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Orchard Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard Medical Practice on 4 August 2016. Overall the practice is rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

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

  • The practice sent letters to all eligible patients for the flu vaccine to attend an annual event where they hired a room. The practice provided refreshments and enabled patients to come and receive their inoculation and meet up with other people at the same time.

  • The practice manager telephoned anyone who gave feedback positive or negative to the practice to thank them personally and to let them know how appreciated it was.

  • The practice’s computer system alerted GPs if a patient was also a carer.The practice had identified 764 patients as carers (4.1% of the practice list).

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.

  • Feedback from patients about their care was consistently positive.

  • The practice staff were committed to going the extra mile for their patients. In 2015 one of the nurses was awarded practice nurse of the year and the reception staff, a HCA and the practice manager had received an award for ‘going the extra mile’. These awards were from the CCG following nominations by the patients of the practice.

  • 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 increasing the number of reception staff and the introduction of ‘one problem clinics’.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints (verbal and written) and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • Staff were proud of the practice and were constantly involved in developing and supporting new ways of providing treatment.

We saw areas of outstanding practice including

  • The practice had produced a video that was played in one of the waiting areas which included some of the GPs and some members of the PPG. This was to encourage patients that maybe lonely and isolated to come and join the PPG or to join the walking group that had been set up in June 2015 in conjunction with members of the PPG. At the time of our inspection there were 15 patients that regularly attended. There were two walks that left from the practice each week where patients or the general public could join in for free and improve their health and wellbeing and meet other people. The practice had received feedback from patients saying how their fitness levels had improved and a consultant had written to the practice after seeing a patient that had started with the walking group and had improved with their wellbeing.

  • The practice was passionate about helping people. The practice had a taxi fund which had been set up with the Patient Participation Group (PPG) in April 2016 to enable patients that were unable to get into the practice or those that needed to go to accident and emergency or the hospital were given money for the taxi. The fund had helped five people so far for example: a vulnerable drug user who could not and would not have gone to hospital with an infected ulcer as they could not afford it so the taxi fund was used; and a patient with long term conditions who had not been attending for reviews had telephoned the practice with a number of problems. This patient could not get into practice and therefore the taxi fund was used and the patient came into the practice for an appointment and also had a review. This patient was now a regular attender for their reviews.

  • Appointments for mental health reviews were offered on Saturday mornings for patients to attend when surgery is quieter and less threatening this also meant that patients could be accompanied by friends or relatives who might be working Monday to Friday. Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 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 and learning was shared with all staff in meetings and newsletters.

  • Action was taken to improve safety in the practice and new processes and policies implemented.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes 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.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 12 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average.

  • 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 all staff.

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

Caring

Outstanding

Updated 12 September 2016

The practice is rated as outstanding for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care.

  • 94% of patients said the GP was good at listening to them compared to the clinical commissioning group (CCG) average of 87% and the national average of 90%.

  • 93% of patients said the GP gave them enough time compared to the CCG average of 86% and the national average of 88%.

  • 94% of patients said the last GP they saw was good at explaining tests and treatments compared to the CCG average of 86% and the national average of 88%.

  • 90% of patients said the last GP they saw was good at involving them in decisions about their care compared to the CCG average of 81% and the national average of 84%.

Feedback from patients about their care and treatment was consistently positive.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. The practice had a taxi fund which had been set up with the Patient Participation Group (PPG) in April 2016 to enable patients that were unable to get into the practice or those that needed to go to accident and emergency or the hospital were given money for the taxi.

  • The practice staff were committed to going the extra mile for their patients. In 2015 one of the nurses, the reception staff, a HCA and the practice manager had received an award from the CCG. This was from nominations by the patients of the practice.

  • The practice manager telephones anyone who gave good feedback on either NHS choices or direct to the practice to thank them personally and to let them know how appreciated it was.

  • The practice had produced a video that was played in one of the waiting areas which included some of the GPs and some members of the PPG. This was to encourage patients that maybe lonely and isolated to come and join the PPG or to join the walking group that had been set up.

  • The practice sent letters to all patients eligible for the flu vaccine to attend an annual event where they hired a room. The practice provided refreshments and enabled patients to come and receive their inoculation and meet up with other people at the same time.

  • The practice had translated the practice leaflet into Syrian as they had Syrian refugees that were registered patients. This was completed for the family before they came into the practice and the GP was able to complete a health and wellbeing assessment and then make appropriate referrals.

  • The practice’s computer system alerted GPs if a patient was also a carer.The practice had identified 764 patients as carers (4.1% of the practice list).

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

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 12 September 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice was a designated C-Card collection point (collection of condoms for ages 13-24). This meant that patients registered for this service could call into the practice to collect condoms.

  • There are innovative approaches to providing integrated patient-centred care. Minor injuries clinic for patients to attend who could then be referred on for x-ray or other diagnostic tests.

  • 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. In response to patient demand and in order to provide more appointments for patients the practice had developed a new way of delivering patient care. The practice had introduced clinics daily with GP and nursing staff which were one problem clinics. These clinics could be booked on the day and enabled patients to attend and be treated quickly.

  • Patients can access appointments and services in a way and at a time that suits them. The practice offered extended hours on Tuesday evening until 8pm and Saturday morning 8am to 11.30am to allow patients that may not be able to attend due to work commitments.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 12 September 2016

The practice is rated as outstanding for providing well-led services.

  • High standards were promoted and owned by all practice staff and teams working together across all roles. 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 meetings.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. 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 comprehensive understanding of the performance of the practice and individuals within the team.

  • The practice carried out proactive succession planning through their ‘grow your own’ model. This had resulted in staff already employed by the Practice being recruited to the practice manager and assistant manager post, salaried GP and partner who had previously been GP Registrars.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients and it had an active patient participation group (PPG) which influenced practice development.

  • 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 knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

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

  • Communication with staff was excellent. In addition to the staff meetings the practice developed a newsletter that was produced every few months. This enabled the practice to feedback to everyone information in relation to patient satisfaction, new services that was coming up for the future and other news such as new staff joining and general information relating to the practice.

Checks on specific services

People with long term conditions

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators showed the practice had achieved 97% of targets which was above the CCG average (82%) and the national average (89%).
  • Longer appointments and home visits were available when needed.

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

Families, children and young people

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • There were systems in place 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 A&E attendances. 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.

  • The practice’s uptake for the cervical screening programme was 83%, which was in line with the CCG average of 85% and the national average of 82%. Patients that had not responded and who had a positive result were sent a letter by recorded delivery. The practice at this stage would also include a leaflet in relation to cervical screening ensuring that it was in the language that was appropriate to the patient, for example Polish or Latvian.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • The practice was a designated C-Card collection point (collection of condoms for ages 13-24). This meant that patients registered for this service could call into the practice to collect condoms. The practice staff had attended a course to be trained in this.

Older people

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

  • Each care home was linked to a named GP to enable continuity of care and to build relationships with the care home and the patients.

  • The nurse practitioner also completed home visits rather than patients waiting for the GPs to complete their morning surgery.

Working age people (including those recently retired and students)

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice had extended hours to 8pm Tuesday and Saturday 8am to 11.30am.

  • Telephone consultations were available and had been increased to meet demand.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe and effective services. The practice was also rated outstanding in responsive for this population group.

  • Performance for dementia related indicators showed the practice had achieved 95% of targets which was above the CCG average (91%) and in line with the national average (95%).

  • 100% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was better than the national average of 88%.

  • Appointments for mental health reviews were offered on Saturday mornings for patients to attend when surgery is quieter and less threatening this also meant that patients could be accompanied by friends or relatives who might be working Monday to Friday. Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

  • Sit and wait appointments were also available for those patients of no fixed abode and those patients with mental health issues.

  • 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 had told patients experiencing poor mental health about 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 may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 12 September 2016

The practice was rated as outstanding for caring and well-led and good for safe, effective and responsive services. The issues identified as outstanding overall affected all patients including this population Group.

  • 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 for patients with a learning disability.

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

  • The practice informed 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.

  • Some GPs and a nurse manager had completed training in safeguarding children to level four.

  • The practice would have sit and wait appointments for those patients that presented on the day who had no fixed abode or were otherwise vulnerable.