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Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Field Road Surgery on 27 October 2015. Overall the practice is rated as good.

Specifically, we rated the practice as good for providing safe, effective, caring, and responsive and well led services. The service provided to the following population groups was rated as good:

• Older people

• People with long-term conditions

• Families, children and young people

• Working age people (including those recently retired and students)

• People whose circumstances may make them vulnerable

• People experiencing poor mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. However, some essential safety checks were due updates.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • 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.

  • There was a clear leadership structure and staff felt supported by management.

However, there was an area of practice where the provider needs to make improvements.

The provider should :

  • Review the results of the 2015 national GP patient survey and consider whether improvements are needed to improve patients’ experience of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services. Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 14 January 2016

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

Patients spoken with on the day and feedback from completed CQC comment cards told us that most patients found it easy to make an appointment with a named GP. However, some patients told us of difficulty in accessing routine appointments. Results from the 2015 national GP survey showed that patients responded positively in relation to satisfaction with how they could access care and treatment. However, patients experience of making an appointment and practice opening hours were below the CCG and national average. The practice had previously reviewed the appointment system in response to patient feedback and made changes although they had not reviewed the results of the most recent survey published in July 2015. However, the PPG had plans to review the most recent survey and undertake a practice survey to ensure findings were acted on.

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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 14 January 2016

The practice is rated as good for being well-led. It had a vision and strategy, staff were aware of the vision and their responsibilities in relation to this. There was clear leadership and staff felt supported by management. The practice had a number of policies and procedures to govern activity. There were systems in place to monitor and improve quality and identify risk. The practice had a patient participation group (PPG) and there was evidence from meeting minutes and discussion with PPG members that the PPG was trying to generate interest, promote itself and engage with patients. Staff had received inductions, appraisals and staff meetings took place.

Checks on specific services

Older people

Good

Updated 14 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice employed a pharmacist to undertake reviews for patients over the age of 75 years. This enabled patients to receive their annual health check including a review of their medication and an assessment of risk factors such as dementia screening and potential risk of emergency hospital admissions.

There were 196 patients, of these 51% had received a reviews.

People with long term conditions

Good

Updated 14 January 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice was an ‘Any qualified provider’ (AQP) for diabetes services. This enabled both patients registered at the practice and patients registered elsewhere to receive diabetes services usually undertaken in secondary care services at the practice.

Families, children and young people

Good

Updated 14 January 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. Rates for standard childhood immunisation were mostly above the CCG averages. 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 14 January 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. The practice offered online services and telephone consultations as well as a full range of health promotion and screening that reflected the needs of this age group.

The practice had increased access for working age patients by reserving extended hour opening for those patients who worked.

People whose circumstances may make them vulnerable

Good

Updated 14 January 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 and those with a learning disability. We saw that there were 16 patients on the learning disability register and the practice had carried out annual health checks for most of these patients with further reviews planned. It offered longer appointments for people with a learning disability.

The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. It had told 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 26 patients on the mental health register and the practice had carried out annual health checks for most of these patients with further reviews planned. The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. 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 (A&E) as a result of experiencing poor mental health.