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Royds Healthy Living Centre Good

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Royds Healthy Living Centre on 19 July 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.

  • 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. The GPs and Business Manager had met with patients to discuss their concerns and improvements were made to the quality of care as a result of complaints and concerns. There were two lead GPs identified who led on all clinical complaints and provided advice and support to other clinicians in the practice in relation to complaints.

  • Risks to patients were assessed and well managed and the practice was able to evidence references for all staff with copies of job descriptions. The practice had a robust electronic storage and retrieval system in place for staff records. All staff had appropriate Disclosure and Barring Service check (DBS) which had been undertaken on all staff. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

  • 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. Staff told us that they would feel confident to raise any concerns with the GP partners and that there was an open and supportive culture within the practice.

  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice

  • Royds Healthy Living Centre actively looked to make sure that they identify and prioritise care for any who may be vulnerable. The practice has pioneered a new template with the CCG in the last year around equitable access needs and they have already met the new standard well in advance of the CCG deadline.

  • In the role as mental health commissioning lead for the CCG a Royds Healthy Living Centre GP led the team that designed and established the award winning First Response Service. All patients on the SMI (Severe Mental Illness) register are given an annual check-up focusing on the five care processes defined nationally.

  • The practice health champions group hosted a number of community focussed social groups such as the” Knit and Natter” group. The practice and the partners used these groups to deliver health education messages and improve access to health care for their patients. For example, the practice focussed on teaching people how to book and arrange appointments and what services were available.

  • The practice health champions managed stalls and provision of second hand clothes. There were stalls in reception that encouraged all to participate in supporting this good cause.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 September 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 things went wrong patients 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 met with patients when necessary.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. We saw evidence that the GPs at the practice had attended female genital mutilation (FGM) awarenesstraining and domestic violence awareness training. Training in these matters had been delivered across the practice staff groups.
  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses.
  • Risks to patients were assessed and well managed including those relating to the recruitment process and checks. The practice was able to evidence references for all staff and copies of job descriptions. All staff had undertaken appropriate checks through the Disclosure and Barring Service (DBS). The staff we spoke with were clear about their roles and responsibilities.

Effective

Good

Updated 19 September 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.
  • 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 with protected learning time on Friday afternoons. The practice supported staff to develop additional skills which would enhance patient care, and also to develop into new and different roles.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 September 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.
  • 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 with protected learning time on Friday afternoons. The practice supported staff to develop additional skills which would enhance patient care, and also to develop into new and different roles.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Responsive

Good

Updated 19 September 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, Bradford District CCG and other practices to secure improvements to services where these were identified.
  • Patients said that they found it easy to make an appointment or speak to a GP. We found that 71% of patients said that the last time they wanted to see or speak to a GP they were able to (79% CCG and 85% national average). We also found that the surgery offered a higher than expected number of appointments for patients and that they had an action plan in place to improve patients’ satisfaction.
  • Feedback forms for the Friends and Family Test for July 2016 showed that 90% of patients were extremely likely or likely to recommend this practice.
  • Patients were able to attend a daily walk in clinic, make same day appointments and book appointments in advance. These could be booked with the receptionist or online.
  • 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.
  • A basic clinical protocol allowed reception staff to direct patients to the Pharmacy First Scheme. This scheme enabled patients to receive prescription medications, to treat a range of common conditions, direct from the pharmacist without a GP prescription.

Well-led

Good

Updated 19 September 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 it.
  • There was a clear leadership structure and staff felt very supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings and had input into the development process.
  • 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 Practice Health Champions group was active and held events and classes for patients to reduce social isolation and increase patient knowledge about the services offered. There was a dedicated patient engagement lead, who had a good knowledge and understanding of the needs of the patient group.
  • There was a strong focus on continuous learning and improvement at all levels. Examples of this were the development of the Business Support Manager from Receptionist through a number of roles and also one of the practice nurses who started as a receptionist with the practice, then trained as an HCA and then as a nurse.
Checks on specific services

People with long term conditions

Good

Updated 19 September 2016

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

  • Nursing staff had lead roles in chronic disease management for example diabetes and patients at risk of hospital admission were identified as a priority.
  • Outcomes for patients with diabetes were comparable to national averages. For example, 99% of patients on the diabetes register had an influenza immunisation in the preceding 12 months, national average 94%.
  • 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.
  • The practice emphasises prevention, for example a spirometry pilot in chronic smokers was undertaken which identified and reduced the number of smokers.
  • The practice has a large team of Practice Nurses with a range of LTC qualifications and experience who can provide support and care to this patient group.
  • The practice has recently been involved in a local incentive scheme “Bradford Breathing Better” targeting the severe asthmatic patients, and also run their own spirometry pilot in chronic smokers to try and prevent the onset of COPD.
  • The practice is a Training Centre for Practitioner with a Special Interest (PWSI) courses delivering diplomas in cardiology, diabetes, women’s health and MSK (Musculoskeletal disorders) in association with the University of Bradford.

Families, children and young people

Good

Updated 19 September 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. For example, when children did not attend for GP or hospital appointments, the practice would ensure that reports were run to check for any patterns occurring or any safeguarding concerns.
  • Immunisation rates were consistently high for all standard childhood immunisations. For example MMR (measles, mumps and rubella) practice was 98% and CCG and national average was 95%.
  • The number of women that had attended for cervical screening in the preceding five years was 76% compared to the CCG average of 81% and national average of 82%.
  • The practice held baby clinics supported by GPs and health visitors and had systems in place to ensure that all babies attended their appointments in line with the immunisation programme.
  • Children were accommodated where possible in evening surgeries to reduce non-attendance at school.
  • Children with severe and long term disabilities were prioritised for appointments regardless of their age.
  • Health Education England made a film at the practice about ‘Spotting the signs of child sexual exploitation’ which has received over 11,500 views on You Tube. (Link - https://www.youtube.com/watch?v=sC4Nn_mYKu0)
  • The practice ensure all patients aged under one are guaranteed a same day appointment.
  • 54 children are currently subject to Child Protection Plan at the practice.
  • All children under 10 years are accommodated in the Same Day Assessment Clinic.

Older people

Good

Updated 19 September 2016

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

  • The practice supported relatively small numbers of older people and offered proactive, personalised care to meet their needs.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Monthly meetings were attended by the district nursing team. The needs of older people, housebound and palliative care patients were also reviewed at quarterly multidisciplinary meetings.
  • The practice worked closely with the community pharmacist who visited older people at home to conduct medication reviews and check compliance.
  • The practice offered same day access for over 80s including home visits.
  • The group of practices was identified as the pilot practice as part of the oral nutritional support project funded by Bradford CCG's. Following an audit of patients prescribed oral nutritional supplements (ONS), some patients were identified as needing a review. In care homes 31 patients were reviewed jointly with the project dietician and community matrons from the practice. Out of the 31 patients, 18 patients had their prescribed ONS stopped, four remained the same, nine patients prescription for ONS changed. This resulted in an annual saving of £13,388, £432 saving per patient.
  • In addition to an annual review all patients over 75 are guaranteed care the same day either by an appointment or by a phone call from the clinical team.
  • The practice has been involved in an “End of Life” project locally with the CCG looking at implementing gold standard care for these patients.
  • Thepractice runs a Dementia Clinic and is Dementia friendly, working closely with Carer organisations to provide support to both patients and their carers.

Working age people (including those recently retired and students)

Good

Updated 19 September 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 reflects the needs for this age group.
  • The practice offered an extended hours service on a Tuesday morning from 7am when patients could be seen by a GP or an advanced nurse practitioner.
  • The practice offered telephone consultations to patients who were unable to attend the surgery in person due to work commitments.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 September 2016

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

  • Data showed that 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is below than the national average.
  • The percentage of patients with schizophrenia, bipolar disorder and other psychoses whose alcohol consumption was recorded in the previous 12 months was 93%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice was opportunistically screening patients for dementia.
  • The practice was participating in a CCG led initiative to offer physical health checks to patients with serious mental illness. A range of services including smoking cessation, ECGs and weight management advice was available to these and other patients.
  • The practice carried out advance care planning for patients with dementia. These would be discussed with family and carers where appropriate.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 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 and staff had undertaken dementia awareness training.
  • A practice GP was involved in designing and establishing the award winning First Response service. All patients on the SMI (Severe Mental Illness) register are given an annual check-up focusing on the five care processes defined nationally.

People whose circumstances may make them vulnerable

Good

Updated 19 September 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 reflects the needs for this age group.
  • The practice offered an extended hours service on a Tuesday until 8pm when patients could be seen by a GP or an advanced nurse practitioner.
  • The practice offered telephone consultations to patients who were unable to attend the surgery in person due to work commitments.