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Inspection Summary


Overall summary & rating

Good

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mount View Practice on 10 November 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 generally assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide 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 they found it easy to make an appointment, 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 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 an area of outstanding practice:

  • The practice worked closely with other agencies in the local area. One GP Partner led an initiative called ‘Healthier Fleetwood’ a partnership of local stakeholders (including council members, police, sports clubs and residents) which focussed on improving engagement and supporting active involvement. Through this the practice were extending their range of social prescribing to include more activity based interventions such as gardening and walking football for people over 50. The practice was also involved with the local police force Early Intervention Scheme. A Police Community Support Officer was based at the practice who sought to identify adults at risk and worked closely with the care co-coordinator to develop support plans.

The areas where the provider should make improvement are:

  • Risk assess decisions relating to the provision of equipment/medicines needed for treatment in emergencies

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2017

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 things went wrong patients received support, truthful information, and a 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 generally assessed and well managed. The range of emergency medicines held on site and decisions to share the ground floor defibrillator with another service were not risk assessed.

Effective

Good

Updated 13 April 2017

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.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Past clinical audits demonstrated quality improvement. The practice had recently begun completing these again and we saw evidence of plans to conduct second cycles of these audits to ensure improvements were made and sustained.

  • 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.

Caring

Good

Updated 13 April 2017

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.

  • 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.

Responsive

Good

Updated 13 April 2017

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.

  • Patients said they found it easy to make appointments when they need one, 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 13 April 2017

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

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity.

  • 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 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 13 April 2017

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. The practice had amalgamated all vascular type conditions (conditions affecting the veins and arteries) into a single clinic appointment to reduce the number of appointments one patient would need to attend

  • Performance for diabetes related indicators was generally better than the national average. For example 85% of patients had their blood sugar levels well controlled compared to 84% locally and 78% nationally. The percentage of patients with blood pressure readings within recommended levels was 81% compared to 82% locally and 78% nationally. The percentage of patients whose last measured total cholesterol was 5 mmol/l or less was 90% compared to 82% locally and 80% nationally. The percentage of patients with a record of a foot examination within the preceding six months was 92% compared to 91% locally and 89% nationally.

  • 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. 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.

Families, children and young people

Good

Updated 13 April 2017

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.

  • The practice’s uptake for the cervical screening programme was 97%, which was higher than the CCG average of 85% and the national average of 81%.

  • 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.

Older people

Good

Updated 13 April 2017

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. Patients aged over 75 had a named GP.

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

  • Older patients at risk of hospital admission, in residential care and aged over 75 and living alone had a care plan in place
  • The practice maintained a palliative care register and held monthly meetings attended by a multidisciplinary team to enable sharing of information relating to patients to improve palliative and end of life care

Working age people (including those recently retired and students)

Good

Updated 13 April 2017

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.

  • Extended hours surgeries were offered until 9pm every Monday, Tuesday and Wednesday for working patients who could not attend during normal opening hours. Telephone consultations were also available.

  • The practice worked closely with other local practices and between them offered additional appointments at weekends.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 April 2017

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 generally better than local and national averages. For example 95% of people experiencing poor mental health had a comprehensive, agree care plan documented in the record compared to 88% locally and 89% nationally. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% compared to 90% locally and 89% nationally. 72% of patients diagnosed with dementia had their care reviewed in a face to face review compared with CCG average of 83% and national average of 84%. The practice recognised this figure was lower and had recently employed a paramedic practitioner who worked closely with care homes and visited people in their own homes to create and update care plans.

  • 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 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.

  • Patients experiencing poor mental health were told about how to access various support groups and voluntary organisations.

  • The practice recognised that they served a population with a high proportion of patients with Mental Health needs and sought to tailor the services they provided. The practice employed a team of Mental Health Nurses to help patients with mild mental health difficulties such as depression and anxiety. Both individual and group care such as anxiety management, mindfulness and stress management were offered. Recovery rates were routinely monitored.  Rooms used for consultations were carpeted so were less clinical and had a painting on the wall to promote calm and prompt discussion. A remembrance day display in the waiting area helped to proactively identify veterans in need of support.
  • Where staff recognised signs of elderly patients becoming forgetful they contacted the mental health team who invited the patient for a memory assessment and worked closely with the Memory Service.
  • The mental health team had a target to offer CBT (cognitive behavioural therapies) to those patients with a diagnosis of COPD and/or diabetes.

People whose circumstances may make them vulnerable

Good

Updated 13 April 2017

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.

  • The practice offered longer appointments for patients with a learning disability and other complex needs.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed 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.

  • Carers were proactively identified and referred to the practice Carers Champion to signpost them to appropriate support services.

  • Prior to being built patients had been consulted as to the design and layout of the building and what rooms would be needed and where. A group of pupils from a local school had then visited the building to assess its accessibility for children and young people, especially those with additional needs. This had led to some minor changes such as larger signage but overall the feedback was good. The pupils also provided a training session to practice staff to raise awareness of the needs of people with additional needs.

  • Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice, including patients in care homes. The paramedic practitioner conducted a large number of these visits using telephone and video calls for support from the on call GP. The paramedic practitioner also produced and reviewed care plans for patients at risk of acute hospitalisation.