who were not registered with the practice. The practice now registers and supports ‘Liveaboards’ (people living aboard canal boats).

  • 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. For example they provide shared care service in partnership with the local addiction service for patients with opiate dependency allowing them to obtain their medication at the surgery. The practice found that this reduces stigma and allowed the practice to manage any physical and psychological problems that may coexist with illicit substance misuse.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.

  • The practice provided in house bereavement counselling via their longstanding attached Community Psychiatric Nurse. We were told that the practice always sent a condolences card to relatives of patients who have passed away.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 August 2016

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

  • 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average. Data provided by the practice showed that there were 50 patients on the practices register for dementia, five declined a care plan, of the remaining 45 patients 73% had care plans in place.

  • Performance for mental health related indicators was above the national average. For example 92% compared to the national average of 88%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example the practice worked closely and signposted patients to Pathway4life, we also saw that the practice signposted patients to the monthly dementia café.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • 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. We saw that patients were also being discussed during the practice bi-monthly unplanned admissions meeting.

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

  • Community Psychiatric Nurse ran sessions at the practice to support patients who were experiencing mental health issues.