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Inspection Summary


Overall summary & rating

Good

Updated 15 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We previously inspected the practice on 20 June 2016 and rated it then as Requires improvement overall. This was because it was not meeting legal requirements in relation to some aspects of patient safety, improving patient outcomes and governance arrangements. The June 2016 inspection report can be found at www.cqc.org.uk/location/1-539009738.

We carried out an announced comprehensive inspection at St Bartholomews Surgery on 09 November 2017 to follow up on breaches of regulations.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • National GP survey results showed patients did not always feel staff involved and treated them with care and concern. The practice took action and carried out a practice based survey which showed improvement.

  • National GP survey results showed patients found the appointment system easy to use and that they could access care when they needed it. Some feedback we received on the day of the inspection was less positive however. The patient participation group highlighted the need for more patient education on appointment booking.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

  • The practice had remedied the shortfalls identified at our previous inspection.

  • The provider had acted on recommendations we made at our previous inspection to improve the business continuity plan; the uptake of cervical screening; identifying and supporting carers; provisions for patients with hearing impairment and for patients for whom English is an additional language; and documenting meetings and following up agreed actions.

The areas where the provider should make improvements are:

  • Consider ways of improving patients’ understanding of the appointment booking system.

  • Include information about the role of the Health Services Ombudsman in its responses to complaints.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 December 2017

Effective

Good

Updated 15 December 2017

Caring

Good

Updated 15 December 2017

Responsive

Good

Updated 15 December 2017

Well-led

Good

Updated 15 December 2017

Checks on specific services

Older people

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • 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.
  • The percentage of patients with rheumatoid arthritis, on the register, who had a face-to-face annual review in the preceding 12 months was 100% which was comparable to 91% within the CCG and 91% nationally.
  • Multi-disciplinary team meetings were not taking place but this was CCG led and they were due to restart and care plans for frail older people were routinely reviewed and updated.

People with long term conditions

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was 88% which is similar to CCG and national averages (CCG average 87%, national average of 89%)
  • The percentage of patients with hypertension having regular blood pressure tests was 86%, which is similar to the CCG and national averages of 84%
  • Longer appointments and home visits were available when needed.
  • Patients had a named GP and a structured annual review to check their health and medicines needs were being met.
  • Multi-disciplinary team meetings were not taking place but this was CCG led and they were due to restart. Care plans were routinely reviewed and updated.

Families, children and young people

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • Childhood immunisation rates for the vaccines given to under two year olds ranged from 80% to 94% (CCG ranged from 82% to 94%) and five year olds from 76% to 94% (CCG also ranged from 82% to 95%).

  • The practice provided weekly walk in family planning clinics.
  • 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.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 69%, which was below the CCG average of 81% and the national average of 82%. Staff told us members of their female community were from religious and ethnic groups that tended to decline cervical screening tests.
  • Appointments were available outside of school hours and the premises were suitable for children and babies, and we saw positive examples of joint working with midwives and health visitors.

Working age people (including those recently retired and students)

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • 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.

Patients aged 40–74 had access to appropriate health assessments and checks that were followed up where abnormalities or risk factors were identified.

People whose circumstances may make them vulnerable

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • The practice held a register of patients living in vulnerable circumstances including those with learning disabilities.
  • The practice offered longer appointments for patients with a learning disability and identified 17 patients on its list, all 17 (100%) had received an annual health check in 2015 – 2016.
  • 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)

Requires improvement

Updated 28 September 2016

The provider was rated as requires improvement for safety, effectiveness and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice:

  • 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 87% and the national average of 84%.
  • The practice carried out advance care planning for patients with dementia.
  • Performance for mental health related indicators was 100% compared to the CCG average at 87% and the national average of 93%, the practice had identified 82 patients on its register with a mental health condition requiring an annual health check and 86% of these patients had received the check.
  • Multi-disciplinary team meetings were not taking place but we saw evidence staff were working with allied mental health professionals in the case management of patients experiencing poor mental health, including those with dementia.
  • 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.