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Inspection Summary


Overall summary & rating

Good

Updated 6 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Warwick House Medical Practice on 10 August 2017. 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.
  • Risks to patients were 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 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.
  • 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.
  • There was an innovative approach to continuous improvement with action plans in place to develop a more integrated model of care between primary and secondary care services.

The areas where the provider should make improvement are:

  • Have a document system to record the regular monitoring of infection prevention control measures.

  • Review and improve the system in place to track blank prescriptions.

  • Undertake administrative staff appraisals.

  • Have a system to actively monitor performance for the Somerset Practice Quality Scheme (SPQS). (SPQS is a system intended to improve the quality of general practice).

  • Embed clinical audits and re-audits to improve patient outcomes and ensure all audits contain a measurable action plan where required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 October 2017

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events which was currently being brought in line with the Trusts system. This meant annual review processes to identify themes and trends and an improved documentation system was to be implemented.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients mostly received reasonable 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 assessed and well managed. However there was no document system for regular monitoring of infection prevention control measures and the tracking of some types of blank prescriptions.

Effective

Good

Updated 6 October 2017

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Audits demonstrated quality improvement however an annual clinical audit plan was not in place and full cycle audits were not always undertaken.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff with the recent exception of administrative staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was delivered in a coordinated way.
  • Active monitoring of the Somerset Practice Quality Scheme (SPQS), a system intended to improve the quality of general practice was not evident.

Caring

Good

Updated 6 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (July 2017) 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.
  • The practice participated in the GP federation test & learn wellbeing advisor project which identified and signposted patients to services to prevent crisis.

Responsive

Good

Updated 6 October 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. For example, the practice provided a musculoskeletal clinic with an extended scope practitioner onsite which gave immediate access to patients presenting with this type of problem. The introduction of this service had freed up time which had allowed GPs to increase their consultation times.
  • Patients said they generally 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. Examples of this were the provision of a vasectomy service which local GPs could refer into, and being part of the violent patient scheme offering primary care to those patients excluded from their own practice.
  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions, including people with a condition other than cancer and people with dementia.
  • 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 6 October 2017

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

  • The provider and 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 it.
  • There was a clear leadership and management structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings with Taunton and Somerset NHS Foundation Trust.
  • 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. A strategic plan was in place to develop an integrated model of care between primary and secondary care services such as the development of a two week wait pathway project for colorectal patients which included an improved way for GPs to make referrals and order tests.
  • Staff had received inductions and attended staff meetings and training opportunities.
  • There was a strong focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients. For example, one GP provided a vasectomy clinic for the local community and another specialised in contraception and sexual health.
Checks on specific services

People with long term conditions

Good

Updated 6 October 2017

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

  • Practice nurses had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health and patients were provided with clear care plans and medicines to prevent escalation of their condition.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that additional needs were identified and met.
  • 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 6 October 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems 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 accident and emergency (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.
  • 82% of women between the ages of 25 and 65 had received a cervical screening test.
  • 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 such as quarterly meetings.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • One GP kept up to date with contraception and sexual health by providing a session per week at the local sexual health clinic.

Older people

Good

Updated 6 October 2017

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

  • Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population which included using frailty scoring to identify those most at risk.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. For example, GP’s provided primary medical care to specific nursing homes.
  • The practice identified at an early stage older people who may be approaching the end of life. It involved older people in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Older patients were offered health promotional advice and support through a wellbeing advisor to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 6 October 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. NHS health checks were provided by an external organisation and the results were monitored by the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 October 2017

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

  • 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • People at risk of dementia were identified and offered an assessment.
  • Patients diagnosed with dementia received follow up consultations following attendance to accident and emergency.
  • The practice had a system for monitoring repeat prescribing for people receiving medicines for mental health needs.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice worked with the local community mental health team which carried out advance care planning for patients with dementia.
  • The practice specifically considered the physical health needs of people with poor mental health. For example, 45 minute appointments were offered for annual mental health reviews.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia. They provided primary medical care for a local hospital for older people with enduring mental illness.

People whose circumstances may make them vulnerable

Good

Updated 6 October 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, those receiving end of life care and patients and families where there were safeguarding concerns.
  • The practice offered longer appointments for patients with a learning disability.
  • 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.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.