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Whitemoor Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whitemoor medical centre on 5 April 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 in place for reporting and recording significant events. Learning was shared with staff at meetings.
  • Risks to patients were assessed and well managed. Health and safety precautions had been taken which included checking equipment was fully working and safe to use and infection prevention control measures were in place.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. Personal development was encouraged and provision made regularly for this for all staff via the appraisal process.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. They had achieved 97% of the total points available with an exception reporting rate of 7%
  • 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.
  • Feedback from patients about their care was positive, however, patients reported that it was difficult to access a routine appointment. Same day appointments were available for urgent needs.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included baby changing facilities and treatment rooms which had been purpose built.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient participation group.
  • The practice had a clear vision which was patient focussed. The strategy to deliver this vision had been shared with staff.

We saw two areas of outstanding practice:

  • The practice proactively conducted a comprehensive case review of any suicide, which included external reviewers to improve clinicians’ identification of those at risk of self-harm
  • The practice worked in collaboration with four local practices on a project to drive improvement in care for older people and reduce emergency admissions from care homes. This had resulted in an 8% reduction in emergency admissions in the preceding 12 months.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 June 2016

The practice is rated as good for providing safe services.

  • There was an effective and robust system in place for reporting and recording significant events. All staff knew how to report incidents.
  • Lessons were shared to make sure action was taken to improve safety in the practice. Detailed records included analysis of the events and risk assessment to reduce potential reoccurrence. Learning outcomes were shared in weekly practice meetings.
  • When there were unintended or unexpected safety incidents, patients received support, information, and an 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. This included infection control procedures, management of medicines, staff recruitment procedures and appropriate training of staff in safeguarding.
  • Risks to patients were assessed and well managed. This included health and safety, ensuring sufficient staff in place to meet patient needs and suitable emergency procedures if a patient presented with an urgent medical condition.

Effective

Good

Updated 6 June 2016

The practice is rated as good 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 were undertaken over two cycles and improvements were made as a result to enhance patient care.

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 through the appraisal process and training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff.

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

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 were 97% of the total number of points available, with 7% exception reporting. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

Caring

Good

Updated 6 June 2016

The practice is rated as good for providing caring services.

Data from the national GP patient survey showed patients rated the practice higher than others for some aspects of care. Feedback from patients about their care and treatment was consistently positive. For example; 87% of patients said their GP was good at listening to them and 96% of patients said they had trust and confidence in their GP. 93% of patients also said that nurses gave them enough time and 97% of patients said that they had confidence in them.

We observed a strong patient-centred culture. Patients told us 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 also saw staff treated patients with kindness and respect, ensuring that confidentiality was maintained.

Staff were motivated and inspired to offer kind and compassionate care. The practice had a holistic approach to treating patients, for example, they had a policy of sending out written confirmation of appointments made over the telephone by vulnerable patients or those who may forget.

Responsive

Good

Updated 6 June 2016

The practice is rated as good 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. It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG) and were innovative in responding to the specific needs of its community by providing extra support to patients.

  • They utilised the services of a Well-being Worker who was able to assist with referrals to the Live Life Better Derbyshire scheme. The scheme provided support for people with specific needs, including people who were carers or required help with exercise or activity, weight management, smoking cessation and help with issues such as debt and housing. A buddy could also be provided to assist people to attend appointments or services and this had assisted three patients in the preceding eight months.

  • They were proactive in providing care for vulnerable people. Annual health checks were provided for all vulnerable people on their registers and there was a recall system to manage non-attenders.

Patients told us that urgent appointments were usually available the same day. However, patients told us that is was often difficult to get a routine appointment and to see their preferred GP. Telephone consultations and home visits were available by appointment and where required. There were also ‘on the day’ appointments available throughout the day for minor illness with the advanced nurse practitioner and the duty GP.

The practice had good facilities and was well equipped to treat patients and meet their needs. The premises were suitable for patients who had a disability

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 6 June 2016

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

There was a clear vision and strategy with quality and safety as its top priority. This 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 risk assessments conducted to identify risk.

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

The practice had a proactive approach to caring for patients who were also carers. They had engaged with external providers and other practices in the locality to enable an enhanced package of care for patients who were also carers.

Staff had received comprehensive 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. Learning and development was encouraged and supported by the partners and management team and dedicated time was assigned for staff to attend development opportunities

Checks on specific services

People with long term conditions

Good

Updated 6 June 2016

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

  • Patients with a long term condition had a named GP who worked collaboratively with the nursing staff who had lead roles in chronic disease management. They used robust clinical protocols in their structured reviews to check their health and medicines needs were being met which were conducted each year or more often where required

  • There were robust recall processes for non-attenders.
  • Patients with chronic diseases were involved in writing their own care plan.
  • The practice provided an anticoagulation service from the surgery, and also in patients’ own homes where required.
  • The practice had received funding for a Community pharmacist due to start in June 2016 and an additional advanced nurse practitioner to manage patients with long term conditions. This was as a result of their participation in the Belper 5 project.
  • The practice provided In house diagnostics, for example spirometry, electro cardiogram (ECG), ambulatory blood pressure monitoring, Doppler ultrasound and 24 hour ECG.

  • The practice had achieved 100% of QOF points for asthma related indicators which was 1% above the CCG average and 3% above the national average. They had an exception rate of 1% which was better than CCG or national averages.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 6 June 2016

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

  • The practice had a policy that any request for an appointment for a child was prioritised. They had provided basic phone triage training for staff to enable them to highlight any ‘red flags’ to the duty doctor immediately.
  • The practice provided dedicated child immunisation clinics with 20 minute appointments to enable full consent and ensure patients were not rushed. This had resulted in immunisation rates being relatively high for all standard childhood immunisations. These were 95%-99% for children under 24 months.
  • There was a breastfeeding room and a baby change area.
  • The practice provided teenage clinics for contraception and sexual health advice and offered long acting contraception services and emergency contraception.
  • 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. There was a dedicated lead GP for child protection working closely with the health visiting and school nursing teams to identify and discuss children at risk.
  • 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 6 June 2016

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

  • There were innovative approaches to providing integrated person-centred care. For example; multi-disciplinary meetings included the social care team, community nursing team, mental health team and care coordinator. The practice also utilised the services of a Well-being Worker who was able to assist with referrals to social care for assessment and support, and help with finding suitable community groups, social activities and befriending services. Assistance with shopping travel and small household maintenance tasks could be arranged.
  • All patients over 75 had a named GP who worked with a care coordinator and advanced community practitioner to monitor admissions to hospital which may have been avoidable and planned future care to avoid further avoidable admissions. Care plans were utilised and shared where needed.
  • The practice had recently appointed an Advanced Community Practitioner to assess and treat patients at home and provided longer appointments within the surgery for the over 65s.
  • The practice worked closely with local care homes, each one having a named GP who visited monthly or more often where required. They also worked closely with a local geriatrician to identify older people who were high risk and plan appropriate care.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice participated in the ‘Belper 5’ project to enable collaborative working with other local surgeries to improve community care for patients, especially the frail elderly.

Working age people (including those recently retired and students)

Good

Updated 6 June 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.

  • The practice offered early morning and late evening extended hours surgeries with GPs and nurses..
  • The practice had implemented a ‘contact us’ button on the practice’s website enabling queries to be directed straight to practice manager for rapid response.
  • Appointments and repeat prescription could be booked on line and an automated telephone booking service was available.
  • The practice held consultant led clinics in house for orthopaedics and general surgery so that patients didn’t need to travel to hospital for their outpatient appointments for these specialities.
  • The practice offered NHS health checks for people aged 40-74 and 17% of the practice population had attended in the preceding 12 months. The practice followed up any health risks or issues identified with strong emphasis on health promotion and disease prevention.
  • 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. The practice had provided a cervical screening test for 85% of eligible women in the preceding five years, which was 2% higher than the CCG average and 4% higher than the national average.
  • The practice had participated in a research project which benefitted patients under 50s in identifying familial breast cancer. This had resulted in two patients being referred for further investigation and treatment who would otherwise not have been identified.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 June 2016

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

  • 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was 8% lower than CCG and national averages. Exception reporting at 9% was the same as the CCG and national averages.

  • The practice carried out advance care planning for patients with dementia and care plans were shared with carers. There was a named GP who reviewed patients with dementia in local care homes.
  • The practice utilised a care coordinator to follow up patients with dementia who had been discharged from hospital. A variety of services were being accessed to support patients and their carers, and multi-disciplinary meetings were held to plan ongoing care.
  • The practice had a GP who had received specific training in the management of substance misuse. Some support services were available at the practice, for example, alcohol support services
  • There was a counselling service and cognitive behavioural therapy (CBT) available at the practice and there was regular contact and discussion with the practice team.
  • The practice told patients experiencing poor mental health about how to access various support groups and voluntary 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.

People whose circumstances may make them vulnerable

Good

Updated 6 June 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. They offered longer appointments for patients with a learning disability and worked closely with their carers. .
  • Annual health checks were provided by a specialist nurse for all vulnerable people on their registers and there was a recall system to manage non-attenders.
  • The practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable people. The meetings included community staff, social team, mental health team, care coordinator as well as practice staff.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Citizens Advice Bureau clinics were held within the surgery.
  • 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. A GP from the practice had recently been appointed as a named adult safeguarding lead for Derbyshire.