Health Checkers Report Westbourne Medical Group November 2012 Draft Report
Health Quality Checks Healthcare is really important to people with a learning disability. People with a learning disability have a right to good quality healthcare that meets their needs. But we know people with learning disabilities do not always get the healthcare they need. Taking part in a check is one way of finding out how well your practice is doing. This Quality Check was carried out by a Team of people from Sunderland People First. The Health Quality Checkers are teams of self advocates who want to make a difference. They use the experts by experience approach to monitor the quality of a service. The Quality Checkers approach is different because people with a learning disability take the lead The check focused on the following standards. I am involved in my care at all times My care, treatment and support is planned to meet my needs I get good care and feel safe I get good care from staff who are trained and know how to do their job well I get care from a service which carries out regular checks to make sure they are doing a good job.
The team who carried out the check Sharon Bell Laurence Emily Wolfenden Cook Emily Wolfenden Gavin Barr Andrew Cowe Nicola Magog
How we did the checks: The Team met with the Managing Partner of the Practice to explain the aims of our project in July 2012. The Practice Partner completed a self-assessment document. This document covers six areas around healthcare and support. We asked that supporting evidence be provided for each area. This information was returned to the Health Quality Checkers in August 2012. The practice agreed to send out a pack of information to people with a learning disability who were registered with their practice. 44 packs were sent out in August 2012. The pack included: Information about the project An invitation to come and talk to the health quality checkers team Questionnaires for themselves and the people who support them We set up a group interview to talk to the staff team which happened in September 2012 We collated all information and this report was written in October 2012.
How many people took part in the check: Quality Checkers met up with three patients with a learning disability, one family carer and two support workers 15 patients with a learning disability and 14 support workers / family carers gave feedback via questionnaires This was an exceptional response and Quality Checkers would like to thank everyone that took part in the Quality Check We spoke to 12 health professionals during two group interviews. The staff we spoke to included the practice manager, practice partner, reception staff (5), nursing staff (3), and 2 GP s. This report is therefore based on the feedback from meetings with patients and supporters, 29 questionnaires returned, evaluation of self assessment document and supporting evidence and meetings with the staff team at the practice. The report is set out under the standards and includes what is working well and suggestions for improvement.
Our first impressions. First impressions are so important and can put us at ease or make us feel anxious. People with a learning disability tell us that access is important for everyone. Access: The Shiney Row surgery is near the local shops and close to local bus routes. There is ramp access to the front of the surgery. There are two manual doors to access the waiting area. An electric door would be more accessible for people that use wheelchairs. There is a car park to the rear of the surgery with four disabled parking spaces. The car park is situated on a slope which may present difficulties for patients with impaired mobility. One Quality Checker who uses a walker found it difficult to negotiate the slope. Patients and supporters commented on the general access to the surgery. Some patients felt that the surgery was difficult to access using a wheelchair: Access is not easy Surgery access fine if mobile Access to the building needs to be improved for wheelchairs
Our first impressions: The reception area is relatively small and on some visits appeared to be quite crowded. Quality Checkers felt that the waiting area is well decorated and made people feel relaxed. There is a split level reception desk. The upper tier is open and we observed how patients were able to communicate easily with reception staff. The lower tier has a glass partition and there were a number of posters and leaflets which restricted viewing. Quality checkers felt that it would be more difficult for patients that use wheelchairs to speak directly to reception staff. Quality Checkers commented that although there was a lot of information in the Practice reception area about the service, we couldn t see anything in easy read format or how to make a compliment or a complaint. All the consultation rooms are located downstairs Staff at the practice informed us that they do arrange appointments for some patients at less busy times of the day We were informed during the quality check that a new reception desk is currently being developed that will be more accessible and provide patients greater privacy. The Practice is currently developing accessible information for patients with a learning disability and we were shown examples of easy read information throughout the check
Photos of the Building: Front access leading to practice reception * Car park access to the practice Disabled parking
Photos of the Building: Reception desk Lower reception desk Reception area
Standard 1: I am involved in my care at all times The evidence is taken from the meetings with patients and questionnaires returned from patients and people who support them: Patients and supporters were very positive about meetings with doctors and nurses at the practice. People told us that the doctor or nurse gave them plenty of time to tell them what was wrong, that they listened to what the person was saying, checked that they understood and asked whether patients had any questions. These are some of the things that patients said: Did not feel rushed Do not always understand but they talk to me and reassure me The Doctor repeats things to me which helps I feel involved Making sure information about health services is accessible to people with a learning disability is one of the reasonable adjustments that health services are expected to make: At the beginning of the Quality Check, we were informed that the Practice does not provide accessible, easy read information. However, during subsequent visits we were shown examples of easy read information relating to Annual Health Checks and communicating pain. The Practice said that they would like more support around making information more accessible for patients with a learning disability.
Standard 1: I am involved in my care at all times Almost all patients said that they had not been offered accessible information during appointments. All patients and supporters that we met said that this would be useful, particularly about services available at the Practice and information about what to expect during Annual Health Checks. Quality Checkers welcome the fact that the Practice is developing accessible information for patients with a learning disability. Information could include the following areas: Services Health problems Health promotion Complaints and Compliments The Practice has recently started using easy read appointment letters and invitation to Annual Health Checks. We met with two patients and one supporter who said that the invitation letters were very useful.
Standard 2: My care, treatment and support is planned to meet my needs The key areas of evidence we looked at were: Establishment of the Learning Disability register How easy it was to get an appointment Annual Health Checks and access to screening Health action Plans The Register: The Practice has a register in place which has the ability to flag up when a patient has a learning disability. This system allows staff to record the following: patients communication needs The need for longer appointments Information regarding Annual health checks and reviews The reception staff explained that they use the register to record additional information: for example, if a patient is unable to read the message board this will be noted so that the Doctor will come out and meet the patient.
Standard 2: My care, treatment and support is planned to meet my needs Making an Appointment: There was a mixed response from patients and carers about how easy it is to make an appointment at the Practice. Eleven out of the fourteen questionnaires said that they found it easy to get an appointment for the person they supported. However all six patients/supporters seen in person said that they had all experienced difficulties making an appointment. The main concerns that people had were trying to get through when the line was engaged and having to wait a long time to speak to a receptionist. These are some of the things that patients and supporters said: I think you should be able to get an appointment when you want one. I also think that you should be able to get on the phone without being engaged all the time I think appointment making by phone could be easier. I ve waited a good 30 minutes before being able to make it You can only phone at certain times
Standard 2: My care, treatment and support is planned to meet my needs Making an Appointment: The Practice are reviewing their appointment system and hope to resolve the issues with the phone line. Alternative ways of making an appointment include visiting the surgery to make an appointment and using the online appointment system. Whilst we recognise that many patients with a learning disability may not use the online booking system, this would be valuable for support workers or carers. The staff at the practice informed quality checkers that they have built-up good relationships with patients. The reception team try and accommodate same day appointments and will arrange appointments at less busy times of the day if this is required. The Practice offer home visits to patients if this is required. Longer Appointments: Having a longer appointment is a reasonable adjustments which gives the patients time to understand and explain their health concerns. Quality Checkers spoke to staff at the Practice and were informed that longer appointments are available. The majority of patients and supporters said that they had not been offered a longer appointment and were unaware of this service. We understand that the doctors and nurses are flexible about the length of an appointment but it would be useful to notify patients about this service so that this can be requested.
Standard 2: My care, treatment and support is planned to meet my needs Annual Health Checks: The Practice offers Annual Health Checks and the Practice Manager said that they are now using the recommended Cardiff template. The Practice is piloting an electronic version of the Annual Health Check system. The staff at the practice contact patients and carers by telephone and invite patients to an Annual Health Check. The staff explain exactly what is involved. The nursing staff at the practice will also speak to patients when they attend scheduled appointments to raise awareness of the checks. The Practice have recently started sending out easy read appointment letters. Patients and supporters that we spoke too were very positive about this. At the meeting, patients are seen by a nurse who does the routine checks like blood pressure, height, weight and talks about health and wellbeing. Patients are then seen by the doctor. Almost half of patients that we spoke to or sent feedback via questionnaires said that they have had an Annual health Check at the Practice. The majority of supporters said that the person they support has not been offered an Annual Health Check. Patients who have had an Annual Health Check were positive about their experience: Everything was fine Very good I understood Very helpful
Standard 2: My care, treatment and support is planned to meet my needs Annual Health Checks: Patients and supporters said that having an Annual Heath Check had made a difference. These are some of the things that people said: Reassured me Found out I had high sugar and blood pressure Helps you stay healthy At the beginning of November, the Practice had 44 patients with a learning disability. 13 people have had an Annual Health Check and 2 patients have an Annual Health Check booked. The Quality Checkers recognise the progress that is being made in this area. The Practice currently send out an easy read appointment letter to patients inviting them to attend their Annual health Check No easy read guidance is forwarded so that patients know what to expect during their Annual Health Check.
Standard 2: My care, treatment and support is planned to meet my needs Health Action Plans: Half of patients that responded said that they had a Health Action Plan. Patients and supporters were generally positive about using the Health Action Plan: These are some of the things that people said: I use it to try and keep healthy Too help with my weight I use it at the hospital and in my care home The staff at the practice informed us that they are now using the Health Action Plans to discuss screening checks and that the action sheets are also used to record outcomes from all Annual Health Checks. It was clear from meetings with patients and supporters that we met with that Health Action Plans are being used to record actions from Annual Health Checks.
Standard 2: My care, treatment and support is planned to meet my needs Screening Programmes: Quality Checkers were informed that patients are sent an invitation letter to invite them for screening appointments. This includes cervical and breast screening. Staff at the practice also follow up with a phone call and that screening is discussed as part of routine appointments. Half of patients that talked about screening said that they had been informed about screening checks. One person said that everything had been explained step by step. All supporters said that the patient was able to access screening programmes through their GP. One patient and one supporter indicated that they had been shown models of body parts to explain how to check yourself. One supporter explained how useful this had been to the patient as part of their Annual Health Check. Patients and supporters that we spoke to said that it would be useful to have information about screening checks in an easy read format.
Standard 3: I get good care and feel safe Evidence for this standard is based on meetings with patients and supporters and feedback from questionnaires. Dignity & Respect: The majority of patients and supporters that met with quality checkers were positive about meetings with health professionals at the practice. People said that the doctors and nurses listened to what they had to say and were polite and respectful. Some concerns were expressed around the communication between reception staff when patients and supporters are checking in. The evidence for this came from one to one interviews and specific comments on seven of the questionnaires. The areas mentioned included: An abrupt tone with patients at reception Having to wait too long at reception because staff are talking to each other Reception staff not being helpful
Standard 3: I get good care and feel safe Evidence for this standard is based on meetings with patients and supporters and feedback from questionnaires. Visiting the Practice: The majority of patients and supporters that we spoke to said that they felt relaxed and comfortable about visiting the surgery. One patient and six supporters commented on the delay that they have experienced whilst waiting for their appointment at the practice. People said that this delay can sometimes mean that: Patients sometimes find it difficult sitting in unfamiliar surroundings Patients don t understand why they are waiting Patients become bored and agitated
Standard 3: I get good care and feel safe Privacy: Due to the small size of the waiting area, it is difficult for patients to talk privately within the general reception staff. Reception staff at the practice explained that if required, patients can talk to staff in the adjacent corridor area. Consent & Capacity: All patients and supporters said that consent is always sought from themselves or a family care before physical examinations. Patients and supporters explained that the GP or nurse would explain what was involved and checked that the person understood the procedure. The Practice have a Patient chaperone service in place whereby a family member or member of the practice staff can be present when an intimate examination or procedure is due to take place. Quality checkers liked the fact that this information was displayed in the reception area. Taking Medication: Supporters all said that if patients required medication, the doctor or nurse gave clear information about how and when to take medication. This included side effects and what to if the patient experienced any problems. Staff at the practice explained that where necessary, they will demonstrate devices such as inhalers so that patients can make a choice based around their individual needs.
Standard 4: I get good care from staff who are trained and know how to do their job well This Standard refers directly to training. Under the Direct Enhanced Service (DES) agreement, practices who signed up to the initiative were expected to have attended multi professional education sessions. These education sessions should have been facilitated by either a local health facilitator /community learning disability team and people with a learning disability. Learning Disability Awareness: Staff at the Practice do not attend any specific learning disability awareness training. The Practice Partner informed us that two members of staff are currently completing the Health Champion training programme. The intention is that all staff at the practice become Health Champions. Consent & Capacity: All members of the staff team are aware of policies and procedures relating to this area. Quality Checkers were informed that any issues are directed to GP s or Practice Partners {see training slide}. It was unclear to quality checkers what training is offered around the Mental Capacity Act and the procedures that are implemented should someone lack capacity.
Standard 4: I get good care from staff who are trained and know how to do their job well Safeguarding Training: The Practice provides in-house training for all members of the staff team. Regular updates are provided by the SSCB at one of their own sessions or sessions provided by Sunderland Time in Time out sessions. The Practice has a Safeguarding Clinical Lead and a Safeguarding Admin lead. The Health Champion training does not contain any specific information around supporting people with a learning disability.
Standard 5: I get care from a service which carries out regular checks to make sure they are doing a good job. Patient Forum Group The practice have an established Patient Forum group which meets monthly. There is currently no members with a learning disability. Patients can also leave feedback on the internet using the e-forum. Quality Checks: This was the first time that people with a learning disability had undertaken a quality check at the practice. Feedback from patients: There are a range of ways that patients can leave feedback about the practice. There is a comments box in the main reception area where patients are encouraged to leave feedback about the service. 163 patients have completed an online questionnaire which asks a range of questions about the service. Complaints and Compliments: Two patients that we met with said that we met with did not know how to make a complaint at the practice. One person said that they would talk to their doctor. Over half of supporters said that they did not know the procedure for making a complaint.
Our Suggestions for the Practice: Continue to provide and develop a range of accessible information, to include complaint and compliments procedure and an Easy Read Annual Health Check guide as well as guides around specific health conditions and screening information. Consult with patients with a learning disability about whether they require accessible information and note this on file for shared use. Create a practice guide to raise awareness of services offered at the practice; for example, longer appointments To continue to promote health action plans and make all patients aware that they will be supported in their use Customer care training to include how to communicate with vulnerable patients and support workers Develop Learning Disability Awareness Training, to include an understanding of communication issues, support requirements and reasonable adjustments. Seek the advice of Experts by Experience and specialist learning disability services to develop the training. Look at ways of engaging with patients with a learning disability to ensure that their voice is heard.
Summary The Health Quality Checkers would like to thank the staff at Westbourne Medical Group for their support throughout the check. The team are enthusiastic about making sure that patients with a learning disability get the right support and have made good progress in providing reasonable adjustments for patients with a learning disability. The Practice has made good progress in promoting Annual Health Checks within the Practice. The team were really pleased that the Practice is making information more accessible for patients, using resources available on the internet. Feedback from patients and supporters was overwhelmingly positive. Patients said that they were given clear information during appointments and that the communication with health professionals was excellent. The Practice has an established Patient Forum Group and is looking at ways to engage with patients with a learning disability.
Meeting with staff from Westbourne Medical Group September 2012