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Archived: Dr R Withers & Partners Good Also known as Yaxley Group Practice

Inspection Summary


Overall summary & rating

Good

Updated 4 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Withers & Partners (Yaxley Group Practice) on 22 November 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and the practice had systems in place for reporting and recording significant events.
  • Risks to patients who used services were assessed and well managed.
  • The practice was proactive and responsive to patients’ needs.
  • The practice had identified 270 patients as carers (1.8% of the practice list).
  • Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
  • 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.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent published results showed the practice achieved 100% of the total number of points available which was above the CCG and the England average by 5% with an exception reporting of 17% which was higher than the CCG average by 6% and higher than the England average by 7%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had recognised this and completed searches to ensure that patients had been exception reported appropriately.
  • 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.
  • 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.

The areas where the provider should make improvements are:

  • Ensure consumables in the practice are checked regularly for their expiry date.

The practice had some outstanding elements:

  • The practice employed a patients librarian who ran the “Age Well Club” at the practice for the older generation to socialise once a week and a “Full of Beans” exercise class for people over the age of 60. The patients librarian organised and ran a carers support group which met once a month and information was displayed in the waiting area, on the practice website and in the monthly newsletter. The patients librarian took on chaperone duties for patients, completed dementia cognitive initial tests when requested by the GPs, helped young people fill out the C-Card scheme registration form, assisted patients to fill out financial, disability and emotional support applications and referred patients to various support groups. Additional training for these roles had been undertaken. The patients librarian visited patients at their homes when they couldn’t attend the practice to see her. Additional training and a DBS check for these roles had been undertaken.
  • A retired GP partner from the practice set up the local food bank in 2015 and the practice had a donation point for food. Vouchers were issued at the practice when GPs identified patients who were in need.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 January 2017

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. For example, the practice wrote a protocol for the management of challenging behaviour after a significant event within the practice.
  • When things went wrong patients received reasonable support and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had arrangements in place to respond to emergencies and major incidents. 
  • We reviewed a range of personnel files and found that all of the appropriate recruitment checks had been undertaken for all staff prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body and the appropriate checks through the Disclosure and Barring Service.
  • Annual infection control audits were undertaken. We saw evidence of recent audits and actions taken to address any improvements identified as a result.
  • The practice had a legionella policy and documented risk assessment in place.
  • Patient safety alerts were logged, shared and searches were completed to ensure that changes were adequately effected on the relevant patient care records.
  • The practice had 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 practice used a Doctor First telephone triage system for the allocation of appointments and the GPs occasionally sat in with each other during telephone triage to ensure efficient and timely triage took place.

Effective

Good

Updated 4 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were higher than the clinical commissioning group (CCG) and national averages however the practice exception reporting rate was high. The practice had recognised this and completed searches to ensure that patients had been exception reported appropriately.
  • 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.
  • The practice had staff training monthly and educational meetings fortnightly however the practice should consider keeping appropriate evidence of discussions at these practice meetings to ensure learning can be shared.
  • The clinicians had regular meetings to discuss referrals.

Caring

Good

Updated 4 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with 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.
  • The practice had a dignity and respect policy.
  • 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.
  • The practice had identified 270 patients as carers (1.8% of the practice list).

Responsive

Good

Updated 4 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • 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.
  • The national GP patient survey results were published on 7 July 2016. The results showed that patients rated the practice generally in line with others for access to care.
  • The practice used a Doctor First telephone triage system for the allocation of appointments.
  • The practice had an e-consult system which allowed patients to consult with their own NHS GP online.
  • The practice ran flu clinics on a Saturday and had administered 2300 so far this year. The clinicians included a pulse check during the flu vaccination clinics and long term condition reviews to check for patients with undiagnosed Atrial Fibrillation (an irregular heart rhythm).
  • The practice had a screened off area for the self-test blood pressure machine and weighing scales in the waiting area. Patients took readings and filled in a form which then went to the GPs to update patient records.
  • A retired GP partner from the practice set up the local food bank in 2015 and the practice had a donation point for food. Vouchers were issued at the practice when GPs identified patients who were in need.

  • The practice employed a patients librarian who ran the “Age Well Club” at the practice for the older generation to socialise once a week and a “Full of Beans” exercise class for people over the age of 60. The patients librarian organised and ran a carers support group which met once a month and information was displayed in the waiting area, on the practice website and in the monthly newsletter. The patients librarian took on chaperone duties for patients, completed dementia cognitive initial tests when requested by the GPs, helped young people fill out the C-Card scheme registration form, assisted patients to fill out financial, disability and emotional support applications and referred patients to various support groups. Additional training and a DBS check for these roles had been undertaken. The patients librarian visited patients at their homes when they couldn’t attend the practice to see her.

Well-led

Good

Updated 4 January 2017

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity which were in need of updating and regular governance meetings were held.
  • 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.
  • 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 strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 4 January 2017

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

  • Nursing staff and the emergency Care Practitioner had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice completed joint reviews for patients who had two or more long term conditions to ensure patients did not have to attend the practice on multiple occasions. The practice had 198 patients who had two or more long term conditions. Patients were called in for their reviews during their birthday month to aid as a reminder of when reviews were due.
  • Data from 2015/16 QOF showed that performance for diabetes related indicators was 100%, which was 10% above the CCG and England averages. The practice’s overall exception reporting rate for all of the clinical indicators was 17% which was higher than the CCG average of 11% and the England average of 10%. The practice had recognised this and completed searches to ensure that patients had been exception reported appropriately.
  • Longer appointments and home visits were available when needed.
  • 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. The practice employed a Pharmacist who regularly reviewed the medication needs of patients.

Families, children and young people

Good

Updated 4 January 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children 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 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.
  • 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 health visitors ran a drop in clinic from the practice for patients who needed it. The midwives ran a two weekly clinic from the practice.

Older people

Good

Updated 4 January 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had a palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis, dementia and heart failure were above the local and national averages.
  • The practice looked after patients living in a local care home. The GPs visited patients weekly and as and when required and the practice employed pharmacist completed six monthly medication reviews.

Working age people (including those recently retired and students)

Good

Updated 4 January 2017

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered evening and weekend appointments due to joint working with other local practices which was in addition to the extended hours clinics provided on a Saturday morning.
  • The practice had a screened off area for the self-test blood pressure machine and weighing scales in the waiting area. Patients took readings and filled in a form which then went to the GPs to update patient records.
  • 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’s uptake for the cervical screening programme was 82% which was the same as the CCG and England averages. The practice exception reporting for the clinical domain was 2% which was better than the CCG average by 7% and the England average by 5%.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 January 2017

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

  • 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average by 8% and the England average by 5% with a 10% exception reporting which was higher than the CCG average by 2% and the England average by 3%.
  • The practice achieved 100% for mental health related indicators in QOF, which was above the CCG average by 6% and the England average by 7%. The rate of exception reporting for the mental health related indicators was higher than the CCG and England averages. For example; the percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months was 100% which was 8% above the CCG average and 10% above the England average with a 17% exception reporting rate which was 6% higher than the CCG average and 7% above the England average. The practice had recognised this and completed searches to ensure that patients had been exception reported appropriately.
  • 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 patients librarian completed dementia cognitive initial tests when requested by the GPs.

People whose circumstances may make them vulnerable

Good

Updated 4 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice is rated as outstanding for their responsiveness to patients in this population group.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice had 66 patients on the learning disabilities register and all patients had been invited to attend a care review. Last year 43 out of the 66 patients had attended for a care review. The practice completed monthly medication reviews for a select group of patients with learning disabilities in residential care. The practice offered longer appointments for patients with a learning disability.
  • The practice completed regular searches of their clinical computer system for patients who may be vulnerable and coded them as appropriate. The practice had 240 patients coded as vulnerable.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice had been in discussions to commence specific vulnerable adult multi-disciplinary teams meetings.
  • 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 during out-of-hours.
  • A retired GP partner from the practice set up the local food bank in 2015 and the practice had a donation point for food. Vouchers were issued at the practice when GPs identified patients who were in need.
  • The practice employed a patients librarian who ran the “Age Well Club” at the practice for the older generation to socialise once a week and a “Full of Beans” exercise class for people over the age of 60. The patients librarian organised and ran a carers support group which met once a month and information was displayed in the waiting area, on the practice website and in the monthly newsletter. The patients librarian took on chaperone duties for patients, completed dementia cognitive initial tests when requested by the GPs, helped young people fill out the C-Card scheme registration form, assisted patients to fill out financial, disability and emotional support applications and referred patients to various support groups. Additional training and a DBS check for these roles had been undertaken. The patients librarian visited patients at their homes when they couldn’t attend the practice to see her.