We carried out an announced comprehensive inspection at Peelhouse Medical Plaza on the 8th September 2015. Overall the practice is rated as good.
Our key findings were as follows:
- There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Staff understood and fulfilled their responsibilities to raise concerns and report incidents.
- The practice was clean and tidy. The practice had good facilities in a large adapted building with disabled access and a lift to staff offices on the first floor.
- The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments. The practice used innovative and proactive methods to improve patient outcomes.
- There was an effective system in place to undertake audits of the operation of the practice and improve patient care.
- The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.
- Patients spoke highly about the practice and the whole staff team. They said they were treated with dignity and respect and they were involved in their care and decisions about their treatment.
- The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).
- Information about services and how to complain was available and easy to understand. The practice proactively sought feedback from staff and patients, which it acted on.
- There was a clear leadership structure with delegated duties distributed amongst the team and staff felt supported by management. The staff worked well together as a team.
- Quality and performance were monitored
We saw areas of outstanding practice including:
- The practice had strategies in place to identify long term conditions early and therefore improve patient care, for example, to identify patients at risk of chronic obstructive pulmonary disease (COPD). This strategy had gained recognition with external accreditation and within the CCG whereby one GP acted as a lead for Respiratory health within Halton CCG and had a special interest in respiratory conditions. They had developed initiatives for better patient outcomes in regard to patients conditions associated with their respiratory health by developing an assessment tool. This tool covered not only clinical features but also a patient’s home situation, their mobilising needs, diet and all other aspects of care to help encompass a more holistic approach and to identify triggers and understanding of each patient’s needs. COPD audits in 2014 and 2015 showed implemented changes to the assessment tools and quality improvements to helping patients with needs such as using their inhaler and teaching appropriate techniques to patients. This work had led to a respiratory strategy for Halton CCG offering a holistic assessment and approach for patients and sharing their initiatives and best practice in assessing high risk patients to other practices within the CCG.
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The practice ran an effective warfarin clinic managed by the advanced nurse practitioner who was able to see a broad range of patients. The practice carried out monitoring of patient satisfaction surveys each year for the service provided by the warfarin clinic which showed a high satisfaction rate 94.3% amongst patients. Re audits showed the effectiveness of their in-house warfarin clinic with results seen for 2013 and 2015 showing monitoring arrangements and assessments carried out. The results helped to show improvements to patients diagnosis, helped stabilise therapeutic medication levels and offered at least annual reviews with all patients recalled. Data produced by the practice comparing figures for 2010 compared to 2015 showed a steady rise of time in range in spite of a steady rise in the number of patients recruited and tested as the service was developed. This indicated that better control was achieved for a far greater number of patients managed. For example in 2010, 218 patients achieved a therapeutic range compared to an increase in 2015 of 246 patients.
- The nurse practitioner managed the overall monitoring and review of unplanned admissions strategy of patients identified at risk of hospital admission. They provided monthly audits of all patient admissions and details of follow up visits to patients to help monitor and reduce admissions and to help support patients with any identified care and unmet needs. Monthly audits helped evidence improvements and positive outcomes for patients which were presented to the clinical team each month to provide good governance of at ‘risk patients.’ Data showed the number of non-elective admissions per 1000 of the practice population aged 75 years + from 2014 to May 2015 showed a sharp decrease. For example in 2014, 385 patients had unplanned admissions compared to 314.4 up to May 2015. Collated data from April 2013 to May 2015 showed an overall decrease in the number of unplanned admissions to hospital showing effective management of their unplanned admissions strategy.
However there were areas of practice where the provider should make improvements:
Review current storage and potential risks to the security of prescription pads when stored in office cabinets when left open for staff access to other equipment and records.
Letter from the Chief Inspector of General Practice
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice