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The Humbleyard Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Humbleyard Practice on 20 December 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • 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.
  • Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with, or above, others for most aspects of care.
  • 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 good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt well supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make an improvement is:

  • Ensure near miss errors identified by staff before medicines were dispensed to patients are recorded and monitored.
  • Ensure that carers are proactively identified.
  • Ensure that verbal complaints are recorded consistently.

We saw one element of outstanding practice:

  • The practice proactively monitored children who did not attend their appointment and followed them up for potential safeguarding reasons. We viewed documented actions and responses for these situations and found this provided a safe approach to reviewing safeguarding needs for children. In October 2015 the practice had audited a week of consultations to confirm adherence to their policy of recording who accompanies a child to a consultation, and to check that staff were recording consent for vaccinations or intimate examinations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 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. The practice proactively monitored for children that were not brought to their appointment and followed them up for potential safeguarding reasons. The practice had also undertaken a two cycle audit on the details recorded of who accompanied a child at consultation.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 27 January 2017

The practice is rated as good for providing effective services.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent published results showed that the practice had achieved 100% of the total number of points available, with 8% exception reporting (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • 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.
  • 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 27 January 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed patients rated the practice in line with, or above, others for most aspects of care.
  • Feedback from patients about their care was positive. 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.

Responsive

Good

Updated 27 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.
  • Data from the National GP Patient Survey published in July 2016 showed that 90% of patients surveyed were able to get an appointment at a convenient time, compared to the local average of 91% and the national average of 92%.
  • 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 only shared with staff and other stakeholders if they were directly involved.

Well-led

Good

Updated 27 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 and felt supported in their delivery.
  • There was a clear leadership structure and staff felt supported by management. There was an overarching governance framework which supported the delivery of the strategy and good quality care. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were 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 lead GP 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 virtual patient participation group was active.
Checks on specific services

People with long term conditions

Good

Updated 27 January 2017

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 100%, which was above the local average of 91% and national average of 90%. Exception reporting for diabetes related indicators was in line with local and national averages.

  • Longer appointments and home visits were available when needed.
  • Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
  • 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.

Families, children and young people

Good

Updated 27 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 A&E attendances.
  • The practice proactively monitored for children who did not attend their appointment and followed up on these for potential safeguarding reasons. The practice had also undertaken a two cycle audit on the details recorded of who accompanied a child at consultation.
  • Immunisation rates were in line with local and national averages 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.
  • The percentage of women aged 24 to 64 registered at the practice who were screened for cervical cancer in line with national guidance was 80%, which was above the local average of 77% and the national average of 74%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 27 January 2017

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice contacted patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Working age people (including those recently retired and students)

Good

Updated 27 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 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.
  • Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice had undertaken 413 assessments from 852 invites during 2015/16.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 January 2017

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

  • The percentage of patients diagnosed with dementia whose care plan had been reviewed in a face-to-face review in the preceding 12 months during 2015/16 was 80%, which was 7% below the local average and 4% below the national average.
  • The practice had 119 registered patients experiencing poor mental health, of which 80 required an annual review. All of these patients had received an annual review in 2015/16.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 27 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 had 78 registered patients with a learning disability of which of whom 64 required an annual review. During 2015/16 all 64 had received a review.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Patients who were carers were identified and signposted to local carers’ groups. The practice had 148 (0.8%) patients registered as carers.
  • 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.