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Inspection Summary


Overall summary & rating

Outstanding

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Wulfstan Surgery on 21 April 2016. The overall rating for this service is outstanding

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

  • There was a system in place to raise concerns and report significant events. Staff understood their responsibilities to raise concerns, and to report significant events. These were discussed regularly at meetings and were a standing agenda item. Learning was shared with practice staff regularly and with other practices in the locality.
  • Patients’ needs were assessed and care was provided to meet those needs in line with current guidance. Staff had the skills and expertise to deliver effective care and treatment to patients. This was maintained through a programme of continuous development to ensure their skills remained current.
  • Risks to patients were assessed and well managed through practice meetings and collaborative discussions with the multi-disciplinary team. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Information about safety alerts was reviewed and communicated to staff by the practice manager in a timely way.
  • Patients told us GPs and nurses at the practice treated them 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 in the reception area and on the practice’s website. Patients told us that they knew how to complain if they needed to.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. This included easy access for patients who used wheelchairs.
  • There was a clear leadership structure and staff told us they felt supported by management. Staff morale was high. Staff were committed and motivated to deliver high standards of care and there was evidence of team working throughout the practice.
  • The practice proactively sought feedback from patients, which it acted on.
  • The practice coordinated a volunteer drivers’ scheme which was run by patients for patients. This free service was provided for those patients who experienced difficulties getting to the practice.
  • The practice became a host practice for research in 2012. They regularly hold research awareness events in order to increase awareness of clinical trials and studies and to encourage participation. These were coordinated by two GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff were encouraged to report all incidents and events as part of their everyday role and responsibilities. The practice carried out a thorough analysis of significant events and shared learning from these with appropriate staff. Where patients were affected they received a written apology and were told about any actions taken 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. Staff had received training relevant to their role.
  • Risks to patients were assessed and well managed. There were robust systems in place to manage patient safety alerts, including medicines alerts which were acted upon and tracked.
  • Appropriate recruitment procedures were followed to ensure that only suitably qualified staff were employed to work at the practice.

Effective

Good

Updated 5 September 2016

The practice is rated as good for providing effective services.

  • 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.
  • The practice operated a continuous audit system to evaluate care and treatment, ensuring that reviews were undertaken and improvements were made to enhance patient care.
  • The practice consistently achieved higher than average results for the Quality and Outcomes Framework (QOF) indicators when compared with other local practices and nationally. Exception rates were below local and national averages in most areas. For example, the proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 97% which was above the local average of 85% and above the national average of 84%.The practice exception rate was 0% which was below the CCG average of 6% and below the national average of 8%. Evidence showed this level had been maintained by the practice for a number of years.
  • The practice was the top achieving practice within the local area in all patient groups for the administration of flu vaccines for January 2016. For example, 88% of patients over 65 years (local average 78%); 69% of patients who were at risk of contracting flu under 65 years (local average 50%); 76% of pregnant women (local average 49%); 82% of patients aged two years (local average 49%); 85% of patients aged three years (local average 48%); and 76% of patients aged four years (local average 42%). Flu clinics were advertised on the practice website and in the practice waiting area. Telephone calls, text messages and letters were also sent out to remind patients about the flu vaccination during the flu season.

  • Staff received the training to maintain and develop their skills so that patients received effective care and treatment. Staff received annual appraisals and had development plans in place to ensure continued personal development. Staff regularly took part in the practice devised quizzes to maintain and improve their knowledge in a range of areas.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Meetings were held regularly and were attended by district and palliative care nurses.

Caring

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for providing caring services.

  • Staff were courteous and very helpful to patients both attending at the reception desk and on the telephone. We observed that patients were treated with dignity and respect.
  • Survey results showed that the practice was consistently rated highly by their patients. Results from the National GP Patient Survey published in January 2016 showed that the practice scored above average for results in relation to patients’ experience and satisfaction scores on consultations with the GP and the nurses; 93% of patients said the last GP they spoke to was good at treating them with care and concern which was above the CCG average of 90% and national average of 85%; 96% of patients said the last nurse they spoke to was good at treating them with care and concern which was above the CCG average of 92% and national average of 91%.
  • The practice carried out their own regular in-house surveys to monitor and evaluate patient feedback on the services they provided. The last survey done in March 2016 showed that 98% of patients were satisfied with online access to this service; 98% of patients were satisfied with access to a GP or nurse; 97% of patients were satisfied with the care they received; and that overall satisfaction with the practice was rated by patients as 98%.
  • Six patients told us they had nothing but praise for the GPs. They said GPs cared for all their patients and gave them the best service. These patients were also extremely positive about all staff at the practice. Patients completed 41 comment cards which gave positive comments about the standard of care received. Data showed that 98% of patients said they found the receptionists at the practice helpful which was above the CCG average of 89% and national average of 87%.
  • The practice had involved patient and carers in a number of initiatives to encourage interaction and support. For example, Christmas tea parties had been held for carers for the last four years. Monthly Nosh’N’Natter meetings had been developed with the first meeting held in May 2016. The Nosh’N’Natter group was a monthly lunchtime get together for patients to meet friends, make new friends, share experiences and enjoy lunch. Free transport was provided for those patients who needed it.

Responsive

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and the local community in planning how services were provided to meet patients’ needs. Meetings were regularly attended with other practices and partner organisations from the locality so that services could be monitored and improved as required.
  • Dedicated notice boards in the waiting area gave patients easy access to information relevant to them. For example, there was a range of leaflets about services provided for the practice’s younger population.
  • Information was available on the practice website for specific population groups. There was a young persons’ page called Sex Etc. with information about various aspects of sexual education specifically aimed at this group.
  • A number of patients were sent regular emails following their appointments to recap what was discussed with the GP during consultations.
  • On-site services such as phlebotomy (taking blood samples), blood monitoring, ear syringing, and midwifery services were provided to reduce inconvenience to patients so they did not have to travel to secondary care providers for these services.
  • The practice had received consistently high rates of feedback from their patients for a number of years. Results from the National GP Patient Survey results published in January 2016 showed that patients’ satisfaction with how they could access care and treatment was above local and national averages. For example, 97% of patients said they could get through easily to the practice by telephone which was above the CCG average of 78% and national average of 73%; 94% of patients described their experience of making an appointment as good which was above the CCG average of 79% and national average of 73%; 97% of patients said they usually waited 15 minutes or less after their appointment time which was above the CCG average of 69% and national average of 65%.
  • The practice coordinated a volunteer drivers’ scheme which was run by patients for patients. This free service was provided for those patients who experienced difficulties getting to the practice.
  • Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked up to three months in advance. Extended hours were available to benefit patients unable to attend during the main part of the working day. Patients confirmed they were able to make an appointment with the GPs and receive continuity of care, with urgent and non-urgent appointments available the same day.
  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders

Well-led

Good

Updated 5 September 2016

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

  • 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. This included arrangements to monitor and improve quality and identify risk.
  • There was a clear vision and strategy to provide quality, safe and accessible services. Staff shared this vision and told us their strategy was to remove obstacles and barriers to providing accessible patient care. Staff told us their overall aim was to be the best practice to give the best care for patients.
  • Staff morale was high with a high level of staff satisfaction. The practice encouraged a culture of openness and honesty. High standards were promoted and owned by all practice staff and teams worked together across all roles. Staff told us they were confident they would be supported if they needed to raise any issues or concerns. They said they felt respected, valued and supported by everyone and that they absolutely loved working at the practice. We observed that everyone was involved in the practice and had a shared commitment to provide the best care for patients.
  • Staff had received inductions, regular performance reviews and attended regular staff meetings and events.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had two active Patient Participation Groups (PPGs) and responded to feedback from patients about suggestions for service improvements. A specific PPG had been formed to represent the views and experiences of patients over the age of 75. Plans were in place for a PPG to be developed specifically for younger patients to get their views, ideas and encourage their involvement in the development of the practice.
Checks on specific services

Older people

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for the care of older patients.

  • Nationally reported data showed that outcomes for patients were higher than average for conditions commonly found in older patients. The proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 97% which was higher than the local average of 85% and the national average of 84%.The practice exception rate was 0% which was below the Clinical Commissioning Group (CCG) average of 6% and below the national average of 8%.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care. They held regular multidisciplinary integrated care meetings where all patients on the palliative care register were discussed.
  • It was responsive to the needs of older patients and offered home visits with rapid access appointments for those patients with enhanced needs.
  • There was a trained co-ordinator employed by the practice, who worked in conjunction with the over 75s project to provide holistic reviews of patients over the age of 75 years. They worked proactively to help patients maintain good health. This had resulted in increased social engagement with older patients aimed at reducing social isolation and loneliness.
  • Health checks were carried out for all patients over the age of 75 years.
  • Support and weekly ward rounds were provided routinely for local care homes for the elderly by a nominated GP to ensure continuity of care was maintained.
  • The practice had provided a free volunteer drivers service for those patients who struggled to get to the practice. This service was run by patients for patients.
  • The practice demonstrated that they were the top practice within the local area in all patient groups for the administration of flu vaccines for 2015. Data showed that 88% of patients over 65 years had received their vaccines, which was higher than the local average of 55%.

People with long term conditions

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for the care of patients with long-term conditions.

  • There were systems in place to monitor patients with chronic diseases. The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice ensured continuity of care in order to achieve the best outcomes for individual patients. All patients diagnosed with a long term condition had a named GP and a structured regular review to check that their health and medicine needs were being met. Reviews were carried out at least annually if not more often. Holistic appointments were offered so that the number of additional times patients needed to attend for appointments was reduced. Longer appointments and home visits were available when needed.
  • For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice achieved higher than local and national rates in providing care and support for patients with long term conditions. The performance indicator for patients with hypertension (high blood pressure) was 91% which was higher than the CCG average of 86% and the national average of 84%. The practice exception rate was 3% which was in line with the CCG and national averages. (Unpublished data for 2015/2016 shows the exception rate as 2%). Performance for diabetes related indicators such as patients who had received an annual review including foot examinations was 98% which was above the local average of 92% and the national average of 88%. The practice exception rate of 3% was below the CCG average of 9% and below the national average of 11%.

Families, children and young people

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for the care of families, children and young patients.

  • There were systems in place to identify and follow up children who were at risk of abuse. For example, children and young patients who had a high number of accident and emergency (A&E) attendances. Staff had received safeguarding training. They were aware of their responsibilities in protecting children who were at risk of harm.
  • Childhood immunisation rates were overall comparable to the local CCG averages. The practice contacted parents when babies and children did not attend for their vaccinations and informed Child Health Services when appropriate.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable and accessible for children, with changing facilities available for babies. There was a child friendly waiting area with a range of toys, books and play equipment available.
  • A range of information and services was provided for their younger population. There was a young persons’ guide to the services available on the practice’s website and a printed guide available in the waiting area. There was also a separate page called Sex Etc. with information about various aspects of sexual education specifically for this group. In the practice waiting area a dedicated notice board provided information and notices specifically for younger patients. The practice also used text and social media as a means of effective communication.

  • Monthly meetings were held with midwives, health visitors, school nurses and the GP safeguarding lead where any concerns they might have were shared.
  • A number of online services including booking appointments, requesting repeat medicines and access to medical records were also available.
  • The Quality and Outcome Framework (QOF) data for 2014/2015 showed the practice achieved higher than local and national rates for the cervical screening programme was 89% which was higher than the local average of 83% and the national average of 82%.

Working age people (including those recently retired and students)

Outstanding

Updated 5 September 2016

The practice is rated as outstanding for the care of working-age patients (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 extended hours so that patients could access appointments around their working hours. Appointment times were available from 7am to 8am every Monday and from 9am to 10.20am on the first and third Saturdays each month for pre-booked appointments only.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

People whose circumstances may make them vulnerable

Outstanding

Updated 5 September 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability. Alternative formats were available for patients to access information such as leaflets in large text, easy read or alternative fonts. The practice offered longer appointments for patients with a learning disability, and had completed annual health checks for all nine patients on their register.
  • The practice was registered as a member of the Safe Place Scheme for patients with a learning disability if they felt vulnerable or needed support.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients and advised them on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments or offered longer appointments.
  • Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns.
  • The practice treated patients of all ages and provided a range of medical services. This included vulnerable groups such as people who lived on visiting narrow boats. The practice told us they had no homeless people or travellers registered as patients, but they would be provided with treatment and health care according to their needs.
  • A poster was displayed in the waiting room advertising support for carers. The practice actively engaged in activities to support carers and their families, such as afternoon tea activities and Christmas parties.
  • Counselling services are provided at the practice to offer support for vulnerable patients.
  • There was a portable hearing loop that could be taken into any clinical room or used at reception to help patients with a hearing impairment. Information was provided in the practice newsletter about various websites patients could also access for support, such as Action on Hearing Loss.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 5 September 2016

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

  • The practice held a register of patients experiencing poor mental health including those patients with dementia. Staff had received training on how to care for patients’ with mental health needs and dementia.
  • Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for these patients who were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice telephoned those patients with poor memory to remind them of their appointment.
  • Patients and carers were encouraged to attend the local Dementia Cafés, based in Leamington. Leaflets were available for patients about these facilities.
  • The GPs and practice nurses understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
  • The Quality and Outcome Framework (QOF) data for 2014/2015 showed the practice achieved higher than local and national rates for support for patients with poor mental health. Patients with mental health concerns such as schizophrenia, bipolar affective disorder and other psychoses with agreed care plans in place were 100% which was above the CCG average of 93% and above the national average of 90%. Although the practice exception rate at 17% was above the CCG average of 10% and above the national average of 11%, the practice provided explanations and demonstrated the action they had taken to address this. (Unverified data showed that the exception rate had reduced to 0% for 2015/2016).The proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 97% which was above the local average of 85% and above the national average of 84%.The practice exception rate was 0% which was below the CCG average of 6% and below the national average of 8%.