You are here

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mossley Fields Surgery on 9 January 2017. Overall the practice is rated as outstanding.

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

  • The practice had an open and blame-free culture with regard to the identification and notification of any significant events and incidents. A thorough analysis of significant events was carried out and these were discussed at monthly practice and educational meetings.

  • The practice used innovative and proactive methods to improve patient outcomes and proactively worked with other local providers. For example, the practice organised a health and wellbeing awareness raising event for patients which was attended by a range of local support organisations such as carers’ and dementia groups. In addition staff had worked in collaboration with the local fire and rescue service to promote “Safe and Well” checks. These checks aimed to assess fire risks in patients’ homes and to provide health and wellbeing information to the elderly and vulnerable.

  • There was a comprehensive programme of audits, and a good understanding of performance and continuous improvement was evident. Findings and associated learning from audits were disseminated to staff.

  • Feedback from patients about their care was consistently positive and above local and national averages. Patients we spoke with said that they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.

  • The practice provided shared care services and clinics which would normally be delivered in secondary care settings such as hospitals. This allowed patients to receive care closer to their homes and reduced the burden on secondary care services.

  • The practice implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback from patients and from the patient reference group (PRG).
  • The practice had a vision which had quality and safety as a priority and there was a clear strategic approach to deliver this vision.
  • The practice had a culture of teaching and training which was promoted. This ensured patient care was provided by staff who were knowledgeable and skilled.

We saw areas of outstanding practice at the surgery which included the delivery of a high number of responsive local health and wellbeing services and initiatives:

  • The practice was responsive to the needs of vulnerable groups and delivered interventions or redesigned operating procedures to actively meet these needs. This included the delivery of shared care services, interaction with traveller families to promote child immunisations and vaccinations and the delivery of services to homeless people.

  • The practice recognised the importance of health promotion to raise community health and delivered a range of activities to support this work. This included:

    • Holding a community health and wellbeing awareness raising event.

    • The utilisation of social media to promote health messages and to improve communication between the surgery and patients.

    • Active support and promotion of other campaigns and messages on behalf of other organisations such as “Safe and Well” checks delivered by the local fire and rescue service.

    • Patients were actively encouraged to participate in the Expert Patient Programme (which offered patients access to learning which supported them to build their confidence, skills and knowledge to more effectively manage their own chronic health conditions such as asthma, diabetes). Over the past 18 months the practice had written to 439 patients to promote the programme (over 15% of the patient list) and to invite them to participate.

  • Clinical pharmacists and nurses delivered a minor ailments clinic. This freed GPs to deal with patients with more complex needs as well as increasing capacity and accessibility.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 March 2017

The practice is rated as good for providing safe services.

  • The practice had an open and blame-free culture with regard to the identification and notification of any significant events and incidents. A thorough analysis of the significant events was carried out.

  • Lessons concerning incidents, complaints and alerts were shared and action taken to improve safety in the practice. For example, these events were fully discussed at practice management meetings and at regular educational meetings. We saw that minutes of these meetings were clear and comprehensive.

  • 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. For example, standards in relation to infection prevention and control were high and the last audit carried out in December 2015 showed an overall compliance score of 98%. We were told by the practice that a further audit was booked for March 2017.

  • Risks to patients were assessed and well managed. Both child and adult safeguarding procedures were in place. The practice was working with local health visitors to develop a formal policy dealing with families who failed to attend key child immunisation appointments.

Effective

Good

Updated 24 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. We saw that the practice actively used data to identify areas for improvement. For example, they had identified bowel cancer screening rates as requiring improvement and had undertaken a campaign to raise awareness and participation amongst patients.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • We saw evidence that clinical audits demonstrated quality improvement. Findings of audits were widely discussed at practice management meetings and educational meetings.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice employed the services of two clinical pharmacists, who with nursing staff, delivered minor ailment clinics and freed GPs to deal with patients with more complex needs as well as carrying out reviews and changes to patient medication.
  • Patients were actively encouraged to participate in the Expert Patient Programme (which offered patients access to learning that supported them to build their confidence, skills and knowledge to more effectively manage their own chronic health conditions such as asthma, diabetes).
  • The practice encouraged staff development and actively supported apprenticeship opportunities. We saw that annual appraisals were being held and were used to identify training needs and career development opportunities.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. For example:

    • 93% of patients said they had confidence and trust in the last GP they saw compared to the CCG and national averages of 92%.

    • 88% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 84% and the national average of 85%.

    • 97% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 90% and the national average of 91%.

    • 92% of patients said they found the receptionists at the practice helpful compared to the CCG and national averages of 87%.

  • Data from the NHS Friends and Family Test collected for December 2016 showed that all of the 28 patients who had responded would be extremely likely to recommend the practice to family and near friends.

  • We saw during the inspection that staff treated patients with dignity and compassion and this was confirmed when we spoke with patients.

  • The practice worked actively with external partners and agencies to improve local health and wellbeing. For example:

    • The practice organised a health and wellbeing awareness raising event for patients which were attended by carers and dementia support groups.

    • Patients with identified needs were signposted to external agencies such as foodbanks for support.

  • Patients were sent text reminders when appointments were due. In addition patients with memory issues were called personally by staff to remind them of appointments.

  • A number of information leaflets were available in easy read format and the surgery display noticeboards were well laid out and easy to understand.

Responsive

Outstanding

Updated 24 March 2017

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, they delivered a shared care service for patients with substance misuse issues which allowed them to obtain medication and monitoring services via the surgery. The practice also hosted a monthly substance misuse outreach clinic.

  • There were innovative approaches to providing integrated patient-centred care. For, example, the practice employed clinical pharmacists within the surgery who carried out reviews and changes to medication, and also delivered a minor ailments clinic.

  • The practice hosted additional services within the surgery which included:

    • A weekly diabetic clinic delivered by a diabetic specialist nurse. This clinic reviewed diabetic patients with more complex needs. Nine appointments were available per week.

    • A weekly clinic delivered by the community mental health nurse and on average around four to six patients were reviewed per week.

    • An ultrasound clinic which could be attended by patients from Mossley Fields Surgery and patients from other practices.

  • The needs of specific groups were recognised such as those with learning disabilities, the homeless and traveller families. The practice adapted processes and working procedures to better meet the needs of these groups and individuals. For example,

  • 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 reference group.

  • The practice held a community engagement event over a weekend in October 2016 which was attended by over 50 people. A range of health, wellbeing and lifestyle services attended the event which included the fire and rescue service, an employment organisation, a carers group and cancer awareness and screening services. In addition to this the practice undertook health checks for attendees which included blood pressure and height and weight checks.

  • The practice made effective use of technology to communicate with patients. For example, patients could book appointments, request prescriptions and access medical records online. In addition the practice made extensive use of social media to cascade information and involve patients in health and wellbeing improvement.
  • Patients could access appointments and services in a way and at a time that suited them. For example, there were early morning appointments available to patients four days a week.
  • The practice premises was newly built, had good facilities and was well equipped to treat patients and meet their specific needs. The needs of vulnerable groups such as those with dementia had been identified and incorporated into the structure and fabric of the surgery building, for example toilets had been fitted with colour contrasting seats.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff at regular practice meetings and educational meetings.

Well-led

Outstanding

Updated 24 March 2017

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

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. This vision was encompassed within the practice’s “Patient Promise” which highlighted the ethos of the practice to deliver good individual care.

  • The practice had a comprehensive understanding of local population needs and performance and this was supported by the effective use of intelligence such as QOF reporting, and the use of the primary care web tool. A programme of continuous clinical and internal audit was also used to monitor quality and to support continuous improvement. Audit findings and associated actions were regularly discussed at monthly practice meetings and educational meetings.

  • 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.

  • The practice had gathered feedback from patients through the patient reference group (PRG) and through surveys and complaints received. The PRG met regularly, carried out patient surveys and submitted proposals for improvements to the practice management team.

  • There was a positive and proactive approach to training and development evident at all levels within the surgery.

  • There was evidence that staff embraced innovation and new ways of working. For example, the practice had employed clinical pharmacists to deliver services within the surgery which would normally have been delivered by GPs, and used social media to improve communication and build relationships with patients.
Checks on specific services

Older people

Outstanding

Updated 24 March 2017

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. All older patients had a named GP and those on long term medication received a regular assessment and review.

  • The practice provided or hosted a number of services which could benefit older patients; these included an anticoagulation clinic (anticoagulants are used to prevent the formation of blood clots in the blood vessels and their migration elsewhere in the body), ultrasound scanning and advanced dressings. In addition staff worked closely with the local integrated care team to treat patients with conditions which could be safely managed in the community such as cellulitis and deep vein thrombosis (a blood clot that develops within a deep vein in the body).

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Staff from the surgery worked in collaboration with the local fire and rescue service to promote “Safe and Well” checks. These checks aimed to assess fire risks in patients’ homes and to provide health and wellbeing information to the elderly and vulnerable.

People with long term conditions

Outstanding

Updated 24 March 2017

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. It had recognised that it had a higher rate of patients diagnosed with certain chronic conditions and put in place services to meet this demand. The practice supported and reviewed patients for conditions which included coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma and diabetes. At the time of inspection of the 293 patients on the asthma register 77% had received an annual review and of the 125 patients on the COPD register 81% had received an annual review. The practice felt that they would be on track to complete these reviews by the end of 2016/2017. Where possible patients with multiple conditions were reviewed at one time. This reduced the need for patients to make repeated visits to the surgery. One of the practice nurses had received specialist training and was able to deliver spirometry services (spirometry is testing that can help diagnose various lung conditions, most commonly COPD).

  • The practice actively worked with other healthcare services to provide care for patients with long term conditions. For example, they hosted a dedicated diabetes clinic staffed by a diabetes specialist nurse for patients with more complex needs.

  • Performance for diabetes related indicators was generally either comparable to or above local and national averages. For example, t

    he percentage of patients on the diabetes register, with a record of a foot examination and risk classification was 94% compared to a CCG average of 90% and a national average of 89%.

  • The practice attended multidisciplinary team meetings with partners such as palliative care nurses, district nurses and the community matron on a quarterly basis where they discussed individual patients. This facilitated the provision of joined up care and enabled all parties to be kept up to date with the care needs of the patient.

  • Staff encouraged patients to engage with and participate in the Expert Patients Programme (a self-management programme for people living with long term conditions. The programme supports patients by increasing their knowledge and confidence, improving quality of life and helping them to manage their condition more effectively). Over the past 18 months the surgery had contacted 439 patients to inform them of the programme and received a 4% response rate.

  • Longer appointments and home visits were available for patients when these were required.

Families, children and young people

Outstanding

Updated 24 March 2017

The practice is rated as outstanding 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. The practice also had systems in place for identifying and following up children who fail to attend hospital appointments to detect any safeguarding concerns. Practice staff met on a quarterly basis with other health professionals to discuss safeguarding issues.

  • Childhood immunisation rates were above the 90% national expected range for vaccinations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 100%. For five year olds vaccination rates ranged from 93% to 96%. The practice was working with local health visitors to develop a formal policy in dealing with families who did not attend child immunisation appointments.

  • The practice’s uptake for the cervical screening programme was 83%, which was similar to the CCG and national averages of 81%.

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

  • Over 50% of appointments were available outside of school hours and in addition to this the practice had introduced urgent child appointments to ensure early and timely access for children whose health might deteriorate suddenly. The practice premises was modern, light, warm and suitable for children and babies.

  • A full range of family planning services were provided from the surgery, these included, free condoms for young people on request, and the fitting of contraceptive implants and intrauterine devices (an intrauterine device or IUD is a small birth control device that is inserted into a woman's uterus to prevent pregnancy).

Working age people (including those recently retired and students)

Outstanding

Updated 24 March 2017

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. For example, the practice offered early morning appointments from 7.30am on four mornings a week. Patients who could not attend the practice could access telephone consultations.

  • The practice was proactive in offering online services and patients could book and cancel appointments, order repeat medication and access medical records online. Over 10% of the practice patient list had signed up to access online services.

  • The practice utilised social media to improve health and wellbeing. For example, to deliver health promotion advice to patients with regard to smoking cessation and dementia. In addition to this, patients were sent text message reminders for appointments and were able to cancel appointments via text messages. The practice also used text messages to deliver key messages such as health advice during hot weather.

  • A health and wellbeing awareness event had recently been held which  included input from a local recruitment agency who provided information to patients seeking work.

  • Patients could access a full range of health promotion and screening that reflects the needs for this age group.

  • The practice had recognised that bowel cancer screening rates were below the national average and undertook a campaign to raise awareness and participation in the screening programme. This activity involved writing to and personally calling patients. At the end of this exercise the practice had contacted 94% of all eligible patients.   

People whose circumstances may make them vulnerable

Outstanding

Updated 24 March 2017

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

  • The practice held registers of patients living in vulnerable circumstances including travellers, those with a learning disability, carers, patients with dementia and mental health problems and children on the child protection register. There were alerts on patients electronic records to identify patients who had been subject to domestic abuse. This ensured staff were aware of the specific needs of these patients and could target and manage services such as health checks and reviews. Where possible patients with a learning disability had reviews carried out in their own home environment to minimise disruption and patient distress.

  • At the time of inspection 34 patients were recorded on the learning disability register and 74% of these patients had had a learning disability review completed in the previous nine months. Additionally staff worked closely with the local cancer screening outreach nurse to offer breast and cervical screening for patients with a learning disability patients .They had supported the outreach nurse to deliver services to these patients in their own home environment.

  • The practice offered longer appointments for patients when this was required such as for those with language needs or patients with complex conditions.

  • To help reduce the challenges that homeless people faced when registering with a GP due to having no fixed address, the practice registered patients who were homeless against the address of a local hostel to ensure they had access to health care services.

  • The practice delivered an avoiding unplanned admissions service for patients who had complex needs and were at risk of an unplanned hospital admission. This involved advanced care planning and close working with other care and support organisations.

  • The practice regularly worked with other health and care professionals in the case management of vulnerable patients. For example, they provided a shared care service for patients with opiate dependency which allowed them to obtain medication and monitoring services via the surgery. The practice also hosted a monthly substance misuse outreach clinic.

  • The practice nurse and locality manager had attended a local traveller site in 2016 to encourage the uptake of child immunisations within the traveller community. During this visit they spoke with 14 families and this led to the vaccination of three children.

  • 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 told us that ensured that ex-military personnel received priority referrals to secondary/primary care services as it was recognised that their condition could be related to past service. Patient records were coded to ensure that referrals were completed in a timely manner.

  • Patients were regularly screened to identify alcohol dependency on registration and during reviews. We saw evidence to show that in the previous 12 months screening had increased by 18%.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 March 2017

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

  • Performance for mental health related indicators were either comparable to or above local and national averages. For example, 97% of patients with schizophrenia, bipolar affective disorder or other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months compared to a CCG average of 92% and a national average of 89%.

  • 91% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was slightly above the local CCG and national averages of 84%.

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. In addition the surgery hosted a weekly clinic run by the community mental health nurse who saw on average four to six patients a session.

  • The practice told patients experiencing poor mental health and dementia how to access various support groups and voluntary organisations. For example, the practice worked closely with, and signposted patients to, a local support group. The group offered specific dementia advice and support and also organised a monthly dementia café.

  • At the time of inspection 35 of the 43 patients (81%) on the mental health register had received a physical health check as well as being in receipt of mental health support.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. The practice health care assistant apprentice acted as the surgery dementia champion and worked to raise staff awareness in this area. Local dementia services had attended awareness days organised by the practice.

  • Patients presenting with depression were routinely assessed using a suicide risk assessment tool and were offered additional support should risks be identified.

  • Reception staff made personal calls to patients with memory issues to remind them of upcoming appointments and reviews.