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Inspection Summary


Overall summary & rating

Good

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wragby Surgery on 8 December 2015. 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.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • 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.
  • 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 practice was a high achiever in terms of patient satisfaction across a wide range of indicators.

We saw areas of outstanding practice including:

  • Effective use of additional funding to care for  those patients over 75 which had resulted in a significant decrease in the number of accident and emergency and un-planned admissions to secondary care for patients in this age group.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should ;

  • Ensure that multi-disciplinary meetings are properly recorded.

  • Implement a written policy to instruct staff on how to ensure the security of prescription pads.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

Effective

Good

Updated 28 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were consistently at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) and used it routinely. 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 and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 28 January 2016

The practice is rated as good for providing caring services. Data showed that patients rated the practice significantly higher than 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. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 28 January 2016

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found it easy to make an appointment with however if they wanted to see a particular GP then they may have to wait for two to three weeks. 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 28 January 2016

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. There was a patient participation group in existence. Staff and GPs had received inductions, and all staff received regular supervision and appraisal of their performance.

Checks on specific services

People with long term conditions

Good

Updated 28 January 2016

The practice is rated as good for the care of people with long-term conditions. Nurse Consultants had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and were recalled every six months for a review to check that their health and medication needs were being met. For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 28 January 2016

The practice is rated as good for the care of families, children and young people. Immunisation rates were relatively high 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, and we saw evidence to confirm this. Nurses had attended local schools, youth clubs, Young Farmers and other youth groups to promote first aid and health topics.

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

Older people

Outstanding

Updated 28 January 2016

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice nurse took a lead role in coordinating and managing manage the health needs of those patients aged 75 and over.

In particular the nurse provided additional support for all over 75 patients in the following groups;

  • Those that had been discharged from accident and emergency departments or hospital

  • patients referred by a staff member who was concerned

  • all patents resident in nursing or care homes

  • all patients with a diagnosis of dementia

  • any elderly patient who had suffered a significant bereavement

  • any patientover 75 who did not attend for a routine review.

Working age people (including those recently retired and students)

Good

Updated 28 January 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, include on-line booking of appointments and repeat prescriptions 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 reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 January 2016

The practice is rated as good for the care of people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice made a room available for the Community Psychiatric Nurse and the nurse had been involved in joint consultations with patients.

It carried out advance care planning for patients with dementia. Health checks for the over 40’s included questions to identify patients with concerns about their memory.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and dementia . All staff had received instruction and were now ‘Dementia Friends’.

People whose circumstances may make them vulnerable

Good

Updated 28 January 2016

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

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