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Inspection Summary


Overall summary & rating

Good

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pool Medical Centre on 23 August 2016. Overall the practice is rated as Good.

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

  • The system for reporting and recording significant events ensured that these were fully investigated and patients affected were notified and supported.

  • Risks to staff and patients were continuously monitored to promote safety, and there were suitable arrangements to deal with emergencies and major incidents.

  • Prescription stationery was stored securely but printer forms were not tracked after being removed from their boxes.

  • Current evidence based guidelines were monitored and adhered to in the planning and management of patient care.

  • The practice held annual staff appraisal meetings to review professional development and identify learning needs. Staff we spoke with during the inspection told us they had access to appropriate training to cover the scope of their work.

  • The patients we spoke with told us they felt they were involved when it came to making decisions about the care and treatment they received. They said that clinical staff were good at listening, allowed them enough time and provided information to help them understand their options.
  • Information for patients about the services available and how to complain was easy to understand and accessible.

  • The practice had a lead staff member for dealing with complaints and we saw that these were properly managed and lessons were learned. The practice took action to improve the quality of care as a result of concerns raised.

  • Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to or higher than local and national averages.

  • 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, and the practice actively sought feedback from staff and patients to improve its offering.

  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice actively engaged with patients and was responsive to the local community. Needs were assessed and action was taken to improve care and encourage healthier lifestyles. For example the practice had worked with its Patient Participation Group (PPG) to organise activities for local over 75s as a means of reducing social isolation. This had resulted in a one third decrease in appointments made by older people, and their number of hospital admissions had also fallen. The PPG had sent a teenage survey to younger patients asking for their views; and the practice had then offered drop-in sessions for teenagers who were not registered with the practice to allow them to attend anonymously for advice. The practice had also run a men’s health evening in a local pub to promote health screening and to educate patients about alcohol intake. As a result of the event the practice identified a small number of patients with previously undiagnosed hypertension who were followed up.

The area where the provider should make improvement is:

  • Continue to monitor security in the management of prescription stationery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 April 2017

The practice is rated as good for providing safe services.

  • The system for reporting and recording significant events ensured that these were fully investigated and patients affected were notified and supported.
  • Learning from incidents was shared and used to improve safety in the practice.
  • There were systems in place to safeguarded patients from abuse.
  • The practice used a variety of processes and risk assessments to ensure that the premises met with required infection control and health and safety standards.
  • Risks to staff and patients were continuously monitored to promote safety, and there were suitable arrangements to deal with emergencies and major incidents.
  • The practice had a system for managing and circulating safety alerts received from external agencies. Prescription stationery was stored securely but printer forms were not tracked after being removed from their boxes.

Effective

Good

Updated 12 April 2017

The practice is rated as good for providing effective services.

  • Quality and Outcomes Framework (QOF) data showed that patient outcomes were in line with or above average compared to local and national averages for the QOF year 2014/15. Following the inspection we also reviewed QOF results subsequently published for 2015/16 and these showed the practice had maintained this performance.
  • Current evidence based guidelines were monitored and adhered to in the planning and management of patient care.
  • The practice conducted clinical audits and participated in benchmarking. We saw examples that evidenced quality improvement.
  • The practice held annual staff appraisal meetings to review professional development and identify learning needs. Staff we spoke with during the inspection told us they had access to appropriate training to cover the scope of their work.
  • The practice worked with other services and health and social care professionals to share relevant information and assess and meet the needs of patients.
  • The practice had made arrangements to identify patients who may require additional support. For example patients receiving end of life care, carers, those at risk of developing a long-term condition.

Caring

Good

Updated 12 April 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed the practice was rated in line with local and national averages for the standard of care provided.
  • There was a good return rate of positive comment cards. Of these, 32 were positive about the practice, and of those with negative comments only two related to caring.
  • We saw that staff were courteous to patients, offering assistance where appropriate, and treating them with dignity and respect.
  • The patients we spoke with told us they felt they were involved when it came to making decisions about the care and treatment they received. They said that clinical staff were good at listening, allowed them enough time and provided information to help them understand their options.
  • Information for patients about the services available was easy to understand and accessible.
  • Staff told us that if families had suffered bereavement, the practice sent a sympathy card and the last GP they had attended a consultation with offered to make a home visit.

Responsive

Outstanding

Updated 12 April 2017

The practice is rated as outstanding 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.
  • The practice had run a men’s health evening in a local pub to offer health screening educate patients about alcohol intake.
  • The practice had worked with a care coordinator and the PPG to organise tea dances at Studley Village Hall for local over 75s, as a means of reducing social isolation. These were ticketed events supported by the practice and had been very successful with over 120 attendees. Since beginning to organise activities for the over 75s there had been a one third decrease in appointments made by older people, and their number of hospital admissions had also fallen. The practice continued to work with the PPG to organise activities to support this group. It had also arranged for older people to visit local schools to talk about their lives.
  • Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to or higher than local and national averages.
  • The practice had a lead staff member for dealing with complaints and we saw that these were properly managed and lessons were learned. The practice took action to improve the quality of care as a result of concerns raised.

Well-led

Good

Updated 12 April 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and approached future challenges with purpose. Staff had a common focus on improving the quality of care and people’s experiences.
  • The practice had implemented a set of core values to guide staff and governance arrangements supported collaboration and the delivery of key aims.
  • There were high levels of staff satisfaction. Staff were proud to work for the practice and spoke highly of the culture. The partners encouraged an open, friendly ethos and complied with the duty of candour in dealing with patients.
  • Innovative approaches were used to gather feedback from different groups of patients. There were consistently high levels of constructive staff engagement and all staff were encouraged to raise concerns.
  • Continuous learning and improvement was embraced at all levels within the practice. GPs proactively participated in research and initiatives.
  • There was a systematic approach to working with other organisations to improve care outcomes and obtain best value for money.
Checks on specific services

People with long term conditions

Good

Updated 12 April 2017

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

  • The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services.
  • The nursing team had lead roles in chronic disease management.
  • Performance for diabetes related indicators was similar to CCG and national averages. For example, 80% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG average of 82% and the national average of 78%. 95% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 92% and national average of 88%.
  • The practice ran specialist clinics and offered longer appointments for patients with long term conditions. Review appointments were coordinated for those with multiple long term conditions.
  • Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Families, children and young people

Good

Updated 12 April 2017

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

  • The practice maintained registers of patients with long-term conditions and used these to monitor their health and ensure they were offered appropriate services.
  • The nursing team had lead roles in chronic disease management.
  • Performance for diabetes related indicators was similar to CCG and national averages. For example, 80% of the practices patients with diabetes had a blood glucose level within the target range in the preceding 12 months compared with the CCG average of 82% and the national average of 78%. 95% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 92% and national average of 88%.
  • The practice ran specialist clinics and offered longer appointments for patients with long term conditions. Review appointments were coordinated for those with multiple long term conditions.
  • Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Older people

Good

Updated 12 April 2017

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

  • The service provided to older people was proactive, personalised and responsive. For example the practice offered home visits and urgent appointments for those with enhanced needs.
  • The practice had worked with a dedicated over 75s care coordinator to identified that 21% of older patients felt lonely. The care coordinator had worked with the practice manager and the PPG to organise activities for the over 75s. This had resulted in a one third decrease in appointments made by older people, and their number of hospital admissions had also fallen. The practice continued to work with the PPG to organise activities to support this group. It had also arranged for older people to visit local schools to talk about their lives.
  • The practice participated in events organised by Silver Line charity, and had recently hired coaches to allow patients to attend a celebrity event at Stratford Civic Centre.
  • Older patients who may need palliative care were promptly identified and involved in planning and making decisions about their care, including their end of life care.
  • The practice monitored older patients discharged from hospital and updated their care plans to reflect their changing needs.
  • Staff we spoke with demonstrated that they knew how to recognise and escalate concerns about signs of abuse in older patients.

Working age people (including those recently retired and students)

Good

Updated 12 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice offered extended opening hours on Monday evenings from 6.30pm until 8pm, and Wednesday mornings from 7.30am until 8am for working patients who could not attend during normal opening hours.
  • Patients could access online services such as repeat prescription ordering and appointment booking.
  • Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours. There was also a triage nurse who worked on Mondays and Tuesdays to advise patients whether a physical consultation was necessary.
  • A full range of health promotion and screening was available, including NHS health checks for those aged 40 to 74.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 April 2017

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

  • Quality Outcomes Framework (QOF) data showed that the practice was performing above local and national averages in its care of patients with dementia. For example, 90% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with an average 85% in the CCG area 84% nationally.
  • Performance for mental health related indicators was also similar to the CCG and national averages. For instance, 91% of patients with a form of psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the CCG average of 93% and the national average of 88%. 91% of the same group had also had their alcohol consumption recorded in the previous 12 months, similar to the CCG average of 94% and the national average of 90%.
  • The practice liaised with multidisciplinary teams in the management of patients experiencing poor mental health and we saw that care plans were in place for those with dementia.
  • The practice worked jointly with the local parish council to promote dementia friendly allotments to patients.

People whose circumstances may make them vulnerable

Good

Updated 12 April 2017

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

  • Longer appointments were offered for patients who needed them, including learning disability patients. There were 16 patients on the practice’s learning disability register at the time of the inspection, ten of whom had received a health check during the previous year.
  • The practice was a member of the Safe Place Scheme for people with a learning disability. This meant there was a logo displayed identifying the practice building to those with a learning disability as a safe place to come if they needed assistance or were experiencing fear. Longer appointments were also available for patients with a learning disability.
  • The practice worked with a multidisciplinary team of other health care professionals in the case management of vulnerable patients.
  • Staff we spoke with during the inspection knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities. All staff had additionally completed IRIS (Identification and Referral to Improve Safety) training in domestic violence and the practice had made individual arrangements to support patients as necessary.
  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 131 patients as carers (2% of the practice list). A member of non-clinical staff had a lead role in managing the carers register and monitoring their uptake of relevant services. For example, carers were able to receive the flu vaccine. There was a board in the patient waiting area providing information for carers about avenues of support available.