Sixways Clinic

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 4 May 2016. The practice was rated as good overall and requires improvement for the delivery of responsive services.

During our inspection we found a breach of legal requirements relating to access to the service. After the comprehensive inspection, the practice wrote to us, to say what they would do to meet the legal requirements in relation to meeting Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Good Governance.

We undertook this desk based focused inspection on the 15 December 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements and should be read in conjunction with the full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sixways Clinic on our website at www.cqc.org.uk. We found the practice had made improvements since our last inspection on 4 May 2016 and they were meeting the regulation that had previously been breached.

Specifically the practice had reviewed their appointment and telephone systems to ensure these were more accessible to patients. This included:

• Providing additional routine appointments daily.

• Seeking feedback from the patient participation group and implementing their suggestions.

• Changing the way patients could book afternoon appointments.

Additionally, the practice had:

• Worked with the clinical commissioning group to create a patient survey relating specifically to access to appointments.

• Reviewed their procedures on prescription pad monitoring and implemented systems and processes to ensure the security and monitoring of prescription pads including handwritten pads were maintained.

The practice also told us they were in the process of reviewing their telephone system with the current provider and were also looking at what other providers could offer.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2016

The practice is rated as good for the care of patients 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 achieved 100% of the targets for care of patients with diabetes in 2014/15 which was above the clinical commissioning group average of 95% and national average of 89%.

• 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.

Updated 22 June 2016

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

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed (04/2014 to 03/2015) was 80% compared to the clinical commissioning group average of 84% and national average of 82%.

• 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.

Updated 22 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• The practice held monthly meetings with community based staff to discuss the care of patients in this population group including those receiving palliative care.

• The practice offered blood testing clinic for patients who were on blood thinning medicines.

• There was a dedicated GP at the practice who carried out a weekly “ward round” at two local nursing homes.

Updated 22 June 2016

The practice is rated as good for the care of working-age patients (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 plans to adjust 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 did not provide extended hours surgery, however, encouraged patients to use Advice ASAP which was an application that patients could download on their mobile phone in order to obtain self-care advice on illnesses and injuries.

Updated 22 June 2016

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was comparable to the clinical commissioning group average of 86% and national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 93% compared to the CCG average of 93% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice carried out advance care planning for patients living with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• There was a mental health nurse who held a weekly clinic at the practice.

• The practice held a weekly social prescribing clinic.

• 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.

Updated 22 June 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice offered annual health checks for patients with a learning disability and patients who were also a carer.

• 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.