You are here

The Morris House Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 22 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Morris House Group Practice on 19 January 2017. 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 for reporting and recording significant events.
  • 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.
  • Data from the Quality and Outcomes Framework showed that patient outcomes for most indicators were comparable to the local and national averages. However, the Clinical Exception Reporting rate was above the local and national average.
  • Patients said they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.
  • 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 GP patient survey results showed that patient’s satisfaction with regards to booking appointments was below the local and national average. Patients said they often found it difficult to make an appointment with a GP and had difficulty getting through to the surgery by telephone.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had identified only 51patients as carers (0.4% of the practice list).
  • There was a clear leadership structure and staff felt supported by management.
  • The practice sought feedback from staff and patients, which it acted on. However, there was no active patient participation group.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • The provider should continue to monitor patient satisfaction rates regarding booking routine and urgent appointments and implement improvements as appropriate.
  • The provider should continue to develop and implement a clinical quality improvement programme aimed at reducing the exception reporting rate for the Quality and Outcomes Framework (QOF).
  • The provider should record batch numbers of blank electronic prescriptions placed in individual printers and maintain records when prescription pads are assigned to individual GPs.
  • The provider should consider proactive strategies to encourage patients to join a patient participation group (PPG) and establish regular communication with group members.
  • The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to all carers registered with the practice.

Professor Steve Field CBE FRCP FFPH FRCG 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system 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. Patients were informed of any improvements made to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 22 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes for most indicators were comparable to the local and national averages. The total QOF points achieved by the practice for 2015/16 was 98% compared to the clinical commissioning group (CCG) average of 92% and national average of 95%.

  • The Clinical Exception Reporting rate of 24% was above the CCG average of 11% and national average of 9%.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

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

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked with other health care professionals to meet the range and complexity of patients’ needs.

Caring

Good

Updated 22 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as comparable to others for several 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 services available to them was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect and maintained confidentiality of patient information.

Responsive

Good

Updated 22 March 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.

  • Patients said they often found it difficult to make an appointment with a GP and had difficulty getting through to the surgery by telephone. The practice was actively trying to address these issues.

  • 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 shared with staff and other stakeholders.

Well-led

Good

Updated 22 March 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.

  • There was a clear leadership structure and staff felt supported by management.

  • The practice had a number of policies and procedures in place to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of good quality care. This included 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 partners encouraged a culture of openness and honesty.

  • The practice had systems in place for the reporting and investigation of incidents. Information was shared with staff to ensure appropriate action was taken.

  • The practice sought feedback from staff and patients which it acted on.

  • The practice had not had an active patient participation group (PPG) for three years. However, the practice did have a patient reference group of approximately 60 patients who they could contact by email if required.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 22 March 2017

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

  • Nursing staff worked closely with GPs and community specialist nurses in the management of patients with long-term conditions.
  • Patients at risk of hospital admission were identified as a priority.
  • The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
  • Longer appointments and home visits were available when needed.
  • Patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
  • For those patients with the most complex needs the GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The management of patients with complex needs were discussed at weekly teleconference multi-disciplinary team meetings held with local hospital clinicians.

Families, children and young people

Good

Updated 22 March 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Immunisation rates for all standard childhood immunisations were comparable to national targets.
  • Children and young people were treated in an age-appropriate way.
  • The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages. Sample taking for cervical smears was carried out by both GP and nursing staff to improve access for patients.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw evidence of joint working with health visitors who attended six-weekly safeguarding meetings at the practice to discuss children of concern.

Older people

Good

Updated 22 March 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local

    and national averages

  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 22 March 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.

  • Extended hours appointments were available at the surgery from 7.30am four mornings a week and up to 7.15pm three evenings a week.

  • The practice was proactive in offering online services. An application form for access to on-line access was included in new patient registration packs to encourage uptake of the service.

  • A telephone consultation call-back service was available for patients who required telephone advice only.

  • A full range of health promotion and screening services were provided that reflected the needs of this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 March 2017

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

  • 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 83% and national average of 84%.

  • 100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 83% and national average of 89%.

  • 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 informed patients experiencing poor mental health 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 had been experiencing poor mental health.
  • A dedicated mental health review clinic was in place with a nurse and GP both in attendance to ensure both a physical and mental health screening and management review could be undertaken sequentially.
  • 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 22 March 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 homeless people and those with a learning disability.

  • The practice offered longer appointments and annual reviews for patients with a learning disability. 70% of patients on the learning disability register had received an annual review.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed vulnerable patients 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.

  • The practice had a higher than average number of patients who were refugees or victims of torture. These patients were referred to appropriate local support services and an alert was placed on the patient’s records.