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Stroud Valleys Family Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

In February 2016, a comprehensive inspection of Stroud Valleys Family Practice was conducted. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good.

We found that the practice required improvement for the provision of safe services because improvements were needed in the way the practice assessed, managed and mitigated the risk associated with the spread of infections.

Stroud Valleys Family Practice sent us an action plan which set out the changes they would make to improve in these areas.

We carried out an announced desk top inspection of Stroud Valleys Family Practice on 22 September 2016 to ensure the practice had made these changes and that the service was meeting regulations. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report published on 11 April 2016.

Our key findings were:

  • The practice had processes in place to prevent, detect and control the spread of infections, including those that are health care associated.
  • Recommended training had been undertaken by practice staff.
  • Procedures were in place for ensuring patients were aware of the chaperone policy.



Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 November 2016

The practice is rated as good for providing safe services. Since our last inspection in February 2016, systems had been put in place to ensure safe patient care.

  • Infection control audits had been completed by the infection control leads.
  • Staff had completed training modules relating to infection control.
  • The practice had a cleaning schedule in place and was able to demonstrate oversight of the contract they had with the owners of the building.
  • Staff had completed recommended training modules.

Effective

Good

Updated 11 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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, however the nurses and some GPs had not received mental health capacity training.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs, for example the diabetic specialist nurse supported the practice when diabetic patients were transferring from oral medicines to injections.

Caring

Outstanding

Updated 11 April 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.

  • 95% said the last GP they saw was good at explaining tests and treatments compared to the clinical commissioning group (CCG) average of 89% and national average of 86%.

  • 99% said the last nurse they saw was good at involving them in decisions about their care, compare to the CCG average 87%, and the national average 85%.

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

  • There was a strong, visible, person centred culture. Staff were highly motivated to offer care that was kind and promoted peoples’ dignity and worked to overcome obstacles to achieve this, for example, the practice had initiated an end of life project for the local area. They worked with the local palliative care team and hospice to ensure patients’ and their relatives had understanding and choice regarding their care and treatment.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on. People who use services were active partners in care. Staff were fully committed to working in partnership with people and making this a reality for each person.

  • The practice had worked effectively with the out of hours services to ensure that patients’ retained autonomy over the care they received and that their wishes were adhered to.

  • When a local practice closed, the partners were proactive in meeting the needs of 550 additional patients who registered with them over a six week period. Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 11 April 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.

  • There are innovative approaches to providing integrated person-centred care. The practice was proactive in initiating a shared care package with the hospital team for a patient with complex needs who was unable to attend frequent hospital appointments due to work commitments which led to improved management of the patients’ condition.
  • 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 (PPG). The PPG group had recently reformed and they fed back to the practice that they would like to invite guest speakers to information evenings that would attract the younger population The practice were happy to engage with this.
  • Patients can access appointments and services in a way and at a time that suits them. 93% patients said they always or almost always see or speak to the GP they prefer, compared to the CCG average 68%, and the national average 59%.
  • Bookable telephone appointments were available with a GP which enabled patients’ to access health care services in a way and at a time that suited them.
  • 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

Good

Updated 11 April 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 this.

  • 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 monthly governance meetings when the practice closed which allowed protected time for all staff to attend.

  • 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 knowing about 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 11 April 2016

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

  • Nursing staff and GP’s worked together effectively to provide chronic disease management. Patients at risk of hospital admission were identified as a priority. Individualised care plans were discussed and updated at each review.

  • Longer appointments and home visits were available when needed. Patients with more than one chronic disease were able to book a longer appointment so that visits to the practice were minimised for the patient.

  • 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

Good

Updated 11 April 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.

  • 73% of patients diagnosed with asthma, on the register had an asthma review in the last 12 months which was comparable to CCG and national averages.

  • 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.

  • 82% of women aged 25-64 had had a cervical screening test in the preceding 5 years (04/2014 to 03/2015)

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

  • The practice provided comprehensive sexual health promotion and services.

  • We saw positive examples of joint working with midwives, health visitors and school nurses such as effective multidisciplinary team working to support young mothers caring for a new baby.

Older people

Good

Updated 11 April 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.

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

  • A nurse visited housebound older patients at home and carried out annual reviews.

  • The practice actively engaged with the services offered by the local community agent. Community agents work with the over 50s in Gloucestershire, providing easy access to a wide range of information that will enable them to make informed choices about their present and future needs.

  • The practice worked effectively and communicated well with relatives of older people facilitating patient centred care.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 83% and comparable to the clinical commissioning group (CCG) and national averages.

Working age people (including those recently retired and students)

Good

Updated 11 April 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 for example late appointments were available 6.30pm to 8pm Monday to Thursdays.

  • 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 was proactive in initiating a shared care package with the hospital team for a patient who was unable to attend frequent hospital appointments due to work commitments which improved health outcomes.

  • Patients were able to book telephone appointments with a GP which enabled patients’ who were working to access health care at a time convenient to them.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 April 2016

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

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, (04/2014 to 03/2015) which was slightly higher than the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 worked closely with relatives and carers of patients’ experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 11 April 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 multi-disciplinary teams in the case management of vulnerable people.

  • 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.