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The Abbey Medical Group Good Also known as Blidworth Surgery

Inspection Summary


Overall summary & rating

Good

Updated 23 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Abbey Medical Group on 2 February 2016. Overall the practice is rated as good.

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. Opportunities for learning were identified and mechanisms were in place to share learning effectively.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Feedback from patients about their care was generally positive. Patients told us staff were polite and helpful and treated them with dignity and respect.
  • Patients told us they generally found it easy to make an appointment with a GP, with urgent appointments available the same day.
  • 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. For example the practice hosted the Citizen’s Advice Bureau one day per week.
  • The practice worked closely with their patient participation group to engage with their patients and the local community. For example, the PPG had facilitated a number of community health education events open to patients of the practice and members of the community.
  • 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.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy was regularly reviewed and areas for improvement were identified on an ongoing basis.
  • 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.

We saw several areas of outstanding practice including:

  • The practice had been selected to participate in a community pharmacy pilot project from October 2015. This placed an independent prescribing pharmacist within the practice for three days each week. From 1 October to 31 December the pharmacist had recorded 420 patient contacts. Contacts included medication reviews, nursing home reviews and queries from staff and patients. Feedback from the practice, patients and the project team was positive about the project. The practice benefitted from having medicines expertise on site and there was increased access to GP time for patients.

  • There was an effective relationship between the practice and the patient participation group (PPG) which benefitted patients. The PPG facilitated a wide range of events to engage with patients and promote healthier living. For example, the PPG had organised an event in November 2015 which was attended by over 100 people and supported by 24 local organisations. In addition the PPG had built strong links with NHS organisations across the area and arranged events related to carers, men’s health and pain management. These events were open to patients and members of the community.

However there were areas of practice where the provider should make improvements:

  • Ensure blank prescriptions are handled securely in line with guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 March 2016

The practice is rated as good for providing safe services.

  • There were effective systems in place to report and record significant events. Mechanisms were in place to identify learning and to disseminate this to relevant staff.

  • Where patients had been affected by unintended or unexpected safety incidents, they were offered explanations and apologies. 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. However, the practice was not ensuring that serial numbers of prescription pads were recorded when these were issued in line with national guidance.

  • Most risks to patients were assessed and well managed. A recent infection control audit had identified some outstanding actions carried over from the previous audit however; the practice had a clear plan in place to address these issues.

Effective

Good

Updated 23 March 2016

  • Data showed patient outcomes were in line with local and national averages. The practice had achieved an overall figure of 99.6% of the total number of points available for the Quality and Outcomes Framework in 2014/15. This was 5.2% above the CCG average and 6.1% above the national average. The practice had an exception reporting rate of 6.4% which was below the local and national averages.

  • 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 and had access to relevant and role specific training.

  • The skill mix of the practice team was kept under review to meet the changing demands of GP practice. For example, the practice was planning to recruit additional nursing staff to create more appointment capacity.

  • Annual appraisals and personal development plans were in place for all staff.

  • Staff worked effectively with multidisciplinary teams to understand and meet the range and complexity of people’s needs. Monthly meetings with wider members of the healthcare team were held to review complex and vulnerable patients.

Caring

Good

Updated 23 March 2016

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 local and nationally for most aspects of care. For example 90% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 85% and the national average of 85%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We observed staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 23 March 2016

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. For example the practice had been selected to pilot the impact of co-locating an independent prescribing pharmacist within the practice.

  • The practice provided an anticoagulation clinic which enabled patients being treated with warfarin to be monitored locally meaning they did not have to travel to hospital for treatment.

  • Patients said they generally found it easy to make an appointment with a GP and urgent appointments were available the same day. The practice offered extended hours access a number of mornings per week.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had comprehensive plans in place to make improvements to its branch site.

  • 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 23 March 2016

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

  • The practice had a clear vision with quality and safety as its top priority. Annual meetings were held to discuss and agree the vision for the practice. The strategy to deliver this vision was reviewed with actions for improvement being identified on an ongoing basis.

  • The practice carried out proactive succession planning and sought to maximise the flexibility of staff resources. For example, the practice was restructuring the nursing team to enable recruitment and increased capacity. In addition reception and administration staff had been trained across a range of roles to facilitate cover and ensure business continuity in the event of staff absence.

  • 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 evidence of strong links with the local community. For example, the practice had worked with local schools to run a competition for pupils to design a new logo for the practice.

  • The patient participation group (PPG) were extremely active. In addition to raising funds for the practice they worked to promote health and well-being of the practice patients and the wider community. They organised a range of events and educational sessions for patients and the community including events related to men’s health, long term conditions and surviving after stroke.

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

Checks on specific services

Older people

Good

Updated 23 March 2016

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

  • 10.6% of the practice population were over the age of 75. The practice offered proactive, personalised care to meet the needs of these patients.

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

  • Enhanced services were provided to local care homes with regular visits being conducted by the GPs and GP registrars.

  • Medication reviews were undertaken in care homes by the practice based pharmacist.

People with long term conditions

Good

Updated 23 March 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. The practice had identified 2.3% of its patients as being at risk of admission.

  • The practice offered nurse practitioner led weekly anticoagulation clinics to provide monitoring for patients taking warfarin.

  • Indicators to measure the management of diabetes were higher than local and national averages. For example, the percentage of patients on the practice register for diabetes with a record of being referred to a structured education programme within nine months of entry onto the register was 96.2%. This was above the local and national averages and was achieved with a 0% exception reporting rate.

  • 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 people 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

Good

Updated 23 March 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.

  • The premises were suitable for children and babies. Urgent appointments were always available on the day.

  • Fortnightly baby clinics were provided at the practice’s branch surgery.

  • One GP and two nurse practitioners provided a service to fit coils and contraceptive implants.

  • The practice had run a competition for children in a local school to design a new practice logo.

Working age people (including those recently retired and students)

Good

Updated 23 March 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.

  • Extended hours appointments were offered three to four mornings each week from 7.30am to facilitate access for working age patients.

  • Telephone triage and telephone consultations were offered where this was appropriate.

  • The practice was proactive in offering online services and all GP appointments were offered through the online booking system

  • Health promotion and screening was provided that reflected the needs for this age group.

People whose circumstances may make them vulnerable

Good

Updated 23 March 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 those with a learning disability.

  • It offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. In addition vulnerable patients were regularly discussed at the weekly partners’ meetings.

  • Information was available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in vulnerable adults. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 March 2016

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

  • 92.1% of patients with a mental health condition had a comprehensive care plan documented in their records in the previous 12 months which was above the CCG average of 81%.

  • 75.5% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was 2.9% below the CCG average. However; this was achieved with an exception reporting rate of 4.3% which was 10.1% below the CCG average.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • It 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 people with mental health needs and dementia and all staff had received dementia training in 2015.

  • The patient participation group was working to set up a memory group to help patients and carers affected by issues related to dementia.