You are here

Wilson 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 Wilson Street Surgery on 9 March 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 and effective systems in place to report and record significant events.
  • Risks to patients were assessed and 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. A number of clinical staff had undertaken additional training to enhance their skills and had developed areas of special interest to support them in taking lead roles within the practice.
  • Feedback from patients regarding their care and treatment was positive. 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.
  • Although some patients reported it could be difficult to get through to the practice by telephone, they said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear understanding of the needs of the local population and services were offered to meet these needs. The practice was committed to removing barriers to access for the most vulnerable patients and regularly provided outreach sessions at the local homeless shelter.
  • There was a clear leadership structure and staff felt supported by management. Staff highlighted the supportive culture within the practice.
  • The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice:

  • The practice demonstrated a strong commitment to improving access to healthcare for people who were vulnerable. For example the practice provided regular outreach sessions at a local homeless shelter and also provided flu clinics at a local day centre for people who were considered vulnerable. Feedback from community based staff working with vulnerable patients was positive about the service offered by the practice.
  • There was a commitment to the identification and support of carers within the practice. The practice had a wide range of available information to support carers and used all opportunities to identify new carers. The practice had identified over 4% of their practice population as carers. In addition to offering health checks and flu vaccinations, events were organised to support and identify carers which coincided with carers week and mini pamper sessions were provided.

The areas where the provider should make improvements are:

  • Continue to review telephone access for patients to improve the ease of patients contacting the practice by telephone.

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 were effective systems in place to report and record significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, information about what had happened and apologies where appropriate. In addition patients 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.

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. For example, the 2014/15 results showed the practice had achieved 99% of the total number of points available. This was above the CCG average of 97% and the national average of 95%.
  • The practice demonstrated a strong track record of effective prescribing including ensuring low rates of antibiotic prescribing.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. The practice had undertaken 17 clinical audits in the last two years.
  • 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. Feedback from other professionals who worked with the practice was positive.

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 in line with local and national averages for most aspects of care. For example 97% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%.
  • Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment. Patients highlighted the compassionate care they had received from staff and said they felt well supported.
  • There was a wide range of information for patients about the services available which was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 19 September 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 that they meet patients’ needs. For example, the practice offered flu clinics at a local day centre and hostel for people whose circumstances might make them vulnerable.
  • The practice offered extended hours services from 7am on a daily basis to facilitate access for working age patients.
  • Though some patients reported it could be difficult to get through the practice by telephone, they were satisfied with the availability of appointments. Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had some consulting rooms located upstairs but had mechanisms in place to ensure that patients who were unable to use the stairs were seen downstairs.
  • 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 anonymously with others such as the patient participation group (PPG).

Well-led

Good

Updated 19 September 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. The vision was shared with patients in practice information and on the website. Staff were clear about the vision and their responsibilities in relation to it.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles. There were robust systems in place to aid communication between all groups of staff with regular formal and informal meetings.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff told us they highly valued the level of support they received from their colleagues and highlighted the strong team working.
  • There was a clear leadership structure and staff felt supported by management.
  • Appropriate policies and procedures were in place to govern activity and these were regularly reviewed and updated.
  • 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 a strong desire to involve patients and the local community in the practice. For example, the practice had arranged a celebration week last year to mark their 120th birthday. Each day was given a theme which focussed on a different group of patients. For example there was a day dedicated to homelessness.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 19 September 2016

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was 100% which was above the CCG average of 93% and the national average of 89%. Exception reporting for diabetes related indicators was above local and national averages; however, we were assured that the practice was exempting patients in line with guidance.
  • 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. Patients with more complex needs were seen more often as required.
  • For patients with the most complex needs, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary team meetings were held and the practice worked closely with their attached care coordinator who was present in the practice two and a half days per week.

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 practice held regularly safeguarding meetings with relevant professionals.
  • Immunisation rates for some standard childhood immunisations were below local and national averages. We saw that the practice encouraged attendance and had tried initiatives such as offering vaccination clinics in the school holidays. The practice also worked closely with community based health care staff to increase attendance.
  • The practice operated a catch-up programme for immunisations, coordinated by their practice nurses.
  • 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 and feedback from these staff was positive about the practice.

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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • All older people were encouraged by the practice to attend for flu and shingles vaccinations as appropriate. In addition to being reminded during appointments, there was information displayed in the waiting areas to encourage attendance.

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. For example, the practice offered extended hours services from 7am on a daily basis to facilitate access for working patients.
  • The practice offered NHS health checks undertaken by their practice nurses for relevant patients.
  • The practice aimed to engage with this group in ways which were relevant and accessible to them, for example, the practice had a presence on social media and engaged with patients via email.
  • 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 a full range of contraceptive services to patients including implant and coil fits. Implants and coils were fitted by three specifically trained GPs.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 19 September 2016

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

  • 92.8% of patients with a mental health condition had a documented care plan in the last 12 months which was above the CCG average of 91.8% and the national average of 88.3%.
  • 84.4% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was in line with the local average of 85.4% and the national average of 84%.
  • 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.

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 homeless people, carers and those with a learning disability.
  • Longer appointments were offered to patients with a learning disability and for those who needed them.
  • The practice provided the secure unit services for the county. This meant the practice saw all of the patients who had been placed on the violent patient list. Appointments were offered three evenings per week on a pre-bookable basis outside of normal surgery hours.
  • Where required patients who needed to use an interpreter were offered one and a longer appointment if needed.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. Feedback from professionals working with vulnerable patients was positive about the practice.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Efforts were made to engage with vulnerable groups. For example, the practice had a week of celebrations to mark their 120th anniversary and one day was dedicated to homelessness.
  • Outreach clinics were offered in the local homeless hostel three times per week and the practice also undertook flu clinics at a local day centre for vulnerable people. Homeless patients were also able to access services at the practice.
  • 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.