You are here

Macklin Street Surgery Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Macklin Street Surgery on19 April 2016. Overall the practice is rated as outstanding.

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

  • There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events.
  • Risks to patients were assessed and managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients said it could be difficult to make a routine appointment with a GP but that urgent were appointments available the same day. The practice demonstrated an ongoing commitment to improving access to appointments and had recruited a new GP who was due to start with the practice soon.
  • 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.

We saw several areas of outstanding practice:

  • The provider had a history of providing high quality medical education. They had demonstrated innovation in their approach to education including the development and hosting of courses for triage and clinical skills accessible to a range of clinicians. In addition the practice provided work experience opportunities for sixth form students who wanted to pursue a career in medicine. The practice was a designated hub as part of the Community Education Provider Network and was working with other organisations locally to offer more placement opportunities for medical students and nurses.
  • There was a commitment across all practice staff to providing high quality, compassionate end of life care for their patients and advanced care planning was in place for all palliative patients. An annual audit of palliative care had demonstrated that the 62.5% of patients on the practice’s palliative care register had achieved a comfortable death in their preferred place of death. The practice was one of only 14 nationally to have achieved accreditation from the Gold Standards Framework. This practice had been shared both regionally and nationally.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place to ensure significant events were reported and recorded.
  • Lessons were shared internally and externally to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, information and apologies where appropriate. 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.
  • Risks to patients were assessed and managed within the practice.

Effective

Outstanding

Updated 19 September 2016

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. Data from 2014/15 showed the practice had achieved 99.7% of the total number of points available. This was 2.7% above the clinical commissioning group (CCG) average and 5% above the national average.
  • Staff used current evidence based guidance and local guidelines to assess the needs of patients and deliver appropriate care.
  • There was an ongoing programme of clinical audit within the practice. The audits undertaken demonstrated improvements in quality.
  • 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 triage nurse was the lead for multidisciplinary working and worked in partnership with the community trust employed care coordinator. Fortnightly multidisciplinary meetings were held to discuss patients, plans were made to reduce the risk of hospital admission.

Caring

Good

Updated 19 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. For example 92% of patients said the GP gave them enough time compared to the CCG average of 88% and the national average of 87%.
  • 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice was the first in the CCG area to receive a dignity award in recognition of their commitment to treating patients with dignity and respect.
  • Views of external stakeholders were positive about the practice and aligned with our findings.
  • We found positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

Responsive

Good

Updated 19 September 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 carried out improvement works in the main surgery and the branch surgery to ensure these were more accessible. This included the installation of automatic doors.
  • Patients said urgent appointments were generally available the same day but a number of patients said they found it challenging to book routine appointments.
  • We saw that the practice were aware of issues patients faced in respect of booking appointments and regularly reviewed their system. Improvements made included investing in a new telephone system and had recently recruited a new GP.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Interpretation services were used effectively to ensure communication with all patients was effective.
  • 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 practice liaised with external stakeholders in their efforts to resolve complaints to the satisfaction of the complainant.

Well-led

Outstanding

Updated 19 September 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. This was underpinned by a clear practice ethos and a mission statement which was shared with patients throughout the practice.
  • Staff were clear about the vision and mission and their responsibilities in relation to it. Staff were engaged with values of the practice.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles. In addition there was evidence of effective partnership working with external organisations to benefit patients.
  • 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 regular governance meetings.
  • 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 practice had an active patient participation group but numbers had recently dropped due to ill health and other commitments. The practice was working to increase membership.
  • There was a strong focus on continuous learning and improvement at all levels. The practice had a well evidenced track record of a commitment to quality medical education. As well as being a teaching and training practice, the practice had been innovative in their approach to educating students and clinicians locally. For example, the practice had designed and delivered triage courses and had arranged and provided work experience for sixth form students wishing to pursue a career in medicines.
  • In addition to being a multi-professional learning organisation, the practice had recently been designated as a Community Education Provider Network hub and was keen to increase the availability of placements for students locally.
Checks on specific services

People with long term conditions

Outstanding

Updated 19 September 2016

he practice is rated as outstanding for the care of people with long-term conditions.

  • Clinical staff had lead roles in chronic disease management and actions were taken to minimise the risk of unnecessary hospital admissions for those patients at risk.
  • Performance for diabetes related indicators was 99.3% which was 6.2% above the CCG average and 10.1% above the national average.
  • Longer appointments and home visits were provided when needed.
  • All patients with long term conditions had a named GP and were offered a structured annual review to check their health and medicines needs were being met.
  • For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Fortnightly multidisciplinary meetings were held and the practice worked in partnership with the community trust employed care coordinator. Feedback from the care coordinator was positive about the level of engagement and commitment to their patients demonstrated by the practice.
  • There was a commitment across all practice staff to providing high quality, compassionate end of life care for their patients and advanced care planning was in place for all palliative patients.

Families, children and young people

Good

Updated 19 September 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. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.
  • Immunisation rates were relatively high for all standard childhood immunisations and the practice worked with health visitors to follow up children who did not attend for 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. There was a dedicated baby changing room available.
  • Urgent appointments were available on a daily basis to accommodate children who were unwell.
  • Rooms were offered to the community midwife free of charge within the practice to facilitate access for patients.

Older people

Good

Updated 19 September 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. Fortnightly multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs. There was evidence that the actions taken had reduced hospital admissions and unnecessary GP appointments.
  • The practice was responsive to the needs of older people, and provided home visits and urgent appointments for those with enhanced needs.
  • Primary medical services were provided for older patients in 17 local care and nursing homes. We spoke with staff from three care homes who were positive about the level of care and treatment the practice provided.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

Working age people (including those recently retired and students)

Good

Updated 19 September 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 services were offered two evenings per week to facilitate access for working patients.
  • 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. Uptake rates for screening were similar to or above the national average. For example, the uptake rate for breast cancer screening was 78.8% compared with the national average of 72.2%.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 September 2016

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

  • 98.5% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national and local averages. This was achieved with a lower than average exception reporting rate.
  • 99.1% of patients with a mental health condition had a comprehensive care plan documented in their records in the last 12 months which was above the CCG average and national average. However, this was achieved with an exception reporting rate which was slightly above the CCG and national average.
  • 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. Feedback from care homes looking after patients with dementia was positive about the practice.
  • The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 19 September 2016

The practice is rated as outstanding 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 and those at risk of a fall.
  • The practice offered longer appointments for patients with a learning disability and for those who required it.
  • The practice has a significant number of drug using patients, and 4.5% of the practice population have been identified as admitting to drinking >30 units of alcohol per week or have problematic alcohol use recorded. The practice regularly worked with other health care professionals in the case management of vulnerable patients. Fortnightly multidisciplinary meetings were hosted by the practice.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice liaised with the trust care coordinator to ensure vulnerable patients had the appropriate health and social care support in place and appropriate referrals were made to other 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.