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Moss Grove Surgery - Kingswinford Good

Inspection Summary


Overall summary & rating

Good

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moss Grove Surgery - Kingswinford on 19 January 2016. Overall the practice is rated as good.

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

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

  • Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.

  • There was a strong focus on continuous learning and improvement at all levels within the practice. The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and improvements to patient care and treatment.

  • The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • There were consistently high levels of constructive staff engagement Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans. Staff were actively engaged in activities to monitor and improve quality and patient outcomes.

  • 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.

  • The practice had a clear vision which had quality and safety as its top priority. We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

  • We observed the premises to be visibly clean and tidy. The practice had good facilities and was equipped to treat patients and meet their needs.

We saw some areas of outstanding practice:

  • One of the GPs had a lead role in women’s health, the GP led on a programme of in-house workshops focussing on women’s health topics and gynaecology in particular. The success of the workshops led to the development of a gynaecology triage system. The practice completed an audit of their gynaecology system which highlighted a 20% reduction in their community referral rates and acute admissions.
  • The practice had very active patient participation group which influenced practice development. We found that they had been involved in a number of successful events and projects at the practice including a successful children’s health event which was led by the GP safeguarding lead and supported by the PPG. The event covered child CPR and guidance on how to effectively manage minor illnesses in small children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2016

The practice is rated as good for providing safe services.

  • The practice was proactive in identifying and managing significant events. There were robust systems in place to monitor safety. These included systems for reporting incidents, near misses, positive events and national patient safety alerts, as well as comments and complaints received from patients.

  • The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses. We saw that significant events were regularly discussed with staff during practice meetings and the practice used these as opportunities to drive improvements.

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

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 10 March 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 members throughout the practice had lead roles across a range of areas.

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and improvements to patient care and treatment Audits were discussed during regular staff meetings and staff were actively engaged in activities to monitor and improve quality and patient outcomes.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

  • Staff, teams and services were committed to working collaboratively. They explored innovative and efficient ways of improving communication with their local health care teams to deliver more joined-up care to patients. We saw evidence that a range of information sharing and engagement meetings took place in addition to the monthly multi-disciplinary meeting.

  • The practice shared data which identified that 99.98% of their identified smokers were given smoking cessation advice; this was 5% higher than the local and national averages; 52 patients had stopped smoking as a result.

Caring

Good

Updated 10 March 2016

The practice is rated as good for providing caring services.

  • We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • Four members of the reception team had been trained as Carer Leads in order to identify and offer support, guidance and information to carers. All front line staff had also completed carer awareness training.

  • The practice also provided information and supported patients by referring them to a number of support groups, onsite counselling services and further support organisations.

  • Results from the national GP patient survey published in January 2015 showed patients were happy with how they were treated and that this was with compassion, dignity and respect.

Responsive

Good

Updated 10 March 2016

The practice is rated as good for providing responsive services.

  • There were longer appointments available for vulnerable patients, for patients with a learning disability, for carers and for patients experiencing poor mental health.

  • Urgent access appointments were available for children and those with serious medical conditions. The practice offered a walk in and wait service for children so that children were usually seen within 30 minutes of requesting an urgent appointment.

  • The practice was proactive in identifying patients with complex health conditions, flags were applied to the system so that these patients were seen as a priority. The practice shared examples of how this system had previously helped them to effectively deal with specific urgent cases.

  • The operated a nurse advisory service so that patients who needed to be seen could see a nurse for basic observations.

  • The practice provided an in-house phlebotomy service for patient blood tests.

  • There were disabled facilities, hearing loop and translation services available. Staff members were also trained to do sign language for patients with a hearing impairment. 

Well-led

Outstanding

Updated 10 March 2016

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

  • The practice had a regular programme of practice meetings and there was an overarching governance framework which 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 partners encouraged a culture of openness and honesty. The practice had systems in place for managing notifiable safety incidents.
  • The practice proactively sought feedback from staff and patients, which it acted on. Staff we spoke with said they felt valued, supported and that they felt proud to be part of the practice team. Staff spoken with demonstrated a commitment to providing a high quality service to patients.
  • 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.

  • There was a strong focus on continuous learning and improvement at all levels within the practice. As a long standing teaching and training practice, the practice was committed to education, training and development. Staff members throughout the practice had lead roles across a range of areas and there were consistently high levels of constructive staff engagement.
Checks on specific services

People with long term conditions

Good

Updated 10 March 2016

The practice is rated as 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.

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

  • The practice developed a successful multi-clinic which acted as a one-stop system for patients with multiple conditions. The practice manager explained how the clinic, templates and protocols had been described as good practice by the local CCG with a view to disseminate the multi clinic service across the local area.

  • The practice was part of a self-management programme in the area to help to patients to manage their long term conditions. The practice recognised that 674 of their patients had type 2 Diabetes and decided to focus on this area as part pf the programme.

  • Performance for overall diabetes related indicators was 91% compared to the CCG average of 88% the national average of 89%.

Families, children and young people

Good

Updated 10 March 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
  • In addition to attending the practices monthly multidisciplinary (MDT) meetings, the safeguarding lead implemented a monthly child multidisciplinary meeting dedicated to child health and child safeguarding.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for under two year olds ranged from 93% to 100% compared to the CCG averages which ranged from 80% to 100%. Immunisation rates for five year olds ranged from 89% to 100% compared to the CCG average of 93% to 98%.
  • The practice offered a walk in and wait service for children so that children were usually seen within 30 minutes of requesting an urgent appointment.

  • The practice also held successful children’s health event which was led by the GP safeguarding lead and supported by the PPG. The event covered child CPR and guidance on how to effectively manage minor illnesses in small children.

Older people

Good

Updated 10 March 2016

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

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

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

  • The practice provided care to patients in several nursing, care and residential homes. Each home had a named GP who conducted regular ward rounds.

  • The PPG chaired a number of successful health awareness events at the practice. The most recent event was a healthy living and healthy life event which was developed specifically for the practices older population.

Working age people (including those recently retired and students)

Good

Updated 10 March 2016

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

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

  • The practice’s uptake for the cervical screening programme was 81%, compared to the national average of 81%.

  • The operated a nurse advisory service so that patients who needed to be seen could see a nurse for basic observations.

  • Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations as well as extended hours.

  • Patients had access to appropriate health assessments and checks. The practice uptake for health checks were at 60%, compared to the national average of 48%.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 March 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

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

  • Performance for mental health related indicators was 92% compared to the CCG average of 93% and national average of 92%. Most of these patients had received a health review and further reviews were planned.

  • Data showed that diagnosis rates for patients with a dementia were 96% compared to the CCG average of 95% and national average of 94%. Most of these patients had received a health review and further reviews were planned.

People whose circumstances may make them vulnerable

Good

Updated 10 March 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 homeless people, travellers and those with a learning disability. Most of these patients had care plans in place and had a regular medication and face to face review.

  • The practice had 39 patients on their learning disability register, data highlighted that 83% of the practices patients with a learning disability had a care plan in place; these patients were also regularly reviewed.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

  • The practice was proactive in identifying patients with complex health conditions, flags were applied to the system so that these patients were seen as a priority. The practice shared examples of how this system had previously helped them to effectively deal with specific urgent cases.