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Inspection Summary


Overall summary & rating

Good

Updated 18 December 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Fronks Road Surgery on 03 November 2015. The practice was rated as inadequate overall. Specifically they were rated as good for caring services, and inadequate for safe, effective, responsive, and well-led services. As a result, we took enforcement action against the provider and issued them with warning notices to comply by 11 March 2016. These warning notices required the provider to make improvements. As the practice was rated inadequate, overall they were placed in special measures for a period of six months.

The practice told us at the beginning of March 2016 they had completed all the work in their action plan, and addressed all the failings set out in the warning notices. We agreed to bring forward the comprehensive follow-up inspection of the practice. This inspection took place on 10 May 2016, and the practice was rated as requires improvement overall. Specifically they were rated good for safe services, and requires improvement for effective, caring, responsive, and well-led services.

We carried out this announced follow-up comprehensive inspection at Fronks Road Surgery on 31 October 2017. Overall, the practice is rated as good.

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

  • The practice had made improvements across all areas identified at our last inspection.
  • Staff members knew how to raise concerns, and report safety incidents.
  • Safety information was appropriately recorded and learning was identified and shared with all staff during practice meetings.
  • The infection control policy met national guidance.
  • Risks to patients and staff were assessed, documented and acted on appropriately.
  • The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
  • Staff assessed patient care in line with current evidence based guidance.
  • The practice had an effective system to act on and review patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
  • Staff showed they had the skills, knowledge, and experience to deliver responsive, effective care and treatment.
  • There were seven clinical audits undertaken and we saw two completed audit cycles enabling improvements to be measured.
  • The system to monitor patients repeat prescriptions was effective.
  • Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
  • Information about the practice services and how to complain was available in leaflet form in the waiting room, in an easy to understand format.
  • The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
  • The facilities and equipment was appropriate to treat and meet patient’s needs.
  • Staff felt supported by the practice manager and clinicians this included their access and support for training. However, succession planning, or to federate and work collaboratively with other practices was not seen.

The areas where the provider should make improvement are:

  • Continue to monitor patient satisfaction to identify areas for improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 December 2017

The practice is rated as good for providing safe services.

  • Staff members knew how to raise concerns, and report safety incidents. These had been reviewed analysed, and monitored to avoid re-occurrences.
  • We saw when things went wrong patients received, reasonable support, truthful information, and a written apology when appropriate.
  • Safety information was recorded appropriately, and when lessons learned, were shared with all staff members.
  • Medicines were stored securely and appropriately in the practice dispensary for safe dispensing and patient use.
  • The practice system to act on patient safety and medicine alerts was effective.
  • The infection control policy met current national and local guidance, with audits to monitor effectiveness.
  • Risks to patients and staff members were assessed, documented, and acted on appropriately.
  • The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
  • The business continuity plan to manage major incidents was effective and accessible to all staff members.

Effective

Good

Updated 18 December 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were lower than other local and national practices. However, data showed improvement from the previous year in all clinical areas.
  • Staff assessed patients’ treatment and care needs and delivered care in line with current evidence based guidance.
  • Seven clinical audits at the practice had been carried out to improve service quality. Two audits were completed audit cycles showing improvement had been achieved.
  • Staff had the skills, knowledge and experience to deliver responsive, effective, care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to meet the range and complexity of patients’ needs in multi-disciplinary meetings.

Caring

Good

Updated 18 December 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice comparably with local and national practices.
  • Patients said they were treated with compassion, dignity and respect.
  • Patients also said they were involved in decisions about their care and treatment.
  • Information for patients about practice services was easy to understand. This information was available at reception.
  • We saw staff treated patients with kindness and respect, and maintained patient information confidentiality at all times.
  • The practice recognised patients who were carers on their computer records. This was to ensure consideration could be given to the needs of patients that were carers. The number of carer’s identified was 305, this equated to 6% of the practice population.

Responsive

Good

Updated 18 December 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local, practice population. They communicated with the local NHS England Area Team and the local Clinical Commissioning Group (CCG) to secure improvements to services where they were identified.
  • Patients told us they could get an urgent appointment to see a GP when they needed one.
  • The practice had satisfactory facilities and equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand. Evidence seen showed the practice appropriately, and in a timely manner to issues raised.
  • Learning from complaints and incidents were shared with all staff.
  • Patient satisfaction results published in the July 2017 national GP patient survey reflected that patient satisfaction was comparable with other local and national practices.

Well-led

Good

Updated 18 December 2017

The practice is rated good for being well-led.

  • The practice had a clear philosophy to deliver quality care and provide good outcomes for patients.
  • The staff told us they felt well supported by the practice manager and could talk to the GPs for support.
  • There was an overarching governance framework, with updated policies and procedures to support practice strategy and quality of care. This included arrangements to monitor and improve quality and identify any risk.
  • The practice was aware of and complied with the requirements of the duty of candour. This was seen in their management of complaints and safety incidents.
  • The practice manager and GPs encouraged a culture of openness and honesty.
  • The practice acted on feedback from staff members, and patients.
  • They focussed on continuous learning and we saw improvement in the practice at all levels.
  • We found the practice had acted on previous concerns found during inspections to improve their service.
  • Staff felt supported by the practice manager and clinicians this included their access and support for training. However, succession planning, or to federate and work collaboratively with other practices was not seen.
Checks on specific services

People with long term conditions

Good

Updated 18 December 2017

The practice is rated as good for this population group.

The practice had twice the national average of people with long-term conditions (LTC). Services provided by the practice for this population group were:

  • Nursing team staff and GPs held lead roles, and had received extra training in chronic disease management.
  • Those people with LTC had a named GP and a structured annual review to check that their needs were met.
  • Diabetes specialist nurse clinic checks and patients care was monitored.
  • Chronic obstructive pulmonary disease (COPD) specialist nurse clinic monitoring.
  • Asthma specialist nurse clinic checks and patients care was monitored.
  • Chronic kidney disease, hypertension, hypercholesterolemia and chronic heart disease were monitored by the GPs during clinic checks.
  • Double appointments or home visits available when needed.
  • Clinicians liaise with the community specialist LTC teams to provide optimal care.
  • Flu vaccinations and annual health care checks were provided.

Families, children and young people

Good

Updated 18 December 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

  • Family planning, including the insertion and removal of implants.
  • Child and baby immunisation clinics.
  • Baby health surveillance checks.
  • Travel immunisation.
  • Cervical screening.
  • Midwife Clinic at the practice.
  • Appointments offered outside of school times for convenience.
  • Premises has adaptations for children and babies.
  • Automatic on the day appointments were available for all babies and children.
  • Email access to request repeat prescriptions.
  • Staff knew how to raise concerns to the safeguarding lead.
  • The practice system to follow-up living in disadvantaged circumstances or those at risk ensured regular review by the GP safeguarding lead.
  • Reception staff support young families by telephoning the day before immunisation appointments to reduce them being missed, or escalate concerns if needed.

Older people

Good

Updated 18 December 2017

The practice is rated as good for this population group.

The practice offered personalised care to meet the needs of older people within its population, services included:

  • Senior health and wellbeing checks.
  • Flu vaccination.
  • All older people had a named GP.
  • Good communication with community nursing teams, including regular meetings, ensured frail and housebound patients were regularly checked.
  • Routine monitoring during home visits provided if a patient had not been seen at the practice or those at the end of life.
  • The practice offered home visits and urgent appointments to those that needed them.
  • Palliative care meetings took place bi-monthly. Patients at risk of deteriorating health were discussed and care plans updated within the multidisciplinary team setting.
  • Staff were sensitive that older people may have additional needs when accessing the practice.
  • Longer appointments offered at patient’s convenience or relatives to transport, or bus times.
  • There was a good uptake for shingles and flu vaccinations due to pro-active practice campaigning.
  • Appointments were offered in ground floor rooms where the patient had restricted mobility and an alert was added to the patient record in this regard.
  • Patients added to ‘my care choices register’ if appropriate to ensure those at the end of life had their wishes respected.

Working age people (including those recently retired and students)

Good

Updated 18 December 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

  • Email access to request repeat prescriptions.
  • A full range of health promotion and screening that reflects the needs of this age group.
  • Availability of health and wellbeing checks.
  • Smoking cessation, weight management and medical checks for insurance and work purposes were available for workers.
  • GP appointments were offered as late as possible to facilitate patient access. Similarly early morning appointments were offered at 8am if needed for this population group.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 December 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

  • ‘On the day’ appointments were provided for people experiencing acute mental health issues.

  • Double appointments were offered to support patients with complex needs, or a telephone appointment to provide reassurance and follow-up in a familiar home setting.

  • Work with multi-disciplinary teams supported patients experiencing poor mental health, and included those with dementia.

  • Staff were trained to safeguard adults and children from abuse.

  • Staff were familiar with the details of the Mental Capacity Act.

  • The staff had received guidance to direct patients that needed mental health support appropriately.

  • Information in the waiting room told patients experiencing poor mental health how to access support groups and voluntary organisations.

  • There was a system to check and follow up on patients that had attended accident and emergency who experienced poor mental.

  • Due to the long wait for assessments in secondary care, the practice offered appointments to enable patients mental health can be monitored at the practice.

  • When necessary arrangements were made with secondary care for assessments to be carried out at the surgery to support the patient.

  • The practice also helped to arrange appointments, transport, and attendance at secondary care appointments for this patient population group.

People whose circumstances may make them vulnerable

Good

Updated 18 December 2017

The practice is rated as good for this population group.

Services provided by the practice for this population group were:

  • Recognition of patients living in vulnerable circumstances included the homeless, travellers, and those with a learning disability.
  • Access to double appointments for patients with a learning disability.
  • Case management of vulnerable patients with other health care professionals for treatment planning.
  • Information for vulnerable patients about access to support and voluntary organisations.
  • Staff were trained to recognise signs of abuse and manage safeguarding concerns.
  • Safeguarding procedures at the practice and the policy met current legislation.
  • The GP safeguarding lead at the practice attended forums when possible.
  • Vulnerable people, where suitable, had alerts attached to their records to allow staff members to act appropriately when dealing with them.
  • Extra care was taken by staff to co-ordinate care for vulnerable patients to support them access services.
  • Co-ordination with community matrons and/or family members regarding consent with a letter of authority gained, ensured staff knew who the patient agreed they could talk to regarding co-ordinating their care.

  • Communication with other agencies where appropriate, to ensure patients had their wishes added to ‘my care choices register’ if appropriate.