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Inspection Summary


Overall summary & rating

Good

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pike View Medical Practice on 22 August 2016. Overall the practice is rated as good.

  • There was an open and transparent approach to safety and an effective system in place 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.
  • Feedback from patients about their care was consistently and strongly positive,
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Most patients said they found it easy to make an appointment with a named GP and 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.
  • 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 provider was aware of and complied with the requirements of the duty of candour.
  • Written correspondence for those with visual impairments was sent using yellow paper and in an enlarged font size.
  • 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.

The areas where the provider should make improvements are:

  • A record should be kept of the telephone discussions held when obtaining staff references.

  • Governance arrangements should be clarified to ensure staff know which GP is taking responsibility for the future development of the practice. For example, it was also not clear how all the activities of the running of the practice were coordinated and how senior staff maintained a clear focus and direction for the whole practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 October 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place 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. 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 7 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or 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

Good

Updated 7 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than 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.
  • We observed a strong patient-centred culture in the practice.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality

Responsive

Good

Updated 7 October 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified.
  • Most patients said they found it easy to make an appointment with a named GP and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 October 2016

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. However, governance arrangements should be clarified to ensure staff know which GP is taking responsibility for the future development of the practice. For example, it was also not clear how all the activities of the running of the practice were coordinated and how senior staff maintained a clear focus and direction for the whole practice
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • 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. However, there was some lack of clarity about the overall leadership of the practice in some areas.
  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 7 October 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • 93% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months. This was compared to the CCG and national average of 88%.
  • 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.
  • Patients identified at risk of hospital admission were given same day appointment.
  • Home visits were provided for annual reviews and follow up appointments.
  • Patients had a named GP.
  • The practice had robust registers to identify those patients with long term conditions.
  • There was an effective appointment recall system in place to ensure that patients were informed of their annual review.
  • There was a monitoring recall system in place for patients whose condition was unstable and they were in need of follow-up care.
  • Double appointments were available and used to ensure that multiple conditions could be treated at the same time, reducing the number of times that the patient had to attend the practice.

Families, children and young people

Good

Updated 7 October 2016

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 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.
  • 79% of female patients between the ages of 25 and 64 attended a cervical screening within a target period of 3.5 or 5.5 years. This compared to the CCG and national average of 74%.
  • 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.
  • GPs were alerted to vulnerable children through the IT system i.e. children in foster care
  • A quiet room was available for mothers who were breast feeding.
  • On the birth of a baby the practice send a congratulation letter that includes an appointment for the post-natal check.
  • There were dedicated immunisation clinics for children, which were also available outside of the dedicated clinic hours to help ensure that all parents have the opportunity to immunise their child.
  • The practice offered a contraception service which includes free condoms, IUD fitting and subdermal implants. Young people requiring contraception were able to make appointments outside of schools hours.
  • The health visitor responsible for this practice was contacted regarding all new patients aged 5 and under to ensure continuity of care and safety. For example children from outside the area who were currently on the at risk register.

Older people

Good

Updated 7 October 2016

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.
  • Home visits and urgent appointments were available for those with enhanced needs.
  • GPs were in the process of developing individual care plans for all patients over 75 years of age.
  • Influenza & pneumococcal vaccinations were offered
  • The practice had disabled access to support patients with mobility problems and all facilities were within the ground floor.
  • Referrals were made to the Staying Well Team which provided a holistic approach to maintaining good health.
  • Each patient had a named GP; however they have the option to see any doctor.
  • Telephone consultations were offered to patients who were unable, or found it difficult to get out of the house.
  • Patients were offered health checks which included a detailed risk assessment of both physical and mental health.
  • The practice offered same day appointments to patients that have been identified with increased hospital admissions.
  • Written correspondence for those with visual impairments was sent using yellow paper in an enlarged font size.
  • The practice had strong links with three large nursing homes for patients with dementia.

Working age people (including those recently retired and students)

Good

Updated 7 October 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 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.
  • Telephone appointments were available and routine appointments were available out of normal working hours to ensure that patients could access a clinician.
  • NHS health checks were promoted and encouraged.
  • The practice offered temporary registration, for example students returning home from university.
  • The patient had access to online appointment booking facilities using the Patient Access System and could order repeat prescriptions without having to attend the surgery. An app could also be downloaded by patients to offer an alternative way to booking appointments.
  • Patients had the option of nominating a pharmacy that could receive their prescription electronically for dispensing.
  • Health checks were provided for patients aged between 40 and 74 years to pre-empt or defer the onset of long term conditions such as diabetes.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 2016

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

  • 84% of patients diagnosed with dementia have had their care reviewed in a face to face meeting in the last 12 months. This was comparable to the CCG and national average.
  • 98% of patients with schizophrenia, bipolar affective disorder and other psychoses have had their alcohol consumption recorded in the preceding 12 months. This was compared to the CCG average of 91% and the national average of 90%.
  • 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.
  • The practice offered annual reviews and individual care plans.
  • Home visits were provided with a double appointment available if needed.
  • Patients had a named GP but could see any clinician.
  • Patients who were at risk of hospital admissions were identified and offered same day consultations.
  • Practice staff had a good working relationship with the one of the local nursing homes with a unit for patients with dementia. Staff regularly attended practice multi-disciplinary meetings and provided updates on issues of concern.
  • Referrals were made to the Staying Well Team for holistic advice and services that were available in the local area. For example the befriending service.
  • The practice computer system alerted patients who presented with repeated non-specific illness that could be disguising deeper mental health issues.

People whose circumstances may make them vulnerable

Good

Updated 7 October 2016

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, travellers 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 were trained in safeguarding procedures and knew how to recognise signs of abuse in vulnerable adults and children.
  • The practice had a strong working relationship with an outside agency so that patients could effectively respond to the possibility of physical and emotional domestic abuse.
  • The practice had a register of patients who have learning difficulties who were offered annual health checks. Correspondence was sent using a specific font as recommended by the British Dyslexia Association.
  • The practice had a register of all known teenage mothers and children with chronic diseases; such as cystic fibrosis and type 1 diabetes.