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Inspection Summary


Overall summary & rating

Good

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at De Parys Medical Centre on 27 October 2015. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • 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.
  • 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.
  • 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 two areas of outstanding practice:

  • The patient participation group worked with the practice to provide a befriending service. The CCG had delivered training to the practice participation group (PPG) members involved and they had all received checks through the Disclosure and Barring service (DBS). They visited patients identified by the practice who may need additional support, for example, if housebound or recently bereaved. They also visited patients in hospital if they had no one else to visit. At the time of the inspection there were 12 members befriending 16 patients. We saw from the PPG meeting minutes that the befriending service was a standing item on the agenda for discussion. Any concerns raised by befrienders were discussed as well as identifying any patients that may find the service a benefit.
  • There was a free and confidential sexual health service run from the practice that was open to both registered and non-registered patients of any age, including young people under 18. They used a C-card system that enabled patients to hand in a card at reception which allowed them to discreetly request free condoms.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 February 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, people received an apology and 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 people safe and safeguarded from abuse.

  • Staff had received safeguarding training appropriate to their role in relation to safeguarding children and vulnerable adults.

  • Risks to patients were assessed and well managed.

  • Arrangements were in place to respond to emergencies and major incidents.

Effective

Good

Updated 18 February 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average when compared to the local CCG 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.

  • The practice made use of the specialist knowledge of the GPs to reduce referrals to secondary care providers.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 18 February 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice comparably with others for several aspects of care.

  • Patients said they felt the practice offered an excellent and caring service.

  • Patients commented that the staff were professional and treated them with dignity and respect.

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

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • The patient participation group worked with the practice to provide a befriending service for patients who required additional support and company.

Responsive

Good

Updated 18 February 2016

The practice is rated as good for providing responsive services.

  • It 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.

  • Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was above the local and national averages in most areas.

  • Urgent same day appointments were available as well as nurse triage telephone appointments.

  • Same day appointments were available for children and those with long term conditions such as asthma and chronic obstructive pulmonary disease

  • 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 evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

  • There was a free and confidential sexual health service run from the practice that was open to both registered and non-registered patients of any age, including young people under 18.
  • They used a C-card system that enabled patients to hand in a card at reception which allowed them to discreetly request free condoms.

Well-led

Good

Updated 18 February 2016

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

  • It 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.

  • The mission statement was displayed in the reception area.

  • 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 practice meetings.

  • There was a 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 complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty.

  • 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 18 February 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.

  • Performance for diabetes related indicators was better than the CCG and national average. The practice achieved 99% of available points compared to the CCG average of 86% and the national average of 89%.

  • Same day urgent appointments were available for patients with asthma and chronic obstructive pulmonary disorder (COPD).

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that 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 18 February 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 uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 83% and the national average of 82%

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

  • We saw good examples of joint working with midwives and health visitors.

  • There was a free and confidential sexual health service run from the practice that was open to both registered and non-registered patients of any age, including young people under 18.
  • They used a C-card system that enabled patients to hand in a card at reception which allowed them to discreetly request free condoms.

Older people

Good

Updated 18 February 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.

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

  • The patient participation group worked with the practice to provide a befriending service for patients who required additional support and company.

Working age people (including those recently retired and students)

Good

Updated 18 February 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.

  • 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 ran a specialist travel service (MASTA), including yellow fever vaccinations.

  • Early morning appointments were available as well as appointments one Saturday per month.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 February 2016

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

  • 74% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

  • Performance for dementia related indicators was better than the CCG and national average. The practice achieved 100% of available points (with 9% exception reporting) compared to the CCG average of 95% and the national average of 95%.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • It 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.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 18 February 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 and annual health checks for people with a learning disability.

  • All staff had an awareness of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) and its implications for patients.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • It had told 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 followed the Gold Standards Framework to care for patients at the end of life

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