You are here

Thorpe-le-Soken Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 24 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorpe Surgery on 01 December 2015. Overall the practice is rated as good. Specifically, we found the practice was good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including all the population groups.

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

  • Staff knew how and where to raise concerns and report safety incidents and near misses. The practice used all opportunities to learn from internal and external incidents to improve service quality.

  • The practice used excellent communication to work with other local healthcare providers to improve their patient outcomes.

  • Feedback obtained from patients about their care was consistently and strongly positive in both the responsiveness and caring aspects of their care and treatment.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from the patients in their patient participation group. For example access to practice services had been improved by extending opening hours and reviewing when appointments are available.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available in the practice, on their website and was easy to understand.
  • The practice had a statement of purpose which had safe, effective, responsive care as its top priorities.

We saw an area of outstanding practice :

  • The clinical leadership and management team were fully committed to a systematic approach to work with patients and local healthcare providers. The practice matron role was developed to create collaborative links with both social care and clinical care organisations. The practice matrons were responsible for implementing the practice approach to Avoiding Unplanned Admissions’ and visited patients identified as in need of frequent or recurrent care, whether this was in their own homes or residential care. The matrons communication weekly with; social services, district nurses, community matrons, palliative care, end of life teams, the practice GP care advisor and other community agencies was to share information and coordinate care for these identified patients. This information was documented and discussed weekly with the practice clinical team to ensure care and treatment was understood for these patients and the team could be proactive with their care to improve quality of life. When the practice population doubled after taking over another practices branch surgery they, recruited a salaried GP, increased their nursing staff and further developed the practice matron roles to take on certain previous GP responsibilities that would free-up their existing GPs to ensure patient care in their local area was not compromised.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 March 2016

The practice is rated as good for providing safe services.

  • The practice had an effective reporting and recording system for significant events.

  • When something went wrong, people received a sincere and timely apology. They were told about any actions taken to improve practice processes to prevent the same thing happening again.

  • Openness and transparency about safety was encouraged at the practice. Staff members understood their responsibility to raise concerns and report incidents in a timely way; and were fully supported when they did.

  • The practice had appointed a GP to lead on safeguarding, children and vulnerable adults and to safeguard them from abuse.

Risks to patients were assessed on a regular basis and were well managed.

Effective

Good

Updated 24 March 2016

The practice is rated as good for providing effective services.

  • Data produced by the practice showed the practice was performing highly when compared to neighbouring practices for their patient outcomes; which were all above the average in comparison with local and national quality outcomes framework (QOF) data for 2014-2015.

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidance.

  • The practice used innovative and proactive methods to improve patient outcomes and it linked with other local providers using their practice developed ‘matron’ role to share best practice and patient care. This was seen in the ‘matron’ holistic approach to assessing, planning and delivering care and treatment. This safe use of innovation and a pioneering approach to care and how it was delivered was actively encouraged.

  • Clinical audits produced by the practice demonstrated quality improvements.

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

  • There was evidence of comprehensive appraisals provided to all staff members at the practice.

  • The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care.

  • They were innovative with their approach to provide multi-disciplinary person-centred care. For example they had developed the role of a practice matron to oversee the co-ordination and management of frail/elderly/vulnerable patients.

New evidence based techniques and technologies were used to support the delivery of high-quality care using the ‘The Productive General Practice programme’ which was in evidence at all levels within the practice.

Caring

Good

Updated 24 March 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice much higher in comparison with others practices nationally and locally for all aspects of care. Feedback from patients about their care and treatment was consistently and overwhelmingly positive.

  • We saw that a passionate patient-centred culture within all practice service development decisions was their main focus for improved care.

  • Staff members were enthusiastic and motivated to offer kind and compassionate care and worked to overcome any difficulties to achieve this. For example a social care professional we spoke with told us the reception staff members were excellent at identifying when the health of patients deteriorated and their need for extra support and knew how to address this.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

Views of external stakeholders were extremely positive and aligned with our findings. For example a manager from a large residential care home told us the GPs and nurses from the practice that visited patients, treated them in a very caring manner and did not rush their visits always taking time to talk to residents to make them feel valued.

Responsive

Good

Updated 24 March 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with their local community to plan how services were provided and ensure they met patients’ needs. For example when a local practice had to give up their branch surgery when they could not recruit GPs. The practice considered how they could support the patients that normally attended Kirby Cross surgery to ensure patient care locally would not be compromised. The practice applied and for and took over the branch surgery service provision, recruited a salaried GP, increased their nursing staff and were innovative in the development of their practice matron roles to take on certain GP previous responsibilities that would free-up their existing GPs to ensure patient care in their local area was not compromised. Thorpe-le-Soken surgery provided the branch surgery with the same level of access and support as their main surgery.

  • Provision of services was designed and run in conjunction with its community to enable people from the local population to access services. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example there were a number of issues that had been raised by the patients and addressed; these included extended opening hours, ease of access, confidentiality in the reception area and its layout, the prescription delivery service and Saturday flu clinics.
  • Patients’ suggestions had also guided the practice to offer patients access to appointments and services in a way and at a time that suited them best. The practice provided clinics, and consultations that ran throughout the day, with clinicians that were always available for the entire 12 hour period between 8am and 8pm every week day.

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

Complaints were managed quickly, openly and in a constructive manner as part of the practice patient feedback system. Information about how to complain was available and easy to understand. Learning from complaints was shared with all staff members and other stakeholders during practice meetings and during the regular communication that took place with their patient participation group (PPG).

Well-led

Outstanding

Updated 24 March 2016

The practice is rated as outstanding for providing responsive services.

  • The practice had a clear vision to deliver high quality care and promote good outcomes for their patients.

    Staff members knew this commitment and what their remit was in relation to this.

  • There was a clear leadership structure and staff members told us they felt supported by management. The practice had a number of policies and procedures which we saw were regularly reviewed and updated to ensure they met good practice and clinical and information governance.

  • There was an overarching governance framework which supported the delivery of good quality care. This included the arrangements to monitor assess and improve quality and identify risks.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. This had been extended to the new branch surgery, and patients that had joined the practice from that area came to speak with the inspection team to express their gratitude and appreciation of the leadership at the practice with regards the improvements they had experience over the last year.

  • The provider was aware of and had a policy showing how they complied with the requirements of the Duty of Candour within the practice.

  • The partners encouraged a culture of openness and honesty. There were systems in place to record and analyse notifiable safety incidents, and evidence was available reflecting this had been undertaken.

  • The practice sought feedback from staff and patients with a proactive PPG that ensured feedback had been acted on.

Practice training records and innovative role development of staff members evidenced a strong focus for training and innovation at the practice.

Checks on specific services

People with long term conditions

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including for the care of people with long-term conditions.

  • Clinical staff members had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Data produced by the practice showed patient outcomes were all above the average in comparison with local and national data for people with long-term conditions.

  • Patients with long term conditions (LTC) were managed within the practice ‘year of care programme’. This programme invited patients to attend the practice once annually to ensure that all of their necessary investigations and health reviews for their LTC(s) could be assessed and monitored in one appointment, saving them from attending the surgery on multiple occasions if they had more than one condition to be monitored. This was benefited patients with multiple LTC(s) particularly those with reduced mobility who found it difficult to attend several appointments.

  • Patients on high-risk medicines or those taking medicines with side effects were offered regular medicine reviews. The dispensary team flagged up overdue medication reviews to the GPs who then organised reviews. The dispensary team and repeat prescription clerks also monitored for any over or under use of medicines and these were communicated to the GPs for review.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP or condition clinical lead worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Longer appointments and home visits were available when needed for people within this population group.

Families, children and young people

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including 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 at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Parents of children told us that children and young people were treated in an age-appropriate way and recognised as individuals.

  • The practice percentage of female patients aged 25-64, attending cervical screening within target period (3.5 or 5.5 year coverage, %) was high at 82.3% in comparison to the local average of 76.7% and national average of 74.3%.

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

  • We saw examples of joint working with midwives, health visitors and school nurses when required for collaborative patient care.

Older people

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. Data produced by the practice showed patient outcomes were all above the average in comparison with local and national data for older people.

  • The practice was responsive to the needs of older people, and offered home visits and urgent and longer appointments if required for those people within this population group with enhanced needs.

  • The designated advanced nurse practitioner (matron) role developed within the practice liaised weekly with social services, district nurses, community matrons, palliative care, end of life, the GP care advisor, and other community agencies to share information and coordinate care for older people.

  • Patients in this population group were booked for a ‘Year of Care’ (YOC) assessment. If concerns regarding mobility, frailty, or memory were found they were offered an assessment by the practice matron, either at home or within the surgery, to create a care plan to meet their on-going needs.

  • The practice had systematically implemented emergency health care plans, avoiding hospital admission plans and ‘do not attempt resuscitation’ (DNAR) choices to reduce burdensome interventions and unnecessary admission to acute care. These plans were populated during internal practice discussion and with the use of a risk stratification tool. If older patients were at risk of admission, they had a care plan of on-going wishes and care needs. Patients were given the opportunity to consent to relevant information being added to the ’out of hour’s’ (OOH) software system, so this provider could deliver continuity of care.

  • The practice identified patients who were carer’s and offered them a carer’s health assessment. The practice identified carers on their computer system to alert GPs, so if they attended for an appointment for their own care needs, the GPs could discuss with them any support they might need in their role as a carer. There was written information available to direct carers to various avenues of support available within the practice, and there were useful links and information available on the practice website.

The ‘GP Care Advisor’ attached to the practice provided, social financial benefit advice, and saw patients at the practice or visited them in their homes if they were housebound or less able to visit the practice. The advisor told me the practice used their services appropriately and always provided them with sufficient information to be able to support patients effectively.

Working age people (including those recently retired and students)

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including for the care of working-age people (including those recently retired and students).

  • The needs of the practice working age population, including those recently retired and students had been identified and the practice had adjusted their services to ensure they were accessible, flexible and offered continuity.

  • The practice ‘year of care programme’ invited patients to attend the practice once annually to ensure that all of their necessary investigations and health reviews for their LTC(s) could be assessed and monitored in one appointment, saving them from attending the surgery on multiple occasions if they had more than one condition to be monitored. This was particularly appreciated by working age patients with a LTC(s) who found it difficult to attend multiple appointments.

  • The practice offered online appointment booking and repeat services as well as a full range of health promotion and screening that reflected the needs of this population group. The practice used further technology for working age people (including those recently retired and students) for example by sending text message reminders to reduce missed appointments and ensure these working people could plan their days.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including for the care of people experiencing poor mental health (including people with dementia).

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

  • It carried out advance care planning for patients with dementia referring them to the memory clinic and all patients in this population group had a dedicated care plan to support their care.

  • Those deemed most at risk were placed on the avoiding unplanned admissions register and had collaborative care plans. Those at risk of medication abuse were put onto more frequently issued prescriptions and the dispensary team kept a record to ensure the prescriptions were collected or dispensed.

  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. They made regular referrals to the GP care advisor to provide benefit advice and support.

  • It 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 received training and had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 March 2016

The practice is rated as good for safe, effective, caring and responsive services, and outstanding for well-led, services. The effects of these ratings apply to everyone using the practice, including for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • It offered longer appointments for vulnerable people and those with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The nurse practitioner matron at the practice took the lead role to visit vulnerable people in the local residential care and learning disability homes. This provided consistency and co-ordination of care for these patients. The practice matron service ensured palliative care patients were identified and provided end of life multidisciplinary care.

  • Vulnerable patients were supported to access various support groups and voluntary organisations.

  • Staff had received training to recognise the signs of abuse in vulnerable adults and children. Staff knew their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies and when to refer to the practice safeguarding lead.

The practice recognised the need to provide extra support for marginalised groups and maintained close links with a local traveller’s community, delivering opportunistic health checks when able.