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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Pound House Surgery in Wooburn Green, Buckinghamshire on 28 October 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Pound House Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 4 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well-led services.

Our key findings were as follows:

  • We saw the practice had reviewed existing health and safety arrangements and environmental risks at both the main practice in Wooburn Green and the branch surgery in Bourne End. For example, gas safety checks and electrical installation checks had been undertaken and supporting correspondence recorded.

  • Revised recruitment policies and processes had been adopted which reflected national guidance. For example, supporting recruitment documentation (Disclosure and Baring Service checks) that was pending during the October 2016 inspection was now all recorded and documented correctly. The practice had also reviewed and amended the supporting policy which reflected updated guidance. Disclosure and Baring Service checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

  • The practice had reviewed and updated the arrangements to record, share and action (where appropriate) medicine and other patient safety alerts. Specifically, practice had subscribed to receive alerts from Medicines and Healthcare Products Regulatory Agency.

  • Further steps had been taken steps to comprehensively track and monitor the security of all prescription stationary. This included a system to log the location of prescription stationary once transferred to the branch surgery.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 2017

The practice had taken appropriate action and is now rated as good for the provision of safe services.

Our last inspection in October 2016 identified concerns relating to how the practice managed and monitored risks. We saw most risks to patients were assessed and managed, with the exception of some environmental and health and safety risks.

Using information provided by the practice we found the concerns had been addressed:

  • We saw the practice had reviewed existing health and safety arrangements and environmental risks at both the main practice in Wooburn Green and the branch surgery in Bourne End.

  • Revised recruitment policies and processes had been adopted which reflected national guidance.

  • The practice had reviewed and updated the arrangements to record, share and action (where appropriate) medicine and other patient safety alerts.

  • Further steps had been taken steps to comprehensively track and monitor the security of all prescription stationary. This included a system to log the location of prescription stationary once transferred to the branch surgery.

Effective

Good

Updated 16 December 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines.
  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the CCG and national averages. Exception reporting rates were relatively high for heart failure and osteoporosis compared to CCG and national averages. The practice had taken a number of measures to try and reduce exception reporting rates.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. However, there were not effective systems to ensure that all staff had undertaken relevant training updates.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 December 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 some aspects of care.

  • 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 16 December 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, in identifying changes to the premises to meet patient need.
  • Feedback from patients about the appointment system was mixed. Some patients reported that it was not always easy to obtain an appointment. However, the practice reviewed the appointment system on a weekly basis and adapted availability to meet patient need.
  • 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 16 December 2016

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

  • The practice had a clear vision 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 a governance framework, but this did not always ensure patient safety or high quality care. Not all reasonable steps were taken to address risks in relation to receiving and responding to all patient safety alerts, Disclosure and Barring Service checks, tracking and storing blank prescriptions, and the premises.
  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
Checks on specific services

Older people

Good

Updated 16 December 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.
  • The practice provided home visits to a local residential home for older people.
  • The practice had developed and delivered a programme to prevent falls and referred patients to appropriate sources of support.

People with long term conditions

Good

Updated 16 December 2016

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

  • GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • QOF indicators for patients with diabetes were comparable to CCG and national averages. The practice had adapted their diabetes template in line with NICE guidance and to support personalised care planning and provided a comprehensive model of diabetes care.
  • 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. 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 rate of diagnosing patients with atrial fibrillation was one of the highest in the CCG in 2015 to 2016. Audit results showed that no patients with atrial fibrillation had experienced a stroke since June 2014.
  • The practice provided an enhanced programme for patients who had experienced heart failure. This involved the provision of education, medical treatment, and written care plans.

Families, children and young people

Good

Updated 16 December 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 average for all standard childhood immunisations.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • In 2014-5 the practice’s uptake for the cervical screening programme was 86%, which was slightly higher than the CCG average of 84% and the national average of 82%. These percentages remained the same in 2015 to 2016.
  • The practice offered chlamydia screening.
  • 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, health visitors and school nurses.

Working age people (including those recently retired and students)

Good

Updated 16 December 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 reflects the needs for this age group.

  • Patients had access to NHS health checks for patients aged 40–74. The practice showed us that they provided a high percentage of NHS health checks compared to CCG percentages.

  • The practice offered early morning and early evening appointments for working patients who could not attend during normal opening hours.

  • The practice provided Saturday flu clinics to encourage access for working patients who could not attend during usual opening hours.

People whose circumstances may make them vulnerable

Good

Updated 16 December 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and provided appointments to patients from a residential home for people with learning disabilities.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 December 2016

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

  • In 2014-15, 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and national average of 84%. In 2015-16, 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 85% and national average of 84%.

  • The practice had developed a comprehensive strategy to further identify and improve outcomes for patients with dementia. The practice provided dementia screening, referrals to other services, and information about support organisations. One GP and a member of reception staff were dementia champions and they had developed information packs for patients with dementia and their families. The practice had provided staff with training about dementia and identified and implemented measures to ensure the practice and environment were more dementia friendly.

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

  • Performance for mental health related indicators was similar to the national average. In 2014-2015, the percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 90% compared to the CCG average of 89% and national average of 88%. For 2015-16, results for mental health related indicators were also comparable to CCG and national averages.

  • 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.