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Dr Isam Saleh Good Also known as Wenlock Surgery

Inspection Summary


Overall summary & rating

Good

Updated 23 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Isam Saleh on 7 December 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.
  • The national GP patient survey asked patients if they felt they were treated with compassion, dignity and respect. The practice was below average for its satisfaction scores on consultations with GPs and nurses. However, the information we received on the CQC comments cards did not reflect the national GP patient survey results. There were 88 comment cards completed and they all had positive remarks about the practice.
  • The practice had an effective system in place for handling complaints and concerns. Information about services and how to complain was available and easy to understand. For example, there were posters and leaflets in the patient waiting area and information on the practice website. 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.
  • A practice charter was displayed in the waiting area and on the practice website.
  • The practice had a patient participation group (PPG) but they had not secured regular attendance from its members. There were posters in the patient waiting area and information on the practice website advertising for new members to the PPG.
  • The practice had been recognised by Live Well Luton as the top performing practice in Luton for providing in house smoking cessation advice in 2016.

The areas where the provider should make improvement are:

  • Implement a system to monitor the use of blank prescription forms and pads in the practice.
  • Encourage patients to attend the national screening programmes for bowel and breast cancer screening.
  • Continue to monitor and ensure improvements to national patient survey results particularly in relation to, treating patients with compassion, dignity and respect and involving patients in planning and making decisions about their care and treatment.
  • Consider identifying a member of staff as a carers lead to continue to identify and support carers.
  • Continue to establish the patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. A significant event reporting policy available for all staff to access on the practice computer system.

  • We saw examples to show that lessons learnt were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received support, 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. Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • Risks to patients were assessed and well managed.

  • Blank prescription forms and pads were securely stored but there was not a system in place to monitor their use.

Effective

Good

Updated 23 February 2017

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. For example, performance for hypertension related indicators was comparable to the local and national averages. The practice achieved 100% of available points, with 2% exception reporting, compared to the CCG average of 97%, with 5% exception reporting, and the national average of 97%, with 4% exception reporting.

  • Staff assessed needs and delivered care in line with current evidence based guidance. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met patients’ needs.

  • Clinical audits demonstrated quality improvement. There had been four clinical audits undertaken in the last two years, all of these were completed audits where the improvements made were implemented and monitored.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Two members of the reception team were trained to give smoking cessation advice and the practice had been recognised by Live Well Luton as the top performing practice in Luton for providing in house smoking cessation advice in 2016.

  • 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 23 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2016 showed patients rated the practice lower than others for several aspects of care. However, patients we spoke to on the day of the inspection and the CQC comments cards we received were all positive about the standard of care received. Many cards said the GP was very good, polite and efficient.

  • Patients said they were treated with compassion, dignity and respect.

  • 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.

  • The practice had identified 28 patients as carers, which was approximately 1% of the practice list. There was a carers board in the waiting area with written information available to direct carers to the avenues of support available to them. Carers were offered an annual health check and flu vaccination.

Responsive

Good

Updated 23 February 2017

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 the Luton Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice had arranged for a Polish speaking smoking cessation advisor to attend the practice regularly to provide specialist support to the local Polish community.

  • 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.

  • Extended opening hours were offered on Wednesdays from 6.30pm to 8pm.

  • 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. The practice manager was the designated responsible person who handled all complaints in the practice. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 23 February 2017

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.

  • They had a practice charter that was displayed in the waiting area and on the practice website.

  • 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 monthly 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.

  • The practice proactively sought feedback from staff and patients, which it acted on. They had a patient participation group (PPG) but they had not secured regular attendance from its members. We noticed posters in the patient waiting area and information on the practice website advertising for new members to the PPG.

  • They made use of the NHS Friends and Family test. Most recent published results showed 100% of 35 respondents would recommend the practice.

  • There was a focus on continuous learning and improvement at all levels.

Checks on specific services

Older people

Good

Updated 23 February 2017

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 held monthly multi-disciplinary team meetings with the community team to discuss any patients at risk of hospital admission or who needed extra care.

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

  • Telephone consultations were available with the GP.

  • A vaccination programme was in place including seasonal flu jabs, shingles and pneumococcal vaccinations.

People with long term conditions

Good

Updated 23 February 2017

The practice is rated as good for the care of people with long-term conditions.

  • The GP with the support of the practice nurse had the lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was comparable to the local and national averages. The practice achieved 90% of available points, with 6% exception reporting, compared to the CCG average of 87%, with 10% exception reporting, and the national average of 90%, with 12% exception reporting.

  • 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.

Families, children and young people

Good

Updated 23 February 2017

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.

  • Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role. The GP was trained to an appropriate level to manage child safeguarding, level 3, and the practice nurse was trained to level 2.

  • Comments from patients on the CQC comments cards showed that children and young people were treated in an age-appropriate way.

  • The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 80% and the national average of 81%.

  • Opportunistic chlamydia screening was offered to 15 to 24 year old patients.

  • 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 and health visitors.

Working age people (including those recently retired and students)

Good

Updated 23 February 2017

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 reflects the needs for this age group.

  • The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Although the uptake was lower than average. For example,

    • 59% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 69% and the national average of 72%.

    • 36% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 50% and the national average of 58%.

  • Extended opening hours were available on a Wednesday from 6.30pm to 8pm. This catered for working patients who could not attend during normal opening hours.

People whose circumstances may make them vulnerable

Good

Updated 23 February 2017

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

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

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

  • 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 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.

  • The practice had identified 28 patients as carers, which was approximately 1% of the practice list. There was a carers board in the waiting area with written information available to direct carers to the avenues of support available to them. Carers were offered an annual health check and flu vaccination.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 February 2017

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

  • 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

  • Performance for mental health related indicators was comparable to the local and national averages. The practice achieved 92% of available points, compared to the CCG average of 90%, and the national average of 93%.

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

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

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

  • The practice had a system in place to follow up patients who had attended A&E 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.

  • A Mental Health Primary Care link worker visited the practice regularly so patients could be seen in a familiar environment.