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Shirehampton Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Shirehampton Group Practice on 16 February 2016. 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. For example, with early assessment of home visit requests, and a high visiting rate. Routine home visiting started before 11am facilitating earlier admissions to hospital if needed or referral to other services.
  • 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.
  • Feedback from patients about their care was consistently 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.
  • Patients said they found it easy to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice reviewed frequent attenders to better understand their needs and to plan their care. They provided regular appointments with a named GP in order to address their needs.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • They had engaged with the local community and arranged an educational session for teenagers with learning disabilities to promote greater understanding of GPs and what happen during a visit to the doctor.
  • 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.

The areas where the provider should make improvement are:

  • Ensure the recruitment documentation held is fully compliant with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

  • Ensure the complaint procedure is fully implemented and learning from these events is disseminated through and implemented by the practice.

  • Review governance arrangements so that processes and systems are monitored for effectiveness, for example, review of actions from meetings, GP buddy arrangements and prescription records.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 March 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, patients received reasonable support, truthful information, a verbal and written apology. 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 well managed.

  • We found the some procedures for the management of the service were not fully implemented, for example, not all recruitment checks had been recorded.

Effective

Good

Updated 31 March 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the 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.

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

Caring

Good

Updated 31 March 2016

The practice is rated as good for providing caring services.

  • 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 observed a strong patient-centred culture.

  • Views of external stakeholders were very positive and aligned with our findings.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice maintained a small branch surgery for ease of accessibility for patients.

Responsive

Good

Updated 31 March 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, they had worked with local practices to secure funding for a care coordinator post.

  • Patients said they found it easy to make an appointment with a named 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. There was limited evidence that learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 31 March 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 regular governance meetings.

  • 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.

  • The Shirehampton Group practice was part of the Clinical Research Network – West of England, a level III practice and actively participated in several projects.

Checks on specific services

People with long term conditions

Good

Updated 31 March 2016

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

  • Nursing staff had specialist training for the management of chronic disease management and patients at risk of hospital admission were identified as a priority. There was a GP lead for each chronic disease, who worked in partnership with nurse led clinics.

  • 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 patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice offered flexible appointments to patients who found it difficult to attend.

  • All patients with significant cancers or those receiving palliative care were allocated a lead and second lead GP for continuity of their care.

  • The practice employed a pharmacist to audit chronic disease management, specifically prescribing, and to provide advice and support for nursing home patients.
  • The practice had made a successful bid for inclusion on to the “Integrated Model of Care for Diabetes Pilot” (HG Wells Project - a new one year pilot aimed at delivering significant and sustainable improvements in the management and treatment of diabetes) being commissioned by the South West Commissioning Support unit.

Families, children and young people

Good

Updated 31 March 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.

  • 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 good examples of joint working with midwives, health visitors and school nurses.

  • The practice worked to provide inclusive services for younger patients, such as hosting the 4YP (for young people) initiative which enabled young patients to access sexual health care with team champions.

  • The practice had produced a series of patient leaflets to inform parents about common childhood illness.

Older people

Good

Updated 31 March 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 patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. For example, with early assessment of home visit requests, and a high visiting rate. Routine visiting started before 11am facilitating earlier admissions or referral to other services.

  • There was a weekly clinic by designated GP at a local care home; they had regular meetings with the care home management team to review of admissions, deaths and training needs.

  • The practice had appointed a care co-ordinator to contact patients following their discharge from hospital.
  • There was a weekly visit by a volunteer from the carer organisation, and monthly carers’ surgery held at the practice where carers were assessed.
  • The appointment triage system enabled patients to speak to a GP if required, and on the day assessments.

Working age people (including those recently retired and students)

Good

Updated 31 March 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 reflected the needs for this age group.

  • They operated an appointment triage system so patients could have a consultation with a GP.

  • The practice offered a range of appointments outside the normal working day including for NHS Health checks.
  • They had recently introduced eConsult for patients to have an online consultation.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 March 2016

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

  • 92.86% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.

  • 77.19% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

  • The practice undertook advanced care planning for patients living with dementia.

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

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisation.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • Patients with mental illness had a named GP who they saw for their consultation.

People whose circumstances may make them vulnerable

Good

Updated 31 March 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 patients, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • They had arranged an educational session for teenagers with learning disabilities to promote greater understanding of GPs and what happen during a visit to the doctor.

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

  • The practice 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. All staff were trained to be 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 hosted a substance misuse worker and recognised the difficulties vulnerable patients had in making and keeping appointments and so offered on the day access.

  • The practice reviewed frequent attenders to better understand their needs and plan their care, and provided regular appointments with a named GP in order to address their needs.

  • The practice had 307 patients recorded with Polish as their first language; the practice had a translatable website and used resources within the practice staff to translate the practice leaflet into Polish.