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Quayside Medical Practice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quayside Medical Practice on 10 March 2016. Overall the practice is rated as outstanding.

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

  • Patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • Feedback from patients about their care was consistently positive.
  • 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, working with a local organisation in providing a workshop so people could learn how to cook on a restricted budget.
  • 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. For example, changing the quantity of pre-bookable appointments available on a Monday as this was the busiest day for the practice with patients requiring urgent appointments following the weekend.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

  • The practice had worked with nursing home staff in developing a system whereby patients with long term conditions could have deterioration in their condition recognised and care intervention started immediately by administering medicines that had been provided for such an issue. This has assisted in reducing A&E attendance by 13% and unplanned admissions by 20% for patients aged 75 years and over in the year from 2014/15 and 2015/16.
  • The practice, recognised the level of deprivation their patients faced. They had collaborated in securing funding from the Clinical Commissioning Group to provide free transport for patients to enable them to attend appointments at the practice and the local hospitals, along with attending the minor injuries unit instead of A&E. The service was also available to patients of neighbouring practices. 28% of Patients using this service had reported that without this support being available they may not have attended their appointments as they may not have been able to afford to get there and 60% of transport users report improved emotional wellbeing due to this service. This service had provided 3,242 passenger trips between February 2015 and January 2016.
  • The practice hosted a carers support worker who provided support and advice for patients on a range of issues once a month. This clinic ran between 9am and 5pm on one Tuesday per month and could be accessed by appointment or by dropping in on the day.
  • The practice undertook an “after death” analysis on patient’s to recognise areas of good practice and to ensure any areas of development were acted upon appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 August 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation. Any alteration to practice following this analysis was reviewed after three months to ensure that the changes made delivered the impact required.
  • Information about safety was highly valued and was used to promote learning and improvement.
  • The importance of significant event reporting, and what to report and how, formed a key part of the induction process for all staff.
  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff. Staff took lead roles to monitor risk, for example, there was a lead for monitoring safeguarding vulnerable patients.
  • Audits to monitor infection were backed up with quarterly compliance checks against the action plan detailed within the original audit.

Effective

Good

Updated 18 August 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.
  • Data showed that the practice was performing highly when compared to practices nationally and in the clinical commissioning group (CCG). The practice achieved 97.8% of the total number of Quality and Outcomes Framework points available (CCG average 97.6%, national average 93.5%), with 9.3% exception reporting (CCG average 9.3%, national average 9.2%). They were above local and national averages for all domains except one, hypertension, we noted the practice had a higher prevalence of this condition when compared to the local and national levels. However, for this area, they were still comparable to both local and national averages.
  • The practice was consistent in their approach to supporting people to live healthier lives and used every possible point of contact to promote and achieve this.
  • 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.

Caring

Outstanding

Updated 18 August 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. For example, 90% of patients found the receptionist at the surgery helpful which was higher than CCG and national averages. During GP consultations 96% of people said the GP was good at explaining tests and treatment, CCG average 90% and national average 86%.
  • 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.
  • The practice had worked with local support groups and had facilitated workshops for patients so as to enable them to learn cooking on a budget.
  • The practice recognised that patient’s social and emotional needs were as important as their physical needs.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 18 August 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs. This included facilitating outreach clinics within the practice so patients could access support and advice from organisation such as the Sussex Community Development Association (SCDA) and “Newhaven Your Way” for mental health support.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example, a GP within the practice had developed a pro forma which gave patient specific care interventions to nursing home staff so as to recognise deterioration in a patient’s condition and thus reduce unplanned admissions and A&E attendances.
  • We saw innovative approaches to providing integrated patient-centred care. The practice hosted a welfare support worker who held a monthly clinic on a Tuesday between 9am and 5pm to give support and advice to carers and any patient requiring support, for example, debt management. Access to this clinic could be either pre-booked appointment or by simply dropping in on the day.
  • 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). For example the practice had recently changed the appointments system in consultation with the PPG altering the quantity of pre-bookable appointments to those available on the day. In addition fewer pre-bookable appointments available on a Monday due to the demand of urgent appointments on that day.
  • Patients accessed appointments and services in a way and at a time that suited them. The practice was pro-active in offering text and online services.
  • The practice had collaborated in obtaining funding from the CCG in setting up a community transport scheme which was free to use and enabled patients to access transport to the practice, and appointments at local hospitals and minor injury units which previously 28% of those that used the service may not have attended due to being unable to afford transport. Of those patients that used the transport facility 78% had a long term health condition and 60% reported an improved emotional well-being. There had been 3,242 passenger trips between February 2015 and January 2016.
  • 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. Learning from compliments was also shared.

Well-led

Outstanding

Updated 18 August 2016

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

  • The practice had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. The practice had recognised the limitation that their current building presented them with in regards providing adequate support to patients and had actively sought to acquire more extensive local premises to deliver more support.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • The practice gathered feedback from patients using new technology, and it had a very engaged patient participation group which influenced practice development.
  • The practice supports medical students seeking to gain experience in general practice.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The management encouraged a culture of openness and honesty throughout the whole team. 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
  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice carried out proactive succession planning and had undertaken a skills audit with the current staff team to enable them to use staff skills, knowledge and experience in future roles.
  • The practice undertook activity audits for all staff groups so as to be able to recognise demand and plan staffing accordingly.
Checks on specific services

People with long term conditions

Outstanding

Updated 18 August 2016

The practice is rated as outstanding 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.
  • Data from 2014/15 showed the percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 1 August 2014 to 31 March 2015 was 96% compared to the national average of 94%.
  • 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. Multidisciplinary care team meetings were held monthly.
  • The practice, recognising the level of deprivation within their patient population worked with the CCG to obtain funding for a free at the point of use transport service to ensure patients could access their service and also attend hospital appointments or the local minor injuries unit thus decreasing the pressure on A&E. Evidence seen documented that between November 2015 and April 2016 there was an average of 15 patient journeys per day. The maximum was 22 journeys. Of those patients who had utilised this service 28% report that without the transport service they would either have cancelled their appointment or simply not attend.

Families, children and young people

Outstanding

Updated 18 August 2016

The practice is rated as outstanding 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 the highest within the CCG area 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.
  • Data showed that the percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 91% compared to the national average of 82%.
  • 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.
  • All clinical staff had received child safeguarding training to level three.

Older people

Outstanding

Updated 18 August 2016

The practice is rated as outstanding 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 has a named GP partner who has leadership responsibility for frail and elderly patients.
  • All patients on the admissions avoidance register are flagged on the practice’s computer system to ensure that they receive an appointment on the same day and that they also had a personalised care plan in place.
  • The practice had created specific patient care interventions and worked in partnership with nursing staff within care homes for the 35 patients that were on their list and residing in these homes. This involvement assisted in lowering both the A&E attendance and unplanned admissions for those aged over 75. The reduction, by the practice, for A&E attendance between the years 2014/15 and 2015/16 was 13% and for unplanned admissions 20%.The practice was actively involved in working with the CCG in establishing the community geriatrician service within the Havens area.
  • The practice held specific multi-disciplinary team meetings monthly to discuss care plans and identify patients who may be at risk of hospital admission. This meeting was attended by GPs, staff from older people’s mental health, adult social care, Living Well, Care for the Carers and District Nurses

Working age people (including those recently retired and students)

Outstanding

Updated 18 August 2016

The practice is rated as outstanding 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 reflects the needs for this age group.
  • The practice offered telephone consultations with a GP of the patient’s choice to discuss issues.
  • Electronic prescribing was available for patients which allowed their prescriptions to be sent directly to a pharmacy of their choice.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 18 August 2016

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

  • 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
  • Data showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 93% compared to the national average of 88%.
  • 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, for example, Newhaven Your Way and the Sussex Community Development Association.
  • 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 actively screened patients for dementia so as to enable early referral to memory assessment services.
  • The practice was engaged with the CCG’s “Golden ticket for dementia” programme which ensured that carers had a point of contact within the practice ensuring that rapid support could be delivered when times become challenging for people.

People whose circumstances may make them vulnerable

Outstanding

Updated 18 August 2016

The practice is rated as outstanding for the care of people who 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 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.
  • The practice had developed partnership working with organisations such as health in mind and Sussex Community Development Association which have delivered outreach services at the practice.

  • The practice held a welfare support clinic one Tuesday per month between 9am and 5pm utilising the practice’s dedicated support worker. Appointments were available to book through reception or people could just arrive on the day. All areas of support and advice could be discussed to assist people looking after someone and introductions could be made to other support organisations if appropriate.