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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Upton Village Surgery on 21 June 2016. The overall rating for the practice was Good. However, the practice was rated as Requires Improvement for providing safe services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Upton Village Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 14 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 21 June 2016. This report covers our findings in relation to those requirements, additional improvements made since our last inspection and further improvements that should be made.

Overall the practice is rated as Good.

Our key findings were as follows:

  • Action had been taken to ensure that a record of the required staff recruitment information was maintained.

The following improvements to the service had also been made:

  • A system had been introduced to ensure a record was made of the receipt and allocation of printable prescriptions.

  • A review of the system for monitoring staff training needs had taken place.

  • The complaint procedure had been revised to reflect the alternative complaint pathways advertised on the practice website.

We identified an area of practice where the provider should make improvements:

  • The provider should ensure that the training plan is followed so that staff receive the training they require for their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 March 2017

The practice is rated as good for providing safe services. Action had been taken to ensure that a record of the required staff recruitment information was maintained. We also found that further improvements had been made to the safety of the practice. A system had been introduced to ensure a record was made of the receipt and allocation of printable prescriptions.

Effective

Good

Updated 20 March 2017

The practice is rated good for providing effective services. The service had put a system in place for recording staff training that would enable them to monitor and plan for staff training needs. This identified shortfalls in mandatory training and a plan was in place to demonstrate how these shortfalls would be met.

Caring

Good

Updated 4 August 2016

The practice is rated as good for providing caring services. We saw staff treated patients with kindness and respect. Patients spoken with and who returned comment cards were positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful. Patients felt involved in planning and making decisions about their care and treatment.

Responsive

Good

Updated 4 August 2016

The practice is rated good for providing responsive services. Services were planned and delivered to take into account the needs of different patient groups. Access to the service was monitored to ensure it met the needs of patients.

The practice had a complaints policy which provided staff with clear guidance about how to handle a complaint.

Well-led

Good

Updated 4 August 2016

The practice is rated good for providing well-led services. 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 were systems in place to monitor the operation of the service. Staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. The practice sought feedback from staff and patients, which it acted on. The practice had a focus on continuous learning and improvement.

Checks on specific services

Older people

Good

Updated 4 August 2016

The practice is rated as good for the care of older people.

The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

The

practice worked with other agencies and health providers to provide support and access specialist help when needed.

The practice worked with the Clinical Commissioning Group (CCG) and with a cluster of three other practices to enhance patient care. For example, the practices had developed a role for and employed a nurse practitioner to work with elderly patients. The aim of this role being to take practice nursing services, such as chronic disease management out to housebound patients and to prevent hospital admissions where possible. This service was currently being reviewed to assess sustainability. Care plans were developed for older people with the aim of ensuring all necessary support was provided and reducing hospital admissions. A review of polypharmacy had been undertaken in the last two years due to it being closely linked with unplanned hospital admissions. There was a plan to re-visit this again with the support of the CCG pharmacy team. Annual health checks for patients over 75 years of age were carried out.

People with long term conditions

Good

Updated 4 August 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives. The practice provided support and information to patients to encourage them to manage their long term conditions and provided care plans to patients to assist with this.

Families, children and young people

Good

Updated 4 August 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. A teenage drop-in clinic was provided and a letter was sent to all teenagers telling them about this service and inviting them to the practice. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. Training records did not clearly show if staff had up to date training relevant to their role. A plan was put in place to address this following our visit. The safeguarding lead staff liaised with the health visiting service, school nurses and midwife to discuss any concerns about children and how they could be best supported. Family planning and sexual health services were provided.

Working age people (including those recently retired and students)

Good

Updated 4 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could order repeat prescriptions on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients.

An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice website provided information around self-care and local services available for patients. Reception staff had received training on sign-posting patients who do not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).

People whose circumstances may make them vulnerable

Good

Updated 4 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example,

if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check.

The staff we spoke with had appropriate knowledge about adult safeguarding and how to report any concerns. Some staff needed training in adult safeguarding and a plan was in place to address this.

Se

rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. A representative from the Carers Trust visited the practice and provided information for patients about the services provided. The practice had received a certificate from the Carers Trust in 2016 recognising the support it provided to carers. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 August 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out assessments of patients at risk of dementia to encourage early diagnosis and access to support, this included opportunistic assessments.  The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients.