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Inspection Summary


Overall summary & rating

Good

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr K K Abraham and Dr J Joseph also known as the Felmores Medical Centre on 3 February 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. Patient safety alerts were effectively managed and actioned to identify and manage risks to patients.
  • There was a system in place for reporting significant events. However, this could be improved with more timely recording and better detailed documentation of discussions and decisions.
  • The practice was visibly clean and tidy.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had lead areas and the skills, knowledge and experience to deliver effective care and treatment.
  • Patients reported higher than local and national levels of confidence in the GPs.
  • Comments from patients were positive and they reflected they were cared for by committed staff who showed them patience and empathy.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that 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 valued, trusted and supported by management. The practice sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

  • Record, investigate and document the dissemination of learning from significant incidents.
  • Maintain individualised cleaning schedules to demonstrate when, where and how rooms and equipment were last cleaned.
  • Update records to ensure they accurately reflect risks and actions taken.
  • Increase clinical audits to inform improvements for patient care.
  • Maintain accurate records of discussions, decisions, and actions taken in meetings.
  • Seek wider views from patients in relation to the services provided and respond to it accordingly.

Professor Steve Field

(CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events. This could be improved by enhanced recording and better documenting of discussions, decisions and learning to improve patient safety.
  • The practice was visibly clean and tidy and cleaning schedules maintained.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. For example a clear system for the timely actioning of patient safety alerts, infection prevention control, fire and legionella risk assessments.

Effective

Good

Updated 10 March 2016

The practice is rated as good for providing effective services.

  • There were clear and effective systems for the dissemination of national guidance and best practice. Staff assessed needs and delivered care in line with current evidence based guidance.
  • Data from the Quality and Outcomes Framework showed patient outcomes were similar to the locality and compared to the national average.
  • Clinical audits demonstrated quality improvement but these could be increased to better inform patient care.
  • Staff were appointed lead roles and additional responsibilities. They were supported to ensure they 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 10 March 2016

The practice is rated as good for providing caring services.

  • We received 52 patients completed comment cards praising the practice for their caring and professional service.
  • Patients reported higher than local and national levels of confidence in the National GP Patient Survey, published 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 10 March 2016

The practice is rated as good for providing responsive services.

  • Practice staff knew and understood their patients’ needs and considered them in how they organised and delivered their services. For example the availability of a phlebotomy service from both the main surgery and branch surgery.
  • Patients said they found it easy to make an appointment with a 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 clear and available for patients to access and understand. The practice thoroughly investigated concerns and responded to them in a timely and appropriate way. Learning from complaints was identified but inconsistently documented, despite being shared with staff.

Well-led

Good

Updated 10 March 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 highly committed and clear about their responsibilities in delivering high quality and accessible care to patients.
  • There was a clear leadership structure and staff felt valued and supported by management. The practice had a number of policies and procedures to govern activity and held weekly 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 knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice sought feedback from staff and patients, which it acted on. The patient participation group was active within the locality meetings.
Checks on specific services

Older people

Good

Updated 10 March 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. For example, the practice nurse contacted patients to coordinate their care to mitigate the need for multiple visits.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

People with long term conditions

Good

Updated 10 March 2016

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

  • Nursing staff had lead roles in diabetes and chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was similar or above the national average. For example, they performed better than the national average for the percentage of patients on the diabetic register who have had an influenza immunisation achieving 100% in comparison to the national average of 94%.
  • 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 medicine 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 10 March 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 failed to attend appointments, had a high number of A&E attendances.
  • Child immunisation rates were high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and staff had received refresher training in Gillick competency.
  • Cervical screening data was comparable to the CCG and national averages.
  • The practice conducted antenatal and postnatal checks.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Working age people (including those recently retired and students)

Good

Updated 10 March 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. The practice provided extended opening hours and online appointments and prescription requests.
  • 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, including travel vaccinations.

People whose circumstances may make them vulnerable

Good

Updated 10 March 2016

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 those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and conducted annual care reviews.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 March 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had below the national average for their mental health QOF indicators and conducting face to face reviews with patients with dementia.
  • Patient comments received made reference to the supportive care provided to patients suffering depression and anxiety.
  • The practice provided open availability for some patients with poor mental health to see the clinical team.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency 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. They coded patient data and informed colleagues of how to meet individual patient needs.