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Inspection Summary


Overall summary & rating

Good

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Bloxham Surgery on 10 May 2016. Overall the practice is rated as good.

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

  • There was a system in place for reporting and recording significant events.
  • Risks to patients were usually assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff were trained in order 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.
  • Information about services and how to complain was available. 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.

Areas the provide should make improvements are:

  • Review the monitoring and checking of the dispensary and medicines management to ensure it reflects all national guidance.
  • Formalise and document the completion of clinical audit to ensure improvements in care resulting from audit are embedded.
  • Improve the coding on the patient record system to ensure that monitoring of repeat medicine reviews is undertaken

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 June 2016

The practice is rated as good for providing safe services.

  • The practice had a system in place for reporting, recording and monitoring 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.
  • Arrangements were in place to safeguard children and vulnerable adults from abuse.
  • Risks to patients were assessed and well managed.
  • Medicines were managed appropriately, although appropriate checks on dispensing medicines were not always taking place.
  • Emergency medicines and equipment were stored appropriately and within expiry dates.
  • The practice was clean and well maintained.
  • Equipment was checked and calibrated.
  • There were health and safety policies in place.

Effective

Good

Updated 15 June 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. Exception reporting was in line with national and local averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement, although re-audit was not always taking place to assure systemic improvements had been made.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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 15 June 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.
  • 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 15 June 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population to secure improvements to services where these were identified.
  • A nursing home was located next door to Bloxham Surgery and a GP visited the home on a weekly basis or when required by patients residing there.
  • The practice employed a community Phlebotomist to visit patients who are unable to come to surgery for blood tests.
  • Diabetic retinopathy clinics were held at the practice to enable diabetics to have their eye screening locally.
  • 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.

Well-led

Good

Updated 15 June 2016

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

  • The practice had a clear vision and 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.
  • Some policies were not monitored to ensure they were up to date and consistent.
  • 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. The patient participation group was active and involved by the partners and manager.
Checks on specific services

Older people

Good

Updated 15 June 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.
  • There was a 45 bed nursing home next door to Bloxham Surgery and a GP with a special interest in care of the elderly visited the nursing home weekly or when required.
  • The practice employed a community Phlebotomist to visit patients who are unable to come to surgery for blood tests.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
  • All appointments were available on the ground floor.
  • Patients over 75 had a named GP.
  • Eligible patients had access to their medicines for any health conditions via the dispensary.

People with long term conditions

Good

Updated 15 June 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 most recent published results were 100% of the total number of points available compared to the clinical commissioning group (CCG) average of 97% and national average of 95%.
  • The practice has a rate of 7% exception reporting compared to the national average of 9% and regional average of 8%.
  • 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.
  • Patients had access to their medicines for any health conditions via the dispensary.

Families, children and young people

Good

Updated 15 June 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 similar to average for all standard childhood immunisations.
  • 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.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Joint working with external organisations took place in the management of children at risk of abuse.

Working age people (including those recently retired and students)

Good

Updated 15 June 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.
  • Patients’ feedback on the appointment system was very positive overall.
  • 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.
  • Travel vaccinations were available.
  • There were extended hours appointments on Mondays until 8pm and either Tuesday or Thursday mornings from 7am every week.

People whose circumstances may make them vulnerable

Good

Updated 15 June 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.
  • 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.
  • Joint working with external organisations took place in the management of patients at risk of abuse or harm.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 June 2016

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

  • Performance for mental health related indicators was 100% compared to the national average 92% and regional average of 95%.
  • There were 31 patients on the mental health conditions register and 24 had a care plan in place. Eight patients had not attended for health checks or care plan discussions.
  • 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 advanced care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.