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Archived: Voyager Family Health Good

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Inspection Summary


Overall summary & rating

Good

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Milestone Surgery on 7 December 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system 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.

  • 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.

  • 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.

  • 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 provider was aware of and complied with the requirements of the duty of candour.

  • The practice had a high number of patients who left the practice each year or lived in the United Kingdom intermittently. This contributed in some way to the difficulties for ensuring that all patients with long term conditions were reviewed regularly.

  • The ten patients we spoke with said they received personalised care and they were fully involved and empowered as partners in their care.

  • The practice team was forward thinking and part of local pilot schemes to improve outcomes for patients in the area.

  • A GP with a Special Interest (GPwSI) ran weekly cardiology and atrial fibrillation clinics for the local community. Patients of Milestone Surgery benefitted from this service by having a GPwSI available to all the doctors in the practice as a valuable resource.

The areas where the provider should make improvements are:

  • The practice should continue to improve patient outcomes for those with long term conditions. This includes performance for diabetes, asthma and chronic obstructive pulmonary disease related indicators.

  • The practice should ensure that they identify and support carers appropriately.

  • Ensure the appropriate provision of annual health checks and health action plans for patients with learning disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 January 2017

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, 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that some patient outcomes were below average compared to the local and national average. This had been identified by the practice and actions were taken to improve the performance of the practice.
  • Patients with learning disabilities were offered annual health checks. However, not all patients had a health check in the last 12 months. There were no specific plans in place to address this shortfall at the time of our inspection.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • 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 24 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similarly to others for most aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Feedback from the ten patients we spoke with also suggested that they received personalised care and they were fully involved and empowered as partners in their care.
  • 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.

Responsive

Good

Updated 24 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and clinical commissioning group to secure improvements to services where these were identified. For example, the practice provided on-the-day and emergency appointments to meet acute demand. The practice also offered commuter clinics in an extended hours period beyond normal working hours. The practice was also taking part in a local initiative to provide extra appointments during the winter months to reduce system-wide winter pressures.

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

Well-led

Good

Updated 24 January 2017

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.
  • There was focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Requires improvement

Updated 24 January 2017

The practice is rated as requires improvement 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. The practice had chronic disease clinics to care for those with long term health conditions.
  • Performance for diabetes related indicators was comparable or lower than the local and the national average in 2014/15. Performance for asthma and chronic obstructive pulmonary disease was also lower than the local and the national average in 2014/15. Unverified data from 2015/16 showed a decline in some areas.
  • We noted that that a new approach had been adopted this year to promote timely reviews to be booked and patients were encouraged to attend their reviews with reminder letters. The practice had a high number of patients who left the practice each year or lived in the United Kingdom intermittently. This contributed in some way to the difficulties for ensuring that all patients with long term conditions were reviewed regularly.
  • Staff at the practice had training appropriate to the care of people with chronic diseases.
  • Longer appointments and home visits were available when needed.
  • 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.
  • The practice employed a pharmacist who was available to talk to patients and liaised with GPs. Medicines for certain patient groups were also monitored to ensure safe prescribing.
  • The practice had regular meetings to discuss the needs of patients who received ‘end of life’ care.

Families, children and young people

Good

Updated 24 January 2017

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 accident and emergency (A&E) attendances.
  • Childhood immunisations rates were high and the practice operated an immunisation clinic on most working days.
  • The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 83% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. The practice ran an after-school clinic programme which had helped to reduce A&E attendances for the paediatric population.
  • The practice worked closely with the local health visiting team and the school nursing team.
  • The practice was taking part in a local initiative to provide extra appointments during the winter months to reduce system-wide winter pressures.
  • The practice hosted in house midwife led clinics two days per week.

Older people

Good

Updated 24 January 2017

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. The practice provided health checks for patients who were over 75 years of age. The practice liaised with the local out-of-hours provider for those patients requiring regular and frequent healthcare support and was taking part in health surveillance programs for the elderly.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided influenza and shingles vaccinations and achieved high rates of immunisations.
  • The practice was taking part in national programmes to prevent people from being unnecessarily being admitted to hospital, they were also involved in a falls prevention programme.
  • The practice worked closely with the local multi-disciplinary team (MDT), including weekly meetings in order to better coordinate the care of elderly patients.

Working age people (including those recently retired and students)

Good

Updated 24 January 2017

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. The practice offered telephone appointments and Saturday influenza vaccination clinics.
  • The practice also offered commuter clinics in an extended hours period beyond normal working hours on Monday evenings and Wednesday mornings.
  • 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. This allowed online repeat prescription requests and direct appointment booking.
  • The practice allowed out-of-area registration for those patients who, for example worked locally but lived elsewhere.
  • The practice operated a triage system which meant patients were able to speak to a GP or a nurse without having to attend the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 January 2017

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

  • The practice kept a register of patients with chronic mental health conditions and carried out regular annual reviews of these patients.
  • The practice closely monitored patients who were taking medicines related to the treatment of mental illness.
  • Performance for mental health related indicators was comparable or better than the local and the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice worked closely with the local mental health teams and with the local Talk plus (talking therapies) groups. The practice hosted the local talking therapies service on site.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia. The practice was dementia friendly and training was provided for all staff on dementia and dealing with patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 January 2017

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.
  • The practice offered longer appointments for patients with complex needs and or a learning disability.
  • Patients with learning disabilities received annual health checks. However, not all patients with learning disabilities received health checks in the last 12 months.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice worked closely with the multi-disciplinary team and maintained close links with the local team of community midwives, health visitors and district nurses. The practice also liaised closely with those nursing homes locally which were looking after vulnerable people.
  • 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.