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The Barcroft Practice Good Also known as Barcroft Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 28 November 2018

This

practice is rated as Good overall. (At our previous inspection in March 2018 they were rated as requires improvement overall).

The key questions at this inspection are rated as:

  • Are services safe? – Good
  • Are services effective? – Good
  • Are services caring? – Good
  • Are services responsive? – Good
  • Are services well-led? - Good

When we inspected The Barcroft Practice on 8 March 2018 we found some breaches in the regulations relating to safe care and treatment, good governance and staffing. We issued requirement notices to the practice setting out the areas they were required to improve. The full report of our inspection on 8 March can be found by selecting the ‘all reports’ link for The Barcroft Practice on our website at www.cqc.org.uk. Following publication of our report, the practice sent us a plan setting out the actions they were taking to rectify the regulatory beaches we had found.

This report covers the announced comprehensive inspection we carried out at The Barcroft Practice on 20 September 2018. We carried out this inspection to follow up on the breaches we found at our previous inspection.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

  • The practice ran weekly ophthalmology and dermatology clinics. These enabled patients with common eye complaints and skin conditions respectively to be seen closer to home, usually within a week, rather than waiting for an outpatient’s appointment.
  • The practice held regular coffee mornings at a local hotel that were run by the practice Elderly Care Facilitator for older people who were at risk of becoming isolated and lonely. There was a programme of speakers and activities were arranged to meet these patients’ needs. Clinical staff, also attended these events. Patients who attended the group spoke highly of the mornings. The practice had data which showed that of 100 older patients who had attended the coffee club in the past year, 74% said they had benefited from attending. They also ran a carers’ coffee mornings four times a year. Information about these was on the practice website and on a notice board in the surgery. These were run in partnership with the local Wiltshire Carers trust, who had staff in attendance at these events to provide support and advice.

There were areas where the provider should make improvements. The provider should:

  • Ensure all staff are aware of the need to remove their security cards from computers when they leave the workstation.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection areas

Safe

Good

Updated 28 November 2018

We rated the practice as good for providing safe services.

Safety systems and processes

The practice had systems to keep patients safe and safeguarded from abuse, although not all were operated effectively.

  • The practice conducted safety risk assessments. It had a suite of safety policies which were regularly reviewed and communicated to staff. Staff received safety information for the practice as part of their induction and refresher training. The practice had systems to safeguard children and vulnerable adults from abuse. Policies were regularly reviewed and were accessible to all staff. They outlined clearly who to go to for further guidance. All the staff we spoke to knew how to identify and report safeguarding concerns. All staff had received up-to-date safeguarding and safety training appropriate to their role.
  • On our previous inspection of The Barcroft Practice in March 2018 we found some breaches in the regulations relating to fire safety. For example, the practice had not recorded a fire evacuation drill since 2010. On this inspection we found the practice had revised their processes for fire safety to ensure all the required actions where completed. We saw documentary evidence they had carried out an evacuation of the building and had written an evaluation report of this. The report included a number of learning points, which had been shared with all staff. The report was also shared with other organisations who used the building.
  • The practice worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.
  • The practice carried out staff checks, including checks of professional registration where relevant, on recruitment and on an ongoing basis. Disclosure and Barring Service (DBS) checks were undertaken where required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • On this inspection we were told only clinical staff acted as chaperones. On our previous inspection in March 2018 we were told non-clinical staff were sometimes asked to be a witness to a consultation in circumstances where the staff member was not acting as a chaperone. However, the practice did not have a clear procedure for this. On this inspection we saw the practice had revised their policies and procedures in this area and had a clear policy covering this.
  • There was a system to manage infection prevention and control. On our previous inspection in March 2018 we saw examples of clinical waste bins that were not appropriately labelled. On this inspection we saw evidence the practice had reviewed their procedures and given additional training to staff to ensure the issue did not reoccur. All the waste bins we saw on this inspection where appropriately labelled.
  • The practice ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions.
  • On our previous inspection in March 2018 the practice did not have a business continuity (or disaster) plan in place. They were in the process of developing such a plan which was nearly complete. On this inspection we saw the plan had now been completed and included the information recommended by recognised guidance.

Risks to patients

There were systems to assess, monitor and manage risks to patient safety.

  • There were arrangements for planning and monitoring the number and mix of staff needed.
  • There was an effective induction system for temporary staff tailored to their role.
  • Staff understood their responsibilities to manage emergencies on the premises and to recognise those in need of urgent medical attention. Clinicians knew how to identify and manage patients with severe infections, for example, sepsis.
  • When there were changes to services or staff the practice assessed and monitored the impact on safety.

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

  • Individual care records were written and managed in a way that kept patients safe. The care records we saw showed that information needed to deliver safe care and treatment was available to relevant staff in an accessible way.
  • The practice had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
  • Referral letters included all the necessary information.

Safe and appropriate use of medicines

The practice had reliable systems for appropriate and safe handling of medicines.

  • The systems for managing medicines, including vaccines, medical gases, and emergency medicines and equipment minimised risks. The practice kept prescription stationery securely and monitored its use.
  • Staff prescribed or administered medicines to patients and gave advice on medicines in line with legal requirements and current national guidance. The practice had audited their antimicrobial prescribing. There was evidence of actions taken to support good antimicrobial stewardship.
  • Patients’ health was monitored to ensure medicines were being used safely and followed up on appropriately. The practice involved patients in regular reviews of their medicines.

Track record on safety

The practice had a good safety record.

  • There were comprehensive risk assessments in relation to safety issues.
  • The practice monitored and reviewed activity. This helped it to understand risks and gave a clear, accurate and current picture that led to safety improvements.

Lessons learned and improvements made

We saw evidence that the practice learnt and made improvements when things went wrong.

  • There was a system for recording and acting on significant events and incidents. Staff we spoke to understood their duty to raise concerns and report incidents and near misses. They told us leaders and managers supported them when they did so.
  • On our previous inspection in March 2018 we found the practice had not completed a review of significant events and incidents to look for themes. On this inspection we found the practice had reviewed and amended their policies and procedures to prevent this issue happening again, and had carried out a review of events.
  • During our previous inspection in March we looked at three significant events and on this inspection, we looked at a fourth. We found the practice carried out adequate reviews and investigation when things went wrong. Staff told us lessons learnt from significant events were shared and we saw that minutes of meetings confirmed this.
  • On our previous inspect we found the practice system to ensure learning was shared with all appropriate staff did not adequately cover staff who were unable to attend meetings. On this inspection we saw the practice had reviewed their procedures and introduced a new system to ensure leaning points from significant were shared with all staff, including those unable to attend meetings.
  • There was a system for receiving and acting on safety alerts. The practice learned from external safety events as well as patient and medicine safety alerts.

Please refer to the evidence tables for further information

Effective

Good

Updated 28 November 2018

We rated the practice and all the population groups as good for providing effective services overall

.

Effective needs assessment, care and treatment

The practice had systems to keep clinicians up to date with current evidence-based practice. We saw that clinicians assessed needs and delivered care and treatment in line with current legislation, standards and guidance supported by clear clinical pathways and protocols.

  • Patients’ needs were fully assessed. This included their clinical needs and their mental and physical wellbeing.
  • We saw no evidence of discrimination when making care and treatment decisions.
  • Staff advised patients what to do if their condition got worse and where to seek further help and support.
  • The practice computer systems enabled them to check patients’ treatments against best practice guidance, to improve their health outcomes and to monitor performance against the QOF.

Older people:

  • Older patients who are frail or may be vulnerable received a full assessment of their physical, mental and social needs. Those identified as being frail had a clinical review including a review of medication.
  • Patients aged over 75 were invited for a health check. If necessary they were referred to other services such as voluntary services and supported by an appropriate care plan.
  • The practice followed up on older patients discharged from hospital. It ensured that their care plans and prescriptions were updated to reflect any extra or changed needs.
  • The practice ran a weekly coffee club for patients over 75.

People with long-term conditions:

  • Patients with long-term conditions had a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with other health and care professionals to deliver a coordinated package of care.
  • Staff who were responsible for reviews of patients with long term conditions had received specific training.
  • The quality outcomes framework (QOF) data showed the practice performance was better than average for some long-term conditions. For example, 87% of patients with asthma, on the register, had an asthma review in the preceding 12 months that included recommended assessment questions, compared to the clinical commissioning group (CCG) average of 78% and national average of 76%.

Families, children and young people:

  • The practice worked closely with the local midwifery team who were based in the practice.
  • Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines were above the national target percentage of 90%, with an average of 95% across the four target groups, compared to the national average of 91%.
  • The practice had arrangements to identify and review the treatment of newly pregnant women on long-term medicines.
  • The practice provided neo-natal checks on those born at home or discharged early.

Working age people (including those recently retired and students):

  • The practice’s uptake for cervical screening was 80%, which was in line with the 80% coverage target for the national screening programme.
  • The practice had systems to inform eligible patients to have the meningitis vaccine, for example before attending university for the first time.
  • Patients had access to appropriate health assessments and checks including NHS checks for patients aged 40-74. There was appropriate follow-up on the outcome of health assessments and checks where abnormalities or risk factors were identified.
  • The practice offered extended hours appointments four days a week and on Saturday mornings once a month for patients unable to attend during usual opening times.

People whose circumstances make them vulnerable:

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

People experiencing poor mental health (including people with dementia):

  • The practice considered the physical health needs of patients with poor mental health and those living with dementia. For example, the percentage of patients experiencing poor mental health who had received discussion and advice about alcohol consumption was 97% (CCG 94%; national 91%); and the percentage of patients experiencing poor mental health who had received discussion and advice about smoking cessation was 96% (CCG 96%; national 95%).

Monitoring care and treatment

The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided. For example, the practice ran a computer search of patients with renal (kidney) impairment who were being prescribed medicines that needed to be used with caution for this condition. The record of these patients were then checked to ensure the treatment was in line with recommended guidance. Where appropriate, clinicians took part in local and national improvement initiatives. For example, the practice was part of a local peer review scheme to support the sharing of performance data and learning between practices.

The most recent published Quality Outcome Framework (QOF) results were 100% of the total number of points available compared with the clinical commissioning group (CCG) average of 97% and national average of 96%. The overall exception reporting rate was 9% compared with a CCG average of 11% and national average of 10%. (QOF is a system intended to improve the quality of general practice and reward good practice. Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate.)

We noted that on our previous inspection in March 2018 we discussed with the practice their exception rate for the prevention of cardiovascular disease which was 67% compared to the CCG average of 32% and national average of 25%. They told us they had identified some coding errors which had caused the high exception rate. We saw new practice data, which has not been externally verified, that showed of 59 patients that met this QOF criteria, two had been excepted. This is equivalent to an exception reporting rate of 3%.

Effective staffing

The practice was able to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.

On our previous inspection in March 2018 we found the practice had not assessed and identified all the training requirements of staff, which meant they could not be sure all staff had the skills and knowledge to carry out their roles. We also found that not all non-clinical staff had received the appropriate safeguarding training. On this inspection we found:

  • The practice had reviewed and revised their staffing policies and had clearly identified what they considered to be essential training for all staff depending on their role. This was in line with recognised guidance.
  • We saw evidence all staff had completed the training identified as essential for their role. This included safeguarding training for non-clinical staff.
  • The practice had a clear record of specialist training completed by clinicians. For example, staff whose role included immunisation and taking samples for the cervical screening programme had received specific training and could demonstrate how they stayed up to date.
  • Staff were encouraged and given opportunities to develop.
  • The practice provided staff with ongoing support. This included an induction process, one-to-one meetings, appraisals, coaching and mentoring, clinical supervision and support for revalidation. The induction process for healthcare assistants included the requirements of the Care Certificate. The practice ensured the competence of staff employed in advanced roles by audit of their clinical decision making, including non-medical prescribing.
  • There was a clear approach for supporting and managing staff when their performance was poor or variable.

Caring

Good

Updated 28 November 2018

We rated the practice as good for caring.

Kindness, respect and compassion

Staff treated patients with kindness, respect and compassion.

Staff understood patients’ personal, cultural, social and religious needs.

  • The practice gave patients timely support and information.
  • Reception staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs.
  • Results from the July 2017 annual national GP patient survey showed patients felt they were treated with compassion, dignity and respect. Two hundred and twenty-two surveys were sent out and 120 were returned. This represented about 1% of the practice population. The practice was comparable for its satisfaction scores on consultations with GPs and nurses.

Involvement in decisions about care and treatment

Staff helped patients be involved in decisions about their care and were aware of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information they are given):

  • Interpretation services were available for patients who did not have English as a first language. We saw notices in the reception areas, including in languages other than English, informing patients this service was available.
  • Staff communicated with patients in a way that they could understand, for example, communication aids and easy read materials were available.
  • Staff helped patients and their carers find further information and access community and advocacy services. They helped them ask questions about their care and treatment.

The practice proactively identified patients who were carers. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 100 patients as carers (1% of the practice list).

  • The practice had recently been awarded a platinum award for caring for carers by a local charity working in partnership with the local authority. We noted this was an improvement from the previous year when they had been awarded a silver award.
  • The practice had an Elderly Care Facilitator who led the practice work with carers and acted as a carers’ champion to help ensure that the various services supporting carers were coordinated and effective.
  • The practice ran a carer’s coffee mornings four times a year at a local hotel and four carer’s clinics at the surgery. Information about these was on the practice website and on a notice board in the surgery. These were run in partnership with the local Wiltshire Carers trust, who had staff in attendance at these events to provide support and advice. They had clear operating procedures setting out how theses coffee morning ran and detailing staff responsibilities.

Results from the national GP patient survey showed patients responded positively to questions about their involvement in planning and making decisions about their care and treatment. Results were in line with local and national averages.

Privacy and dignity

The practice respected and promoted patients’ privacy and dignity.

  • Staff recognised the importance of patients’ dignity and respect.
  • The practice complied with the Data Protection Act 1998.

Please refer to the evidence tables for further information.

Responsive

Outstanding

Updated 28 November 2018

We rated the practice and all the population groups as good

 for providing responsive services.

Responding to and meeting people’s needs

The practice organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

  • The practice understood the needs of its population and tailored services in response to those needs. (For example, extended opening hours, online services such as repeat prescription requests, advanced booking of appointments, advice services for common ailments and text messaging.)
  • The practice improved services where possible in response to unmet needs.
  • The facilities and premises were appropriate for the services delivered.
  • Care and treatment for patients with multiple long-term conditions and patients approaching the end of life was coordinated with other services.
  • The practice had a member of staff who was the Elderly Care Facilitator. They telephoned patients on discharge from hospital to offer support, and to enquire whether a GP visit or other assistance was required.

Older people. 

  • The practice ran a weekly coffee club and wellbeing clinic in a local hotel aimed at older people who were at risk of becoming more isolated and lonely, in partnership with another local GP practice. It was coordinated by the practice Elderly Care Facilitator. Appointments could be made to see a nurse who also attended. Patients were given the phone number and email address of the Elderly Care Facilitator to help them to keep in touch. There was a diary of events and they conducted six-monthly surveys to get feedback from patients attending. The practice had data which showed that of 1158 patients over 75 registered with the practice, 114 had attended the coffee club in the last year and 74% of these said they had benefited from attending the club. The data showed an increase in attendance at the club by patients over 75, compared with the data we saw on our previous inspection. Patients who used the weekly club commented on how valuable the club was to them. They also commented that the Elderly Care Facilitator would contact patients who usually attended, in the event they had not attended, to check they were well.

  • All patients had a named GP who supported them in whatever setting they lived, whether it was at home or in a care home or supported living scheme.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The GP and practice nurse also accommodated home visits for those who had difficulties getting to the practice due to limited local public transport availability.

People with long-term conditions: 

  • Patients with a long-term condition received an annual review to check their health and medicines needs were being appropriately met. Multiple conditions were reviewed at one appointment, and consultation times were flexible to meet each patient’s specific needs.
  • The practice held regular meetings with the local district nursing team to discuss and manage the needs of patients with complex medical issues.
  • The practice held a weekly ophthalmology clinic which enabled optician’s referrals to be seen usually within a week rather than waiting for an outpatients appointment and meant patients did not have to travel to the regional hospital. GPs running this service had received additional training and peer review to deliver this service. There was evidence the practice had low referral rates in this speciality compared to other GP practices and that of 97 patients seen last year, 58 would otherwise have been referred for an outpatients appointment. 
  • The practice had a GP with a special interest in dermatology who had received additional training and peer review and who ran a weekly dermatology clinic. This enabled patients to be seen more quickly than a hospital referral and avoided them having to travel to hospital. We saw evidence this service had reduced the number of hospital referrals for dermatology and that of 129 patients seen last year, 102 would otherwise have been referred to secondary care.

Families, children and young people:

  • We found there were systems 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 accident and emergency (A&E) attendances. Records we looked at confirmed this.
  • All parents or guardians calling with concerns about a child under the age of 18 were offered a same day appointment when necessary.

Working age people (including those recently retired and students):

  • The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours and Saturday appointments.
  • Telephone consultations were available which supported patients who were unable to attend the practice during normal working hours.

People whose circumstances make them vulnerable:

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

People experiencing poor mental health (including people with dementia):

  • Staff interviewed had a good understanding of how to support patients with mental health needs and those patients living with dementia.
  • The practice held GP led dedicated monthly mental health clinics for patients with a learning disability. Patients who failed to attend were proactively followed up by a phone call from a GP.

Timely access to the service

Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.

  • Patients had timely access to initial assessment, test results, diagnosis and treatment.
  • Waiting times, delays and cancellations were minimal and managed appropriately.
  • Patients with the most urgent needs had their care and treatment prioritised.
  • The appointment system was easy to use.

Results from the July 2017 annual national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to local and national averages. This was supported by observations on the day of inspection and completed comment cards.

Listening and learning from concerns and complaints

The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.

  • Information about how to make a complaint or raise concerns was available and it was easy to do. Staff treated patients who made complaints compassionately.
  • The complaint policy and procedures were in line with recognised guidance. Seventeen complaints were received in the last year. On our previous inspection in March we reviewed three complaints and found that they were satisfactorily handled in a timely way.

The practice learned lessons from individual concerns and complaints and also from analysis of trends. It acted as a result to improve the quality of care

Well-led

Good

Updated 28 November 2018

We rated the practice as good for providing a well-led service.

Leadership capacity and capability

Leaders had the capacity and skills to deliver high-quality, sustainable care.

  • Leaders had the experience, capacity and skills to deliver the practice strategy and address risks to it.
  • They were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
  • Leaders at all levels were visible and approachable. They worked closely with staff and others to make sure they prioritised compassionate and inclusive leadership.
  • The practice had effective processes to develop leadership capacity and skills, including planning for the future leadership of the practice.

Vision and strategy

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

  • There was a clear vision and set of values. The practice had a realistic strategy and supporting business plans to achieve priorities.
  • The practice developed its vision, values and strategy jointly with patients, staff and external partners.
  • Staff were aware of and understood the vision, values and strategy and their role in achieving them.
  • The strategy was in line with health and social priorities across the region. The practice planned its services to meet the needs of the practice population.
  • The practice monitored progress against delivery of the strategy.

Culture

The practice had a culture of high-quality sustainable care.

  • Staff stated they felt respected, supported and valued. They were proud to work in the practice.
  • The practice focused on the needs of patients.
  • Leaders and managers acted on behaviour and performance inconsistent with the vision and values.
  • Openness, honesty and transparency were demonstrated when responding to incidents and complaints. The provider was aware of and had systems to ensure compliance with the requirements of the duty of candour.

  • Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these would be addressed.
  • All staff had received regular annual appraisals and career development conversations in the last year. Staff were supported to meet the requirements of professional revalidation where necessary and the practice had a clear record of specialist training completed by clinicians.
  • Clinical staff, including nurses, were considered valued members of the practice team. They were given protected time for professional development and evaluation of their clinical work.
  • There was an emphasis on the safety and well-being of all staff.
  • The practice told us they promoted equality and diversity. They identified and addressed the causes of any workforce inequality. Staff we spoke to felt they were treated equally.
  • There were positive relationships between staff and teams.

Managing risks, issues and performance

There were processes for managing risks, issues and performance.

  • On our previous inspection in March 2018 we found the practice had not adequately identified the training needs of all staff. On this inspection we saw the practice had reviewed and revised their policies around training and had a clear set of training they had identified as essential for all staff depending on their role. They had introduced new systems to monitor training and help them identify when essential training was due and which staff had not completed essential training. These records showed that all staff, with the excepting of some newly appointed staff and three on sick leave or maternity leave, had completed all the essential training.
  • The practice had processes to identify the specialist training requirements of staff, such as immunisation training for staff in this role.
  • The practice had processes to manage current and future performance. Performance of employed clinical staff could be demonstrated through audit of their consultations, prescribing and referral decisions. Practice leaders had oversight of MHRA alerts, incidents, and complaints.
  • There was a process to identify, understand, monitor and address current and future risks including risks to patient safety. We saw examples of action tracker charts the practice used to record actions required and the progress made in completing them. These helped the practice insure actions required were completed and signed off by the appropriate staff member.

Clinical audit had a positive impact on quality of care and outcomes for patients. There was clear evidence of action to change practice to improve quality.

The practice had plans in place and had trained staff for major incidents.

The practice implemented service developments and where efficiency changes were made this was with input from clinicians to understand their impact on the quality of care.

The practice had undertaken a review of the latest national GP patient survey and in most areas they had agreed what action they would take to improve their results. For example, they identified that their score for patient’s experience of making an appointment was below the national average and took action by providing further training and guidance to reception staff.

Appropriate and accurate information

The practice acted on appropriate and accurate information.

  • Quality and operational information was used to ensure and improve performance. Performance information was combined with the views of patients.
  • Quality and sustainability were discussed in relevant meetings where all staff had sufficient access to information.
  • The information used to monitor performance and the delivery of quality care was accurate and useful. There were plans to address any identified weaknesses.
  • The practice used information technology systems to monitor and improve the quality of care.
  • The practice submitted data or notifications to external organisations as required.
  • There were robust arrangements in line with data security standards for the availability, integrity and confidentiality of patient identifiable data, records and data management systems.

Engagement with patients, the public, staff and external partners

The practice involved patients, the public, staff and external partners to support high-quality sustainable services.

  • A full and diverse range of patients’, staff and external partners’ views and concerns were encouraged, heard and acted on to shape services and culture. For example, they had reviewed the results of the GP patient survey and identified a number of actions they could take to improve their performance.
  • There was an active patient participation group.
  • The service was transparent, collaborative and open with stakeholders about performance.

Continuous improvement and innovation

There were systems and processes for learning, continuous improvement and innovation.

  • There was a focus on continuous learning and improvement at all levels within the practice.
  • The practice was a GP training practice and accepted qualified doctors training to become GPs. The practice felt this helped ensure the practice remained open to continuous improvement.
  • We saw evidence the practice shared learning and planned service development with other local GP practices.

  • Staff knew about improvement methods and had the skills to use them.
  • The practice made use of internal and external reviews of incidents and complaints. Learning was shared and used to make improvements, although the system for this was not always effective.
  • Leaders and managers encouraged staff to take time out to review individual and team objectives, processes and performance.
Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Older people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good