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Creswell and Langwith Primary Care Services Good

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Inspection Summary


Overall summary & rating

Good

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Creswell and Langwith Primary Care Services on 11 May 2016. The overall rating for the practice was ‘requires improvement’ and the practice was asked to provide us with an action plan to address the areas of concern that were identified during our inspection.

We carried out a second announced comprehensive inspection at Creswell and Langwith Primary Care Services on 15 February 2017 in order to assess improvements and the outcomes from their action plan. The overall rating for the practice following this inspection is good.

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

  • The arrangements to keep patients safe and protected from harm had significantly improved since our previous inspection. For example, we were assured that there was an effective and timely process in place to recall patients affected by safety alerts to ensure patients were protected from potential harm. Systems to ensure the health and safety of staff, patients and visitors had been strengthened including safety testing in respect of fire and electrical safety, and the management of infection control.
  • At the previous inspection the trust and practice staff highlighted to us the significant risks associated with inaccurate and incomplete patient records which they had inherited. A dedicated role had been created to summarise patients’ notes and together with a further member of staff they had undergone training in clinical coding, medical terminology and summarisation, they worked closely with clinical staff to recall patients to update treatments and review conditions where necessary.
  • There is an effective system in place for reporting and recording significant events. Learning was applied from events to enhance the delivery of safe care to patients.
  • New staff told us they had been supported in their induction process, at trust and practice level, and had been provided with substantial shadowing opportunities and regular clinical supervision to ensure ongoing support.
  • A clinical audit programme was being used to drive improvements in clinical care and treatment.
  • The trust had a clear policy and commitment to staff training. All members of the practice team had received an appraisal in the last 12 months, including the GPs, with the identification of individual training needs.
  • Staff worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
  • Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. National patient survey data indicated that the patients mostly rated the practice in line with others in the local area.
  • The practice staff engaged with their Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. The trust had brought stability to the practice and had restructured a practice team with an effective skill mix including a pharmacist and two advanced nurse practitioners.
  • Data from the national patient survey reflected that patient satisfaction with access to the service was in line with other local practices and national averages.
  • Information about services and how to complain was available and easy to understand and learning from complaints was shared across the practice.
  • The practice had a clear vision and the trust had invested time to engage with staff to help them develop a better understanding of what the organisation aspired to achieve and future plans for development. The practice team had subsequently developed a patient’s charter to reflect on what this meant to them.
  • There was a clear understanding of the performance of the practice, which was monitored on an ongoing basis. Lead roles had been designated to staff which had resulted in a significantly greater achievement in QOF targets.
  • Practice staff were clear about the leadership structure for the practice. Communication between the trust and staff working at the practice was regular and effective and staff told us they felt more involved in decisions about the practice.
  • There was an active Patient Participation Group (PPG) which worked with the practice to review and improve services for patients.

However, there were some areas the trust should make improvement:

  • Continue to engage with parents and carers of children to improve the immunisation uptake of five year olds.
  • Continue to look at ways to increase the uptake of annual reviews of patients with a learning disability.
  • Continue to consider what action needs to be taken to improve areas of lower patient satisfaction with the service.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 April 2017

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. There were effective processes in place to investigate significant events and to share learning from these.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. There was a designated GP responsible for safeguarding and had regular meetings with community based health professionals to discuss patients at risk.
  • There was a timely process in place to recall patients affected by safety alerts to ensure these patients were protected from potential harm.
  • Systems to ensure the safety and well-being of staff, patients and visitors had been greatly improved since our previous inspection in respect of infection control management, risk assessment, and the safety testing of fire and electrical safety.

  • The practice followed effective recruitment procedures to ensure all staff had received the appropriate pre-employment checks.
  • The management of prescriptions on site had been improved since our previous inspection, with effective systems to monitor and control stock levels.
  • The practice had effective systems in place to deal with medical emergencies.

Effective

Good

Updated 6 April 2017

  • Data from the Quality and Outcomes Framework (QOF) showed outcomes for patients were significantly below local and national averages. The most recently published results showed the practice had achieved 68.7% of the total number of points available. This was 26.2% below the clinical commissioning group (CCG) average, and 26.6% below the national average. However data supplied by the practice showed they had already achieved 91% of the available points with further time to improve until the end of the 2016/17 QOF year. This data had not yet been verified and published.
  • Practice supplied data showed significant improvements in the QOF performance for all conditions and the practice had prioritised this as a way of engaging with patients with long term conditions and reviewing diagnosis and treatments plans.
  • The trust had employed external auditors to ensure patients’ records were safe and kept up to a high standard as well as reviewing individual notes as they were uploaded onto the computer system as part of a ‘paper light’ programme.
  • Clinical audits were taking place to determine whether treatment was in line with best practice guidelines and this area had been prioritised by the pharmacist and clinical staff as a means of improving patient outcomes.
  • The trust had a clear policy and commitment to staff training. Action had been taken following our initial inspection (May 2016) where we found some staff had not received training the trust identified as mandatory. At this inspection we found effective management of training and all staff had completed training modules through online resources and practice training sessions.
  • Staff worked effectively with the wider multi-disciplinary team to plan and deliver high quality and responsive care to keep vulnerable patients safe.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and actively sought further training to enhance their skills to contribute to practice development. New staff were undergoing supportive and well planned inductions to introduce them to their new roles.

Caring

Good

Updated 6 April 2017

  • Data showed that patients mostly rated the practice in line with other local practices for several aspects of care. Results had shown a steady increase over the preceding two years. However, 76% of patients said the GP gave them enough time which was lower than the CCG average of 86% and the national average of 87%. This was an area still needing attention.
  • Patients told us they were treated with care and concern by staff and their privacy and dignity was respected. Feedback from comment cards aligned with these views.
  • The trust provided information for patients which was accessible and easy to understand.
  • We observed staff treated patients with kindness and respect, and maintained confidentiality. Reception staff were observed to accommodate patients’ needs.

Responsive

Good

Updated 6 April 2017

  • Early morning appointments were available on a Friday for patients who were unable to attend during normal hours.
  • Patients told us there had been improvements in availability of clinicians and that if they needed an urgent appointment they would often be able to get one the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs and there were plans to upgrade the branch surgery to improve the service delivered there.
  • The practice staff engaged with the local Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. The trust had brought stability to the practice and had restructured the clinical team with an effective staff skill mix.
  • Data from the national patient survey reflected that patient satisfaction with access to the service was in line with other local practices. These results had increased over the last two years.
  • Information about services and how to complain was available and easy to understand and learning from complaints was shared across the practice

Well-led

Good

Updated 6 April 2017

  • The practice had developed a vision underpinned by values to provide high quality care for their patients. The trust had worked with the practice team to ensure they recognised and understood the role and values of the organisation, and were able to contribute towards organisational aspirations and objectives.
  • The trust provided leadership support to the practice. However, the practice team had been empowered to develop their roles and a GP was the designated clinical lead with accountability to one of the trust’s clinical directors. The practice was encouraged to retain their own identity and the trust provided advice and support as necessary, including managerial support for human resources and finance.
  • Following our previous inspection, staff had been given lead areas which had helped to significantly improve QOF outcomes. Staff were aware of their responsibilities and the practice was on target to achieve a much improved QOF achievement in 2016-17.
  • The practice had a wide range of policies and procedures to govern activity and these were regularly reviewed and updated.
  • Since our previous inspection in May 2016, we observed that the practice had acted upon our previous findings and made improvements to strengthen arrangements for governance within the practice.
  • The practice and the trust encouraged and valued feedback from patients, staff and the public. Internal patient satisfaction surveys supplemented feedback from other sources, and the practice responded positively to feedback to make improvements. Staff were encouraged to suggest improvements through meetings and the trust ran an annual staff satisfaction survey.
  • The patient participation group (PPG) met regularly and worked with the practice to champion patient experience. The PPG were able to provide examples of suggestions they had made to enhance patient satisfaction at the practice.
Checks on specific services

People with long term conditions

Good

Updated 6 April 2017

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

  • There was a recall system for patients during the month of their birth to provide time for health and medicines review covering all conditions in one appointment this had been effective at increasing the recalls and patients told us they felt more involved in their care and treatment.
  • The practice had established a weekly diabetic clinic which was run by a diabetic specialist and practice nurse to increase educational opportunities and engage with patients who previously had poor management of their diabetes. This had included initiating insulin locally, ‘diabetes and you’ and ‘better blood sugar’ sessions to increase awareness around self-management and ‘pre diabetic’ engagement to reduce the numbers of patients developing diabetes.
  • GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.
  • Clinics were run on a weekly basis including; citizens advice bureau, smoking cessation and ‘Live Life Better Derbyshire’

Families, children and young people

Good

Updated 6 April 2017

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

  • Systems were in place to identify children at risk. The practice had a child safeguarding lead and staff were aware of who they were.
  • 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. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.
  • Immunisation rates were below local averages for all standard childhood immunisations. However we saw that children were called in line with the immunisation schedule and any parents who refused to attend were offered an appointment to discuss the implications and referred to the health visiting team, if appropriate, for additional support.
  • The practice offered a full range of contraception services including coil fitting and implants.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Urgent appointments were available on a daily basis to accommodate children who were unwell.

Older people

Good

Updated 6 April 2017

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

  • Staff offered proactive, personalised care to meet the needs of the older people in its population. For example, a practice pharmacist visited local care homes to review medicines, complementing the input provided by the GP and nurse practitioner.
  • A care coordinator reviewed recent discharges and arranged home visits when suitable to support patients in recovery. They also monitored those patients at high risk of hospital admission to implement care in the home with the support of community teams and practice clinicians.
  • Home visits were offered and urgent appointments for those with enhanced needs.
  • There was a dedicated phone line for care homes, community teams and vulnerable patients to contact the practice reducing the time taken to arrange appointments.
  • Staff offered older people the option to see their preferred choice of clinician to improve continuity of care.

Working age people (including those recently retired and students)

Good

Updated 6 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 staff had adjusted the services offered to ensure these were accessible. This included access to telephone appointments, and the availability of pre-bookable extended hours’ GP appointments between 6.45am and 8am on a Friday.
  • Online services such as electronic prescriptions and GP appointments were offered through the online booking system as well as access to patient’s records.
  • The practice’s uptake for the cervical screening programme was 77.9%, which was below the CCG average of 82.4% and the national average of 81.8% with exception reporting rates in line with local averages, and approximately 3% lower than national averages.
  • The practice provided direct access for patients to see a musculoskeletal physiotherapist to enable patient with conditions including back pain to be seen quickly.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 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 66% which was 27.5% below the CCG average and 26.8% below the national average. The exception reporting rate for mental health related indicators was below the CCG and national averages. Practice supplied data which showed the practice had achieved 95% of the available points in the current year which was a significant improvement on the previous year with time left to increase this further. This data had not yet been verified or published.

  • The number of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 93.9% (with no exception reporting) which was 7.3% above the local average and 10.2% above the national average. Practice supplied data showed the practice had achieved 94% of the available points with time left to increase this further. This data had not yet been verified or published.
  • Patients had access to confidential self-referral ‘talking mental health’ and in-house clinics every week.
  • Staff regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • Staff told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The care coordinator monitored admissions to the emergency department to assess patients who would benefit from further care at home or a review and contact the patients to arrange support.

People whose circumstances may make them vulnerable

Good

Updated 6 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, and 53% had received an annual health check between April 2016 and 15 February 2017.
  • The practice offered longer appointments for patients with a learning disability and for others who required this.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register.
  • A dedicated care-coordinator helped to signpost local community support and voluntary groups such as the wellbeing worker and citizens advice service.
  • The practice had a nominated carer’s champion with literature and support available for carers including identification a named carers support worker, annual health checks and seasonal influenza vaccinations.
  • Staff put in place follow up appointments with the same GP wherever possible to ensure continuity of care.
  • Translation services were available for patients whose first language was not English