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Wolverhampton Road Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wolverhampton Road Surgery on 18 May 2016. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had an understanding of their performance and had undertaken clinical audits to identify areas for improvement.

  • Patients said they were treated 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had reviewed the appointment system and introduced telephone clinics to increase the number and type of appointments available for patients.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. The practice had a well-established patient participation group.
  • The provider was aware of and complied with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Ensure staff acting as chaperones understand their responsibilities, including where to stand during an examination.

  • Review system for logging prescriptions to ensure an appropriate audit trail is maintained.

  • Review the way in which patients who are carers are identified and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse. There was a lead GP for safeguarding. The practice was working to further develop the register of vulnerable patients.

  • The practice had comprehensive systems to monitor and prevent the spread of infection.

  • The arrangements for managing medicines, including emergency medicines and vaccines, in the practice kept patients safe.

  • Risks to patients’ health and safety were assessed and well managed across the practice.

Effective

Good

Updated 20 July 2016

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. The practice had achieved 96.9% of the total number of points available. This was higher than the national average of 94.8% and the CCG average of 95.1%.

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

  • Clinical audits demonstrated quality improvement.

  • The practice demonstrated performance improvement in other areas including prescribing and referral rates.

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

  • There was evidence of appraisals and personal development plans for all staff.

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

Caring

Good

Updated 20 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for several aspects of care. For example, 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 88% and the national average of 85%).

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

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

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

  • The practice had identified 49 patients as carers which was equivalent to 0.5% of their practice list. Further work was underway by the practice to further develop this register.

Responsive

Good

Updated 20 July 2016

The practice is rated as good for providing responsive services.

  • The practice was actively engaged with the Staffordshire and Surrounds Clinical Commissioning Group (CCG) and therefore involved in shaping local services.

  • The practice had reviewed the appointment system and introduced telephone clinics to increase the number and type of appointments available for patients.

  • Urgent appointments were available the same day and appointments could be booked in advance.

  • The practice employed two advanced nurse practitioners (ANP) who had undergone special training that allowed them to diagnose and treat a wide range of common conditions. This provided GPs with greater capacity to see patients that presented with complex needs.

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

Well-led

Good

Updated 20 July 2016

The practice is rated as good 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.

  • 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.

  • 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 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. The patient participation group was active and were instrumental in driving forward improvements within the practice

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 20 July 2016

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

  • The practice had a robust call and recall system to ensure that patients attended their medical appointments.

  • Tools were used to provide support to the face to face care provided. For example, an App was used, which reminded patients to send in their blood pressure readings by text message from a mobile phone which clinicians could then read and analyse remotely.

  • Patients at risk of hospital admission were identified as a priority. Admission avoidance plans had been drawn up and regularly reviewed. The number of emergency admissions for 19 ambulatory care sensitive conditions was in line with the national average.

  • Performance for the five diabetes related indicators were comparable to the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 89% compared with the national average of 88%.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 20 July 2016

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

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

  • Same day emergency appointments were available for children.

  • Pre and post-natal services were provided and patients had access to a community midwife who held clinics at the practice.

  • Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages.

  • Chlamydia screening and a full range of reversible contraception and contraception counselling was offered including coil fitting.

Older people

Good

Updated 20 July 2016

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

  • The practice was actively engaged in immunisation and health promotion for the elderly. Vaccination rates for uptake of the seasonal flu vaccination were all above national averages. For example, 75% of patients aged 65 or over had received the vaccination compared to the national average of 69%.

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

  • The practice was actively working with local care homes and looking at innovative ways of improving the care provided for patients in these care settings including the use of Skype for consultations. GPs, advanced nurse practitioners and nurses regularly visited care homes, and undertook medicine reviews and routine assessments as well as urgent care issues.

  • The practice had a robust call and recall system to ensure that all patients, including older people, attend appointments when necessary with a doctor, nurse, HCA or the pharmacist.

  • The practice offered a flexible appointment system including extended hours surgeries to accommodate those who may otherwise be unable to attend during the day.

Working age people (including those recently retired and students)

Good

Updated 20 July 2016

The practice is rated as good 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.

  • Extended hours appointments were available each Monday evening and on Saturday mornings twice per month.

  • Patients were able to speak with a doctor for advice when necessary every working day via the telephone.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 July 2016

Performance in three mental health related indicators was in line with or slightly above with the national average. For example:

  • 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the national average.

  • 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record compared with the national average of 88%.

  • 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the last 12 months compared with the national average of 90%

  • Where required, patients were offered double appointments to allow sufficient time to deal with any complex issues.

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

  • Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had focused on developing their dementia register over the past 18 months and as a result had seen an increase in patients identified with dementia.

People whose circumstances may make them vulnerable

Good

Updated 20 July 2016

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

  • The practice was developing a register of vulnerable adults living in vulnerable circumstances.

  • The practice offered longer appointments for patients with a learning disability. Annual health checks were offered.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice had worked with the learning disability team and actively promoted the use of accessible, pictorial care plans for this group of patients.

  • 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.

  • Following the inspection, the practice appointed an administrator who managed the list of those on the Child Protection Register and all associated correspondence, ensuring that it was acted upon appropriately.

  • The practice had identified some of their patients as carers. Further work was needed however to further develop this register.