Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2016 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Swadlincote Surgery on 14 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Clinicians followed national guidelines and protocols available to them in the identification and management of severe infections such as sepsis.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care at the right time.
• The practice was a training practice and the partners were proud of their reputation for being a practice of choice for trainee GPs and other clinical roles.
• Results from the latest national GP patient survey showed that the practice had performed above local and national averages in the majority of the questions about patient experience. This was particularly evident in relation to GP access and comments regarding being listened to and having tests and treatments explained.
• Care planning was embedded within the practice to reflect individual patients’ needs and their own wishes. We saw that care plans were thorough and were used extensively for patients in care homes, those with complex needs and patients who were vulnerable.
• The practice was responsive to patient’s feedback and had invested in a new telephone system with an additional line to improve access for appointment requests.
• They had implemented a Medical Interoperability Gateway system (MIG) which enabled the sharing of specified datasets of patient information between healthcare providers in ‘real time’ to enable a more effective response for relevant healthcare professionals.
• The practice utilised a care coordinator who worked with the practice and community team to identify patients who were at risk of unplanned admission to hospital.
• The practice utilised data clerks to manage the recall system and free up time for nurses to manage their time more effectively. They contacted non-attenders by telephone to re-schedule their appointment
• They had set up an internal Locum system to enable consistency of care for patients
• The partners and practice staff were very proud of their reputation for being highly regarded as an excellent training practice and able to recruit new GPs and other clinical staff easily as trainees and also for permanent positions.
• Some of the GP partners held strategic lead roles within the clinical commissioning group (CCG) which helped influence and drive improvement in the delivery of patient care within the locality.
• The practice were proactive in identifying risk of falls and taking action to reduce this. All GPs used a fragility index score for patients at risk and created a care plan for those patients which was shared with relevant health care providers.
• The practice had achieved dementia friendly status
• The practice had created effective links with local schools and universities to assist young people who were interested in a medical career, as well as providing training and mentorship for GP Registrars and advanced clinical practitioner (ACP). They also worked collaboratively with Derbyshire Community Healthcare Services (DCHS) to provide training and mentorship for an additional ACP.
• They had designed an ANP triage hub and were about to commence this as a pilot project. Patients would benefit by seeing an ANP with a specialism most suited to their symptom and would receive the most appropriate advice first time.
• They had developed a support board in the reception area to assist patients who needed extra help in navigating health care systems and who were vulnerable but may not be on any other register. For example, patients who had an alcohol dependency and homeless people.
• The practice had developed their own risk stratification tool within the clinical system to identify patients who were vulnerable for a variety of reasons.
• The practice had recently set up a bereavement café to help bereaved relatives feel less isolated.
• A workshop for new parents had been set up and due to commence the following week for the first time. The anticipated impact of this was that new parents would be better informed to manage their child’s health. This would potentially improve attendance for scheduled child health checks.

We saw an area of outstanding practice:

• The practice worked with their local CCG to reduce waiting times for local mental health provision. This had resulted in a reduction in waiting times for patients to receive access to psychological therapies within six weeks from 66% to 76% of patients. Many were seen within four weeks of referral.

The area where the provider should make improvement are;

• Ensure that all mandatory training updates are completed by relevant staff and are recorded centrally.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swadlincote Surgery on 7 September 2016. Overall the practice is rated as outstanding.

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

• Most staff understood and fulfilled their responsibilities to raise concerns and report incidents
• The practice used alternative methods to improve patient outcomes, For example; they had recruited a physician’s associate and an advanced nurse to provide additional clinical support for routine and urgent needs.
• Feedback from patients about their care was consistently positive.
• The practice had corroborated with another practice within their locality to plan how to manage winter pressures and share resources.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice were striving to achieve dementia friendly status by completing training for all non-clinical staff and PPG members, and had implementing dementia friendly signage,
• The practice had implemented a lead GP to provide monthly ward rounds at the care homes aligned to them
• The practice had strong and visible clinical and managerial leadership and effective governance arrangements

We saw areas of outstanding practice:

• The practice worked closely with the multi-disciplinary team which enabled 90% of patients on the practice’s palliative care register to die in their preferred place of death.
• The practice had researched the needs of their population and had adjusted the skill mix of their staff so they were able to provide alternative ways of providing clinical care. They recruited a physician’s associate who was able to work alongside GPs to assess and treat patients. This had reduced the waiting time for routine appointments by two days. They had enabled two healthcare assistants (HCA) to develop clinical skills to NVQ level 3 and provide specialist clinical care including wound care, phlebotomy and basic chronic disease assessments with appropriate oversight and mentoring from a clinician. They had also funded a post graduate course for a practice nurse in advanced practice to enable chronic disease management and urgent care to be provided in the practice. This reduced the workload for GPs and improved access to care for patients seeking urgent care and had reduced waiting time for patients with a chronic illness by three days.

We found one area where the practice should take steps to make improvement;

• The practice should ensure that all staff fully understand what a significant event is and enable staff to record and report all events that are significant, including events that they may not think are serious in nature.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with one GP, the nurse manager, a nurse practitioner, two health care assistants, the reception manager, a receptionist, the practice manager and deputy practice manager during our inspection. Patients told us they were satisfied with the care and treatment they received.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. Comments made by patients about the service included “Dr X explains everything, and prints off information for me to take away and read” and “The (diabetic) nurse gives me lots of information and brings in low sugar products to show me that they’ve seen when shopping.”

Staff had received training on safeguarding children and vulnerable adults. Staff were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We saw that the practice was clean and tidy, and patients and staff had access to hand washing facilities and antibacterial gel. Not all staff had received infection control training and effective systems were not in place to check expiry dates of equipment.

The provider had systems in place for monitoring the quality of service provision. There was an established system for obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements were made by the practice staff.