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Inspection Summary


Overall summary & rating

Good

Updated 4 August 2016

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Grand Union Health Centre on 28 April 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.-However, only a small number of patients had been identified as carers to provide them with support.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice supported homeless patients who lived in a hostel next door to the practice, the majority of whom were registered with the practice. They were given same day appointments and the reception team supported them to make GP and hospital appointments, and often collected them from the hostel. The practice also provided them with an outreach service for annual flu vaccinations to care for as many of these patients as possible.

The areas where the provider should make improvement are:

  • Monitor improvements to medicines management to ensure systems remain robust.
  • Keep under review improvements to the workflow system to ensure pathology results and scanned letters and tasks are completed within stated timescales.
  • Ensure relevant clinical audits are completed through the full audit cycle where the improvements made are implemented and monitored.
  • Review systems to improve the identification of carers and provide support.
  • Update the practice’s policy on notifiable incidents in line with 2014 regulations.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. On the day of the inspection we identified some deficiencies in medicines management but the practice addressed these immediately after the inspection and provided supporting evidence for this.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 4 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • The practice recognised that the workflow system needed to be more robust and immediately after the inspection implemented a new protocol for managing pathology results and scanned letters and tasks with clear timescales for the completion of follow up action.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement, although evidence was available of only one completed audit where the improvements made were implemented and monitored.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 4 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • The practice recognised that it needed to do more to identify and support carers and immediately after the inspection undertook to revisit and implement more rigorously the carers identification protocol it had put in place in January 2016.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 4 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice participated in CCG audits of outpatient referrals to various specialties, to ensure that these were appropriate.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 August 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken. However, the practice’s policy on notifiable incidents needed to be updated to reflect the new 2014 regulations.
  • The practice proactively sought feedback from staff and patients, which it acted on. A combined patient participation group had recently been formed following the practice merger and was becoming active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

Older people

Good

Updated 4 August 2016

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

  • 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.
  • There was a named GP for all patients over 75 years and close liaison with the community matron, district nurses and primary care navigator for signposting patients and relatives to access services and for management of their conditions.
  • The practice held regular meetings for avoiding admissions with a multidisciplinary team (district nurses, practice nurses, all doctors, medicines management team, social services and palliative care). There was also close working with the local rapid response team, which included doctors and nurses to keep patients over 65 well, at home and out of hospital.
  • Care planning was in place for frail patients, and also for all over 65s as part of whole systems integrated care pilot.

People with long term conditions

Good

Updated 4 August 2016

The practice is rated as good for the care of people 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 performance for the QOF indicators for long-term conditions was above average including for diabetes related indicators.
  • 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.
  • The practice participated in a number of hospital services including an in house phlebotomy service, electrocardiograms (ECGs) and 24 hour blood pressure monitoring. There was an in-house anticoagulation service for the practice’s patients and also patients from several other local practices.
  • The practice hosted a drug dependence programme with an in-house drugs counsellor and methadone prescribing.

Families, children and young people

Good

Updated 4 August 2016

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

  • 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 people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 78% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. There was same day access for children and young people who were unwell both in the morning and after school. A priority service for was available for unwell children who attended the practice.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Under the local ‘Connecting Care for Children’ initiative monthly paediatric clinics and multidisciplinary team meetings took place in the practice involving a paediatric consultant and four local GP practices.

Working age people (including those recently retired and students)

Good

Updated 4 August 2016

The practice is rated as good for the care of working-age people (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 adjusted 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 reflected the needs for this age group.
  • There were GP telephone consultations for some medication reviews, results and advice.
  • The practice provided a travel vaccination clinic.

People whose circumstances may make them vulnerable

Good

Updated 4 August 2016

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

  • Patients living in vulnerable circumstances including vulnerable families, homeless people, refugees and asylum seekers and those with a learning disability were flagged on the patient record system.
  • The practice offered longer appointments for vulnerable patients, where necessary. Patients with a learning disability were offered an annual review.
  • 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.
  • Homeless patients who lived in a hostel next door, were given same day appointments and the reception team supported them to make GP and hospital appointments, reminded them, and often collected them from the hostel, if required.
  • Weekly prescriptions were provided for patients at risk of overusing medications and the practice signposted patients to addictions services in house and externally.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 August 2016

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

  • QOF performance for mental health related indicators was above average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • Patients with complex mental health needs were identified and referred into the practice’s in house out of hospital mental health programme or common complex mental health programme. There was a practice based psychiatric nurse available to support this.
  • There were same day appointments/telephone phone triage for patients experiencing acute mental health problems.
  • There were annual mental health reviews and a recall system to encourage attendance. Patients with acute mental illness were offered an annual 30 minute appointment, a six monthly 20 minute appointment and two further 10 minute appointments per year. Patients with depression and anxiety were offered two 20 minute and seven 10 minute appointments annually to support their symptoms.