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Heartwood Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heartwood Medical Practice on 21 September 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. There were effective systems in place to support staff to report and record significant events. Learning from significant events was shared will all relevant staff and stakeholders.
  • Risks to patients and staff were assessed and well managed. The practice had a range of risk assessments in place.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received training which provided them with the skills, knowledge and experience to deliver effective care and treatment.
  • Feedback from patients about their care, and their interactions with all practice staff, was generally positive. Patients said they were treated with compassion, dignity and respect.
  • Information was displayed in the waiting area and on the practice website which told patients about how to complain.
  • Patients said they were generally able to access appointments when they needed them. The practice was continually working to improve patient access to appointments and had recently introduced sit and wait appointments after morning and afternoon surgery.
  • The practice used clinical audits to improve patient care.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
  • There was a strong and proactive leadership structure within the practice, and staff felt well-supported by management.
  • The practice worked closely with their patient participation group (PPG) to review and improve the services it delivered.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

In response to a high number of care home patients the practice had implemented a number of support measures for these patients. For example:

  • The advanced nurse practitioner undertook regular wards rounds at care and nursing homes
  • One of the GPs had provided training for care staff in the identification of urinary tract infections.
  • The practice had put together a care home support pack for their local care homes. Support packs contained a wide range of information including information about visit requests; early observations templates; management of coughs and colds; information about falls and pain information.
  • Data showed that there had been a reduction in requests for nursing home visits. For example, in March to May 2014 there were 150 requests compared with 99 requests for the same period in 2016.

A total of 321 patients within the practice aged over 18 had a care plan in place. This was equivalent to 4.1% of the practice population and was significantly higher than their target of 2%. Where a care plan was discussed and agreed, patients were provided with a ‘gold card’ which gave patients access to a bypass telephone number to enable them to access services more quickly where this was required. Patients were then offered telephone or face to face access to clinicians as required. Nursing and care homes were also provided with the gold cards to ensure they received the same level of service.

The areas where the provider should/must make improvement are:

  • The provider should continue to review and monitor access arrangements to ensure improvements reflect positively on A&E attendances and emergency admissions

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 November 2016

The practice is rated as good for providing safe services.

  • There were systems in place which enabled and supported staff to report and record significant events and incidents. Lessons were shared 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 actions taken 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.
  • Medicines, including vaccines and emergency drugs, were stored safely and appropriately with good systems to monitor and control stock levels.
  • Risks to patients were assessed and well managed. The practice had a range of risk assessments in place and these were regularly reviewed.
  • Systems were in place to support the practice staff to respond to major incidents and emergencies.

Effective

Good

Updated 3 November 2016

The practice is rated as good 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.
  • The exception reporting rate for the practice was 7.2% which was 3.9% below the CCG average and 2% below the national average. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • Staff assessed the needs of patients and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. In addition the practice regularly reviewed their performance internally and externally with other local practices.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Annual appraisals and supporting development plans were in place for staff. There was a commitment to the training and development of staff across all staffing groups within the practice.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. The practice worked closely with their designated care coordinator and the wider multidisciplinary team. Monthly meetings were held to ensure the needs of the most vulnerable patients were being met.

Caring

Good

Updated 3 November 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 some aspects of care. For example 96% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the compared to the CCG average of 92% and national average of 91%.
  • 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.
  • There was a commitment across the practice to providing high quality care for patients who were receiving end of life care. The practice was working towards Gold Standards Framework accreditation. In addition to this, the practice supported the national Dying Matters campaign and had hosted a stall in the town centre to promote the work being done in this area.
  • We were told about a number of examples of staff meeting the needs of patients. For example, care home staff told us GPs would see patients on their way home outside of surgery hours to provide continuity of care.

Responsive

Good

Updated 3 November 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.
  • The practice provided extended hours access to appointments for GPs and nurses on a daily basis from 7.30am.
  • Patients said they were generally able to make an appointment, with urgent appointments available the same day. Patients said it could sometimes take longer to get an appointment with a named GP.
  • The practice was aware of some issues with access and was in the process of implementing improvements including a new telephone system and the introduction of sit and wait appointments after morning and afternoon surgery.
  • 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 3 November 2016

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

  • The practice had clean aims to deliver high quality care and promote good outcomes for patients. Staff were clear about the values of the practice and were engaged with these. .
  • There was a clear leadership structure and staff felt supported by management. Staff spoke highly of the partners and the practice manager and highlighted examples of support provided.
  • Policies and procedures were in place to govern and support activity within the practice. Regular management and partnership meetings were held to discuss issues related to the governance of the practice.
  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and plans were in place to recruit younger members to ensure the membership of the group was representative of the patient population.
Checks on specific services

People with long term conditions

Good

Updated 3 November 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 82.8% which was 10.3% below the CCG average and 6.4% below the national average. The exception reporting rate for diabetes indicators was 6% which was below the CCG average of 13.4% and the national average of 10.8%.
  • Diabetes had been identified as an area for improvement and the lead GP was undertaking additional training in this area. Data provided by the practice which had not yet been published showed improvement in this area.
  • Performance for indicators related to hypertension was 100% which was 1.4% above the CCG average and 2.2% above the national average. The exception reporting rate for hypertension related indicators was 3% which was below the CCG average of 4.1% and the national average of 3.8%.
  • Longer appointments and home visits were available when needed.
  • All these patients 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Monthly meetings were held with the multidisciplinary team to review patients with complex needs.

Families, children and young people

Good

Updated 3 November 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. Regular meetings were held with the health visiting service to discuss children at risk of harm.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Appointments were available outside of school hours with nursing and GP appointments available on a daily basis from 7.30am.
  • The premises were suitable for children and babies with baby changing and breastfeeding facilities available if required.
  • Information for young people was available on the practice website.

Older people

Good

Updated 3 November 2016

The practice is rated as good for the care of older people.

  • Proactive, personalised care was offered to meet the needs of the older people in its population. Care plans were in place for older patients with more complex needs. Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.
  • All patients with a care plan in place were provided with a gold card which afforded them rapid access to appointments.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had high number of patients in care homes and engaged well with care homes to meet their needs. Regular ward rounds were undertaken in addition to support for care home staff.
  • 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 3 November 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 appointments were available on a daily basis with nurses and GPs.
  • 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.
  • Text messaging was used within the practice to confirm appointments and communicate normal blood test results (with the consent of the patient).
  • The practice was engaging with a local sixth form college to promote their patient participation group (PPG) to attract younger members.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 84% and the national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 November 2016

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

  • Performance for mental health related indicators was 100% which was 3.1% above the CCG average and 7.2% above the national average.
  • 85.3% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 0.1% below the CCG average and 1.3% above the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • Patient experiencing poor mental health were told about how to access support groups and voluntary organisations.
  • The practice supported a local care home for patients with dementia and feedback from their staff was overwhelming positive about the practice. They told us their patients were always treated with dignity and respect.
  • Systems were 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

Good

Updated 3 November 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. Vulnerable patients, including those who were homeless, were supported to register at the practice.
  • The practice offered longer appointments for patients with a learning disability and for those who required them; 74% of patients with a learning disability had received an annual health check in the last 12 months.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Information was available to support vulnerable patients to access various support groups and voluntary organisations.
  • The practice was working with Derbyshire Carers Association to offer carers assessments for patients within 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.