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Inspection Summary


Overall summary & rating

Outstanding

Updated 29 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Lane Surgery on 23 February 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 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 on an ‘ad hoc’ basis at planned development events.
  • Information about safety alerts was reviewed and communicated to staff by the practice manager in a timely fashion. Recommendations made by the CCG pharmacist following medicines reviews were followed up by GPs.
  • 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.
  • Patients we spoke with told us doctors 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 patients told us that they knew how to complain if they needed to.
  • Urgent appointments were available on the day they were requested. Patients said that they were able to see their preferred GP within one day. Routine appointments could be booked up to four weeks in advance and were usually available the next day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included easy access for patients who were wheelchair users, baby changing facilities and a private room for breastfeeding.
  • 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 appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice

We saw several areas of outstanding practice including:

  • Hosting of a screening programme for Abdominal Aortic Aneurysm (AAA) which was attended by 302 people aged over 65.This led to aneurysms being detected in 5.5% of patients who attended which would otherwise have remained undetected.
  • Implementation of a Melanoma Awareness event at the practice where screening was provided on the day and onward referrals made to treat potential or actual identified skin cancers for five patients who might otherwise have not visited their GP about their skin lesion.
  • The practice utilised a questionnaire so that patients with dementia and their carers were able to identify their preferences. This was done to assist with treating them with dignity and respect at times when they were unable to communicate effectively.

However there was one area of practice where the provider should make improvements:

  • The practice should review the system of clinical audits to ensure all are repeated as part of the continuous improvement in outcomes for patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 April 2016

The practice is rated as good for providing safe services.

There was an effective system in place for reporting and recording significant events, and lessons learned were shared throughout the practice at regular meetings. When there were unintended or unexpected safety incidents, patients received a verbal and 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 and staff had received training relevant to their role.

Risks to patients were assessed and well managed. Infection prevention and control procedures were completed to a satisfactory standard. There were robust systems in place to manage safety alerts, including medicines alerts which were acted upon.

There was a robust process for managing incoming mail including test results which were acted upon on the same day if required.

There were enough staff to keep people safe.

Effective

Outstanding

Updated 29 April 2016

The practice is rated as outstanding for providing effective services.

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) and other locally agreed guidelines, and clinicians used these as part of their work.

Audits and reviews were undertaken and improvements were made to enhance patient care. For example, an audit identified that 50% of patients fitted with an intra-uterine device had failed to attend their six week check. The practice amended the patient information leaflet about the six week check, and implemented an SMS text reminder to patients prior to their check up appointment.

The practice hosted and promoted an abdominal aortic aneurysm (AAA) screening service for 302 patients aged  65 and over which detected aneurysms in 5.5% of those patients which would otherwise have remained undetected

The practice provided a melanoma screening event which was attended by 23 patients and identified five patients who required treatment or further investigation and two others for close monitoring.12 skin lesions were photographed and kept on the patients record for future monitoring. The screening event enabled patients to be referred for treatment who might otherwise have not visited their GP about their skin lesion.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for staff.

Staff worked closely with multidisciplinary teams to plan, monitor and deliver appropriate care for patients. The teams included midwives, health visitors, the community matron, district nurses and the mental health team.

Caring

Outstanding

Updated 29 April 2016

The practice is rated as outstanding for providing caring services.

Data showed that patients rated the practice higher than others for several aspects of care. For example; 95% of patients said their GP gave them enough time and 99% of patients said they had trust and confidence in their GP.

Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. For example; 95% of patients said that their GP involved them enough in decisions about their care and 98% of patients said that their GP treated them with enough care and concern.

Information for patients about the services available was easy to understand and accessible. We also saw staff treated patients with kindness and respect, ensuring that confidentiality was maintained.

Responsive

Good

Updated 29 April 2016

The practice is rated as outstanding for providing responsive services.

They were aware of the practice population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. The practice acted on suggestions for improvements for example by providing a ‘meet the new doctors’ event when two new GPs were recruited.

Patients told us they were satisfied with the appointment system and said they found it easy to make a routine appointment which was usually available the next day. Urgent appointments were always available the same day. Telephone consultations and home visits were available by appointment and where required.

The practice had good facilities and was well equipped to treat patients and meet their needs. The premises were suitable for patients who were disabled and there were baby changing facilities and a private room for breastfeeding.

Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff

Well-led

Good

Updated 29 April 2016

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

There was a clear vision and strategy which was shared with staff who were clear about their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. High standards were promoted and owned by all practice staff and teams worked together across all roles. There were systems in place to monitor and improve quality and identify risk.

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and had influenced change within the practice through regular collaborative meetings with the practice management team.

Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities. There was a high level of constructive engagement with staff and a high level of staff satisfaction.

All GPs had completed their revalidation process and those GPs who were skilled in specialist areas used their expertise to offer additional services at the practice.

Checks on specific services

People with long term conditions

Good

Updated 29 April 2016

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

  • All these patients had a named GP and a structured annual review with a nurse to check their health and medicines needs were being met. The nurses had received training in chronic disease management and worked closely with the named GP and the CCG pharmacist to ensure safe and effective prescribing through medicine reviews. For those patients with the most complex needs, support was provided by the community teams where required. For example the heart failure team, musculo-skeletal team and the community matron.
  • The nurse practitioner was also a qualified diabetic nurse specialist. Her role included supporting patients to manage their diabetes including the regular monitoring of blood sugar levels. Nationally reported data for this practice was comparable to the CCG and national averages. They had provided influenza vaccination for 95% of people on the diabetes register compared to the national average which was 94%.
  • Longer appointments and home visits were available when needed. Prescriptions could be ordered using the electronic system.
  • Health reviews for patients with more than one long term condition were combined so that they did not have to attend multiple appointments
  • The practice reviewed 83% of patients diagnosed with asthma, on the register, in the last 12 months. This was 4% higher than the CCG average and 8% above the national average for conduction annual asthma reviews.

Families, children and young people

Good

Updated 29 April 2016

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 those who were at risk. For example, children and young people who had a high number of A&E attendances. Immunisation rates were high 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. Comment cards also supported this.
  • Appointments were available outside of school hours and the practice told us that children were always seen on the same day. The premises were suitable for children and babies and had baby change and breast feeding facilities.
  • We saw positive examples of joint working with midwives, school nurse and health visitors who told us that they had a positive working relationship with the practice and that concerns about patients were regularly discussed and quickly addressed. We saw minutes of meetings where issues relating to children were discussed.
  • Postnatal and eight week baby checks were available which were 30 minute appointments to enable time for vaccinations and to discuss post natal wellbeing including post natal depression. This was followed by a 30 minute appointment with the practice nurse for first vaccinations.The practice streamlined these appointments to enable opportunity for support and education. The health visitor is contacted when input is required

  • The practice provided emotional support and signposting to victims of domestic violence and followed up their care when they moved to safe refuge.

Older people

Outstanding

Updated 29 April 2016

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

  • The practice offered proactive, personalised care to meet the needs of older people in its population. Thirteen percent (13%) of the practice’s patient list were over 65years and most of them were being cared for at home.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They worked closely with the community matron and district nursing team to help provide consistent care for people who were housebound.
  • They held monthly collaborative meetings with the community support team and social work team to discuss individual needs and to plan ongoing care for patients. Safeguarding concerns were also discussed at this meeting.
  • The practice worked closely with district nurse team and the MacMillan nurse team to plan care for patients who were receiving palliative care to anticipate their needs. Home visits by GP’s were made and where necessary this included weekend visits for people at the end of their life. The practice held  quarterly meetings with the palliative care team to discuss palliative care and included care for the families caring for patients who were on the palliative care register.
  • The practice had arranged for a screening programme to be hosted at the practice to identify potential or actual abdominal aortic aneurysm in patients over the age of 65. The screening programme was proactively promoted during influenza vaccination sessions and on the practices website. The abdominal aortic aneurysm (AAA) screening service was attended by 302 patients over a number of sessions resulting in a detection rate of 2.6% for the invited patients and a detection rate of 5.5% for those patients who were aged over 68 and had self referred for the screening programme.
  • Data from the Derbyshire Abdominal Aortic Screening Programme showed that since the screening clinics were hosted at Park lane surgery,  73% of attendees were from Park Lane surgery and the remaining 27% from the other seven practices combined.

Working age people (including those recently retired and students)

Outstanding

Updated 29 April 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. For example; appointments could be booked online and telephone consultations were available by appointment. Routine appointments were available until 6pm each evening and, if necessary a later appointment could be arranged.

Repeat prescriptions could be ordered using the online ordering service and, on request, prescriptions could be sent to local pharmacists for collection directly from the pharmacy saving a visit during working hours to the surgery.

The practice was proactive in offering a range of health promotion that reflected the needs for this age group, This included NHS checks and over 40 checks as well as screening for cervical cancer and bowel cancer. This was advertised in the practice and on the website.

They had recently provided a screening event where patients were invited to attend to be screened on the day. The melanoma awareness day was attended by 23 patients, 5 of whom were referred for further investigation and treatment, and two others closely monitored

The practice achieved 85% for providing cervical screening for eligible female patients within the last year which was 4% higher than the CCG average and 8% higher than the national average

People experiencing poor mental health (including people with dementia)

Good

Updated 29 April 2016

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

The practice had a population that was higher than average for older people and were alert to the need to provide dementia screening opportunistically. They offered annual reviews to patients diagnosed with dementia and in the preceeding year, with 72% having their care reviewed in a face to face meeting. This was below the national average of 84%. The practice were exploring ways to increase patient engagement to improve attendance at annual reviews.

Appointments were provided on demand for people with dementia, and where a carer requested a home visit, this was always accommodated at short notice. A questionnaire was provided to patients and their carers to identify their preferences and assist with treating them with dignity and respect at times when they were unable to communicate effectively.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Ninety-four (94%) of patients with a mental health condition had a care plan that had been reviewed in the preceeding year which was 2% above CCG average and 6% above national average

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. This included counselling and telephone support provided by local 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.

Staff had a good understanding of how to support patients with mental health needs and dementia and described situations where they had assisted people who appeared confused or were particularly anxious.

People whose circumstances may make them vulnerable

Good

Updated 29 April 2016

The practice is rated as 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 with a learning disability and told us that they had built up a trusted relationship with their patients over a number of years. There was a named GP for patients with learning disabilities who worked with the patient’s carer or case worker to assess the level of support required and to review the care plan with the patient to ensure ongoing personalised care. An annual health check was offered and longer appointments were available.They had completed health checks for nine of the 13 patients on their register

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed them 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.

Interpreters were available, including sign language for deaf people, and chaperones were always offered.