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Dr Maurice O'Connell and Partners Good Also known as Beacon Surgery

Inspection Summary


Overall summary & rating

Good

Updated 10 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Maurice O’Connell & Partners (The Beacon Surgery) on 1 March 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.
  • Feedback from patients about their care was consistently and strongly positive.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • Urgent appointments were available on the day they were requested.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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 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 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.

We saw one area of outstanding practice:

  • Elderly patients who were resident in care homes were visited each week by a GP allocated by the practice to that care home to ensure continuity of care. This was introduced in 2014 and has led to a 25% reduction in unplanned hospital admissions for these patients.

The areas where the provider should make improvements are:

  • To review policies in regard of staff whose role means they have unsupervised contact with patients and either risk assess the role or carry out relevant checks to ensure patient safety.

  • To review what actions the practice could undertake to ensure that the maximum numbers of carers are identified within their patient list.

  • To review their policies regarding completing legionella risk assessments so as to ensure patient and staff safety .

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 June 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.
  • The practice had policies and procedures in place to help with continued running of the service in the event of an emergency.
  • The practice was clean and tidy and there were arrangements in place to ensure appropriate hygiene standards were maintained.
  • Although risks to patients who used services were assessed the practice did not undertake a legionella risk assessment in place. However, we noted the practice did have water samples tested annually to ensure the quality and safety of the water supply.

Effective

Good

Updated 10 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework from 2014/15 showed patient outcomes were at or above average for the locality and compared to the national average with the exception of patients suffering from mental health issues where the practice was lower than the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans including an annual checklist that covered areas such as policies, procedures and training issues for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • GPs at the practice had forged a working relationship with the radiology department at Redbury hospital which allowed them to book investigations directly thus making the treatment time quicker for patients.

Caring

Good

Updated 10 June 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published January 2016 showed patients rated the practice higher than others for all 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.
  • We observed a strong patient-centred culture.

Responsive

Good

Updated 10 June 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.
  • 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 June 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 clear about the vision and their responsibilities in relation to this.
  • 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. This included arrangements to monitor and improve quality and identify risk.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and worked in close partnership with the practice.
  • There was a strong focus on continuous learning and improvement at all levels.
  • There was an effective skill mix of doctors, practice nurses and healthcare assistants.
Checks on specific services

Older people

Good

Updated 10 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Elderly patients who were resident in care homes were visited each week by a GP allocated by the practice to that care home to ensure continuity of care. This was introduced in 2014 and has led to a 25% reduction in unplanned hospital admissions for these patients.
  • All patients over 75 years of age are ensured a same day appointment.
  • The practice had a safeguarding lead for vulnerable adults.

People with long term conditions

Good

Updated 10 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.
  • Data from 2014/15 showed the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 92% compared to the national average of 88%.
  • 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.
  • For patients with more complex diabetic needs there was a clinic serviced by the diabetic specialist nurse within the practice.
  • The practice has on site spirometry testing available for those patients with asthma and chronic obstructive pulmonary disease (COPD).

Families, children and young people

Good

Updated 10 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 relatively high for all standard childhood immunisations.
  • Data from 2014/15 showed the percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was 82% compared to the national average of 75%.
  • The practice ensured that children needing emergency appointments would be seen on the day or were offered a same day telephone appointment to discuss any concerns.
  • 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 94% compared to a national average of 82%.
  • 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.
  • The practice offered a comprehensive range of family planning services with two GPs proficient in coil insertion and a further two GPs able to place contraceptive implants.
  • Childhood immunisations were given when it was convenient to the patients and not at a prescribed clinic time.
  • The practice offered online appointment booking and prescription requests for patients along with a text reminder service for appointments.

Working age people (including those recently retired and students)

Good

Updated 10 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 could pre-book early morning appointments from 7am one day a week as well as one evening session until 7.30pm once a week. Saturday morning appointments were also available from 8am.
  • The practice offered NHS health-checks and advice for diet and weight reduction.
  • The practice offered a range of other services such as minor surgery, ear micro-suction and a rectal diagnostic clinic which was less time consuming for patients than attending an outpatient clinic would have been.

People whose circumstances may make them vulnerable

Good

Updated 10 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 multi-disciplinary teams in the case management of vulnerable people.
  • Translation services were available for patients who did not use English as a first language.
  • The practice could accommodate those patients with limited mobility or who used wheelchairs.
  • Carers and those patients, who had carers, were flagged on the practice computer system and were signposted to the local carers support team.
  • The practice had recently introduced a system whereby the health care assistant visited vulnerable patients in their own homes to advise them about health care.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice had a close working relationship with the pharmacy next door and requested medicines to be blister packed for patients requiring this.
  • 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 June 2016

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

  • Data from 2014/15 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 53% compared to the national average of 88%. The practice had recognised this and devised a plan to address the matter and evidence was seen that at the time of inspection the practice had achieved 83% in areas affecting mental health.
  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 73% compared to the national average of 84%.
  • The practice had recognised that they had low mental health data and had put into place a system to alleviate the number of patients who did not attend for their appointments. This system included telephone reminder calls and appointments nearer to the date of making their appointment.
  • The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
  • All patients on the Mental Health register were proactively invited in to see their usual doctor annually. This appointment was always made during the morning surgery times so that the GP could do blood tests if needed.
  • The practice provided in house counsellors for all patients as needed and there were also some counsellors in training who saw patients. The practice had developed special rooms for this purpose and these were furnished comfortably and away from the clinical areas of the practice.
  • It carried out advance 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.
  • It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.