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Inspection Summary


Overall summary & rating

Good

Updated 30 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Town Surgery on 12 July 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.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained 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 and easy to understand. 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.
  • The practice had organised and hosted six patient educational events. A consultant attended these events and covered topics such as women’s health, men’s health, diabetes, dementia and healthy lifestyle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 September 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 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.

  • 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.

Effective

Good

Updated 30 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar compared to 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 for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 30 September 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.

  • Patients said they were listened to and were happy with the care and treatment they received.

Responsive

Good

Updated 30 September 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. Extended hours were available on Tuesday and Thursday evenings every week for patients who could not attend during normal opening hours.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. There were parking bays for patients with a disability and automatic doors to enter the building. The practice had wide corridors, easy access for wheelchairs and had large consulting rooms to accommodate wheelchairs, prams and families. On-line booking of appointments and medicine requests were offered by the practice.

  • 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 30 September 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 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. 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 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.

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

Checks on specific services

Older people

Good

Updated 30 September 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. Patient over the age of 75 had a named accountable GP who was also their named care co-ordinator.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had a register for patients who may need additional care in order to avoid unplanned hospital admissions. Regular multi-disciplinary team meetings took place to discuss all patients on the register. These patients had care plans in place and had telephone access for ordering medicines.
  • The practice had run immunisation campaigns regarding flu, shingles and pneumonia.
  • The practice had a dedicated telephone line for nursing and residential homes and community teams for easier access.

People with long term conditions

Good

Updated 30 September 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. There was a GP clinical lead and administrator for all disease registers and the nursing team was trained in supporting patients with long-term conditions.
  • All patients on chronic disease registers were on a recall system and those who did not attend appointments persistently were flagged up to clinicians to follow up.
  • Longer appointments and home visits were available when needed. The practice nurse and health care assistant provided home visits for chronic disease management for those who were unable to get to the practice.
  • 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. A practice nurse was available during extended hours to facilitate ease of access to chronic disease reviews and NHS health checks were provided for early identification of chronic diseases.
  • The practice offered a Diabetic Retinopathy service through an external provider and INR Screening to monitor patients on anti-coagulant medicine (INR stands for International normalized ratio and is used to determine the clotting rate of blood).

Families, children and young people

Good

Updated 30 September 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. The practice had a system to monitor its childhood immunisation programme and non-attenders were discussed with the practice manager for an appropriate follow up.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice ran health promotion campaigns regarding vaccination against nasal flu and rotavirus.
  • Sexual health advice, including chlamydia screening as well as a comprehensive contraception service was available.
  • Cervical cytology appointments were conducted by a practice nurses during normal nursing clinics.
  • On-line appointment booking and prescription ordering was also available.

Working age people (including those recently retired and students)

Good

Updated 30 September 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. Extended Hours were available on Tuesday and Thursday evenings. Telephone consultations were also available with all clinicians on a daily basis.
  • The practice triaged all calls on the same day and appointments were offered if appropriate with the Triage Nurse or clinicians.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 30 September 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 children and had notes on patient records to highlight vulnerable adults.
  • The practice offered annual health checks and 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 worked with local community support groups and informed vulnerable patients about how to access various support groups and voluntary organisations. This included a well-being service, information was provided about the Citizens Advice Bureau and how to make requests for food bank vouchers.
  • 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 30 September 2016

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

  • Annual reviews were offered to all patients on the practice’s mental health register. 92% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 88%. 80% of patients diagnosed with a dementia had, had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had regular contact with community psychiatric nurses and had a system in place for medicines monitoring.
  • The practice 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.
  • Patients had access to a confidential self-referral for Cognitive Behaviour Therapy which was organised by the local psychology services.