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Inspection Summary


Overall summary & rating

Good

Updated 22 August 2016

Letter from the Chief Inspector of General Practice

When we visited Underwood Surgery in January 2016 we found concerns, related to the safe delivery of services. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good.

We found that the practice required improvement for the provision of safe services because improvements were needed in the way the practice assessed, managed and mitigated the risks associated in relation to safeguarding and non-clinical staff performing chaperone duties.

Underwood Surgery sent us an action plan that set out the changes they would make to improve these areas.

We visited the practice to undertake a focused inspection on 2 August 2016 to ensure the practice had made these changes and that the service was meeting regulations. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report of 14 January 2016.

Our key findings were:

  • The practice had robust processes in place to identify and protect vulnerable adults and children who could be at risk.
  • The practice had put in place procedures to ensure risks were mitigated in relation to non-clinical staff performing chaperone duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 August 2016

The practice is rated as good for providing safe services. Since our last inspection in January 2016 systems had been put in place to ensure safe patient care.

  • The practice had a register of vulnerable adults and children

  • Alerts were visible on the practice computer system to ensure all staff were aware of vulnerable adults and children

  • Monthly meetings had been initiated and we saw evidence that patients on the register were discussed and their records updated within the meeting.

  • Practice staff had been updated and were aware of their individual responsibilities in relation to safeguarding issues.

  • The practices chaperone policy was in line with recommended guidelines.

Effective

Good

Updated 16 March 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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. However, not all staff had received appraisals where training, learning and development needs were identified and recorded.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 March 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 16 March 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs for example the practice supported the local food bank by collecting food at the practice and identifying people who would benefit from its 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, the practice worked closely with university student services to identify improvements that could be made for the benefit of students such as mental health support.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, changes to the annual recall system for chronic diseases were made to minimise the number of times patients were asked to attend the practice for reviews
  • 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 the practice responded quickly when issues were raised.

Well-led

Good

Updated 16 March 2016

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

  • The practice did not have a clear vision and strategy and supporting business plan. Staff were not clear about the future plans of the practice, due to uncertainty about the continuation of the contract to provide medical services to students. Staff were unsure how this would impact the practice and individual staff.

  • 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.

  • The practice proactively sought feedback from patients and had an active patient participation group (PPG).

  • All staff had received inductions but not all staff had received regular performance reviews that included a development plan.

  • Regular meetings were held for clinical staff however meetings for non-clinical staff did not take place regularly.

  • 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 March 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 care for three nursing homes. Patients were reviewed every two weeks by a designated GP. The practice worked with a community pharmacist linked to the homes to review people on multiple medicines.

  • The percentage of patients aged 65 or over who received a seasonal flu vaccination was 75% and comparable to the CCG and national averages.

  • Longer appointments and home visits were available for older patients when needed

People with long term conditions

Good

Updated 16 March 2016

The practice is rated as good for the 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. Individualised care plans were discussed and updated at each review.

  • 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. We spoke with district nurses attached to the practice who confirmed that team working with the practice was effective and that GP’s responded to requests by the district nursing team on the same day.

  • Multidisciplinary meetings were held regularly with community based health staff.

Families, children and young people

Good

Updated 16 March 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to 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.

  • 72% 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.

  • 82% of women aged 25-64 had had a cervical screening test in the preceding five years (01/04/2014 to 31/03/2015).

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Working age people (including those recently retired and students)

Good

Updated 16 March 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 for example early morning commuter surgeries were available on Mondays and Tuesdays.

  • 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.

  • The practice provided extensive online health promotion, advice and support which were tailored to meet the needs of its student population.

  • Services offered to students had been adapted to meet their needs. For example, sports physiotherapy and additional sexual health services.

People whose circumstances may make them vulnerable

Good

Updated 16 March 2016

The practice is rated as good for people whose circumstances may make them vulnerable.

  • The practice did not hold a register of patients living in vulnerable circumstances. It was unable to identify the percentage of patients who had received an annual health check.

  • Some staff were unaware of who the safeguarding lead within the practice was. The practice did not hold a register of vulnerable adults and did not proactively identify vulnerable children.

  • The practice held a register of 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.

  • 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.

  • The practice had no homeless patients. All staff were aware of a local service that offered medical care to the homeless and signposted people appropriately. There were no policies or arrangements to allow people with no fixed address to register or be seen at the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 March 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia for example the practice employed a community mental health nurse to work with students at the university and we saw that people were referred to alternative services appropriately. The practice also employed a community mental health nurse who held clinics weekly at the practice for those with complex mental health needs.

  • 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.

  • 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.