CQC rated outstandingNovember 2015
Bow Medical Practice
Michelle Freeburn – Managing PartnerChair Mid Devon Practice Managers GroupChair Pan Devon Practice Managers GroupPractice Manager representative Devon LMC representing North and East Devon CCG areasBoard Member Mid Devon HealthcareMost important role - Mum to two boys!
Bow is a small village in rural Mid Devon, nestled on the edge of the Dartmoor national park.We have a branch surgery, three miles away, in the town of North Tawton – famous as the setting for the Jam and Jerusalem television series.Patient list size circa 5,000.Team of 25 staff, working across the two sites.
What makes Bow Outstanding?
Garry Higgins, Head of GP Inspection for the South, said:“We found that Bow Medical Practice is providing an effective and responsive service which is a real asset to the people living in this part Devon.“Feedback from patients was excellent and staff made every effort to fully involve people in decisions about their care and treatment.“The practice demonstrated a comprehensive approach in managing the differing needs of their patients, proactively gathering feedback, and reflected these needs when planning and delivering services.“This is an example of what outstanding care looks like.”
Are they safe?
As a practice we have a very low threshold to risk. No blame culture.We actively encourage all team members to noteALLerrors no matter how small, to maximise our opportunity to learn from internal and external incidences.Minor and significant events are discussed with individuals concerned, then discussed within the relevant team at out monthly team specific meeting (Clinical/ Dispensary, Admin) and reviewed at our Practice Team meeting to share learning.Events are recorded on a register to help us to identify trends or themes.Offer staff support, truthful and timely information to parties involved, implement actions and review, review, review.
“Staffunderstood and fulfilled their responsibilitiesto raiseconcerns and report incidents andnear misses. Thepractice had a low threshold for reporting sothat allopportunities for learning from internaland externalincidents were maximised.”
Are they safe?
All internal and external Policies and Procedures, Business Continuity Plan, PGD’s, Audits and Alerts are available to all staff electronically.Safeguarding issues are discussed not only at Clinical Team Meetings but shared in the correct context with all staff at Practice Team Meetings, to raise awareness.We are proactive in our approach andliaise positivelywith the Infection Control Team, CCG Safeguarding Nurses, CCGMedicines Optimisation team and other stakeholders – most importantly our PPG.
“Wereviewed safety records, incident reportsnational patientsafety alerts and minutes of meetings wherethese werediscussed.“
Are they safe?
Standard Operating ProceduresDesigned to enable a team member to work following the SOPs without prior knowledge of our environment.Indexed, each SOP interlinks and references all relevant SOPsReviewed annually by the teamAmended as necessary in year, following consultation with the team at our monthly team meeting.
Are they effective?
Laying the foundation from day one:Induction programme, with named mentor during probationary period.Role specific trainingPlanned training programme, identifying staff learning needs.Appraisal and ongoing support
“Thelearning needs of staff were identified through asystem of appraisals, meetings and reviews of practicedevelopment needs. Staff had access to appropriatetraining to meet these learning needs and to cover thescope of their work. This included ongoing supportduring sessions, one-to-one meetings, appraisals,coaching and mentoring, clinical supervision andfacilitation and support for the revalidation of doctors.”
Are they effective?
Access toinformation and responsiveness to alerts–Robust system, risk assessment and monitoring of compliance.Monitoring of guidelines through risk assessments, audits and random sample checks of patient notes.Utilising the clinical system to improve patient outcomes, setting up searches to identify and review. Also to place helpful information and alerts on patient notes, i.e. where a patient is or has a carer.Regularmeetings with multidisciplinary team. Sharing information to understand and meet patientsneeds.Engaging with the PPG to find innovative ways to raise awareness of health promotion through a PPG newsletter in the local parish magazine, attendance at the local farmers market and a successful health promotion day held in the town hall.
“Staffworked together and with other health and socialcare servicesto understand and meet the range andcomplexity ofpeople’s needs and to assess and plan on-goingcare andtreatment. Community nursing staff verified thatGPs wereapproachable and responsive if they hadany concernsabout patients.”
“Thepractice used innovative ways to raise awarenessabout health promotion with the community.“
Are they caring?
Services to patients provided in person, via telephone and online ensuring maximum access to our professionals.Open Access surgery, five mornings per week. No appointment necessary.15 minute appointments – Patients reported that they felt listened to, supported and had sufficient time during consultations.All complaints and compliments are recorded and acted upon, both informal andformalResults from the national GP patient survey are above national and local average in the majority of scored areas.
We observed that members of staff were courteous andvery helpful to patients and treated people dignity andrespect.
“Thepractice was above average for the majority of its satisfaction scores on consultations with doctors and nurses with responses ranging from 93.9 % to 100%.”
Are they caring?
Prescriptions delivered by GP’s to housebound patients during home visits. Often used as a reason to visit vulnerable older patients, who may not like to “trouble the Doctor”.Flu vaccines for housebound patients provided by GP’s.Little handed to out of hours providers, GP’s visit patients after hours particularly end of life patients.Senior GP has a specialist interest in elderly medicine and end of life care. Provides vulnerable patients, or families with little support, with a mobile number during end of life, which can be called 24/7.PatientParticipation Group,withvolunteers in each area that we serve who are willing to deliver medications to patients – with express patient consent.
“Otherexamples were shared with us demonstrating thatGPs went beyond what was expected of them.”
Are they responsive to patients needs?
All partners have an “Open Door” policyWe have a supportive and active patient group meeting bi-monthly, which all partners attend.Suggestion box available for privatecomments. Publicopen commentsbookin waiting area.Consistent high achievement - national patientsurvey.Reviewed and discussed with PPG and practice team.Engagement with patients at local farmer’s market and Health Fair held in the Town hall.Close links with our community nursing team and onsite specialists including: Devon Carers, physiotherapist, midwife and chiropodist.
“Innovativeaccessto healthcarewas being promoted in conjunction withthe patientparticipationgroup.For example, a Healthy Living Daywas organisedby the PPG in October 2015 and wellattended bypractice staff who offered mini health checksto peoplein the community.”
Are they well-led?
Clear vision and strategy, all team members understand our values.Business plan regularly reviewed, weekly Partnership meeting.Structured approach, not hierarchical.Monthly team meetingsWhole practice team meetings and quarterly half day team training.
“Staff said they felt respected, valued and supported,particularly by the partners in the practice. All staff wereinvolved in discussions about how to run and developthe practice, and the partners encouraged all membersof staff to identify opportunities to improve the servicedelivered by the practice.”
Are they well-led?
Forward thinking, engaged with the wider healthcare community.Partners external roles include involvement with the Exeter Medical School and LocalMedical Committee.
“The partners in the practice have the experience, capacity and capability to run the practice and ensure high quality care. They prioritise safe, high quality and compassionate care. Thepartners werevisible in the practice and staff told us that they were approachable and always take the time to listen to all members of staff.”
Thank you for listening
“Wesaw several areas of outstanding practice including:The practice has a strong vision, which puts quality, effective care and treatment as its top priority. The partnership is structured with distinct roles and responsibilities, utilising the experience and skills of partners to the full. As a result, all business and clinical matters are delivered effectively at the practice.The practice provides truly holistic patient centred care. Many examples were seen demonstrating that patients were treated with dignity and received compassionate care. Carers and patients verified that GPs went above and beyond what was expected of them, for example providing 24 hour/7 day telephone access and support for vulnerable patients receiving end of life care.The management of the quality and health outcomes for patients at the practice is based on a comprehensive and responsive approach to local need. A proactive approach towards self-management and health is delivered in partnership with the Patient Participation Group. For example, patient support groups have been set up for patients. These include a walk and talk group to improve fitness and reduce the risk of social isolation.The leadership at the practice inspired a shared purpose, which was aimed at providing patient services closer to home. A GP held qualifications enabling them to provide acupuncture to patients for pain relief. Another GP was supervising a community healthcare worker with a post graduate qualification so that they would be able to provide additional treatments, such as steroid injections, which would normally be carried out at the hospital.”