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Inspection Summary


Overall summary & rating

Good

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection at this practice on 28 September 2016 and found breaches of regulation and rated the practice as ‘Requires improvement’ in the safe and well-led key question. The practice was rated as ‘Requires improvement’ overall. The full comprehensive report on the 29 September inspection can be found by selecting the ‘all reports’ link for The Uppingham Surgery on our website at www.cqc.org.uk.

Specifically we found that;

  • The practice did not have a clear or consistent system for reporting, recording and monitoring significant events, incidents and accidents.

  • The systems and process to address the risks associated with fire and legionella were not implemented well enough to help ensure people were kept safe.

  • There was no clear process in place to alert health care professionals that patients were being prescribed disease modifying drugs in secondary care.

  • The provider had not have systems in place to ensure that staff were properly recruited.

  • The practice had a governance framework in place which supported the delivery of the strategy and quality care. However, we found the systems and processes in place with regard to significant events, monitoring of risk and staff recruitment were not effective

This inspection was an announced focused inspection carried out on 9 May 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 in our previous inspection on 29 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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The practice is now rated as ‘Good’ in the safe and well-led key questions and ‘Good’ overall.

Our key findings were as follows:

  • There were systems for recording, monitoring, acting, reviewing and learning from significant events.

  • There were systems to assess and monitor the potential risk from fire and legionella.

  • Systems had been improved to help ensure that patient notes were summarised in a timely manner.

  • There was a clear process in place for the management of disease modifying drugs prescribed for patients in secondary care.

  • Staff were recruited only after the necessary checks had been made.

In addition we found that:

  • Blank prescription pads were managed in line with national guidance.

  • Random spot checking of the cleaning efficacy at all four surgeries had been introduced.

  • Meeting agenda across all staff groups were formalised and discussions recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2017

At our previous inspection on 29 September 2016 we found that:

  • The practice did not have a clear or consistent system for reporting, recording and monitoring significant events, incidents and accidents.

  • The systems and process to address the risks associated with fire and legionella were not implemented well enough to help ensure people were kept safe.

  • There was no clear process in place to alert health care professionals that patients were being prescribed disease modifying drugs in secondary care.

  • There was no spot checking of cleaning to ensure its efficacy.

  • Not all staff had been subject to the appropriate checks prior to being recruited to work at the practice.

At our inspection on 9 May 2017 we found that:

  • There was effective and consistent reporting, recording and monitoring significant events, incidents and accidents.

  • People were protected from the risks associated with fire and legionella were effective.

  • Medicines prescribed by secondary care were managed in a manner that protected patients.

  • Spot checks were carried out to ensure the efficacy of the cleaning of the buildings.

Effective

Good

Updated 6 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average 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.

  • The medicines management lead GP conducted regular medicines searches and audited aspects of prescribing, to ensure prescribing was in line with best practice guidelines.

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

Caring

Good

Updated 6 December 2016

The practice is rated as good for providing caring services.

  • Results from the July 2016 national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was comparable or above average for its satisfaction scores on consultations with GPs and nurses. For example:

  • 97% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%)

  • 91% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 90% and the national average of 91%).

  • Comments cards we reviewed told us 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.

  • The practice’s computer system alerted GPs if a patient was also a carer.  The practice had identified 179 patients as carers (1.6% of the practice list).

Responsive

Good

Updated 6 December 2016

The practice is rated as good for providing responsive services.

  • The practice worked with the local CCG to plan services and to improve outcomes for patients in the area. Services were planned and delivered to take into account the needs of different patient groups and to help provide flexibility, choice and continuity of care. For example, the practice now used the GP triage model which meant that all patients who contact the surgery for an appointment were triaged by their own GP if the call was before 12 midday or by the duty doctor until 6pm.

  • Comments cards we reviewed told us that patients said 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 evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 23 June 2017

At our previous inspection on 29 September 2016 we found that:

  • The practice had a governance framework in place which supported the delivery of the strategy and quality care. However, we found the systems and processes in place with regard to significant events, monitoring of risk and staff recruitment were not effective.

At our inspection on 9 May 2017 we found that:

  • Policies and protocols had been reviewed and updated where appropriate.

  • There was an effective system that supported the safe recruitment of staff.

  • Updated risk assessments and policies had been implemented in respect of fire safety and legionella.

  • An effective system of significant event recording, analysis, learning and review was in place.

Checks on specific services

People with long term conditions

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • 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.

  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was150/90 mmHg or less was 95.5% which was 4.9% higher than the CCG average and 4.2% higher than the national average. Exception reporting was 3% which was 2.9% lower than the CCG average and 2.5% lower than the national average.

  • The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that includes an assessment of asthma was 77.3% which was 3.7% higher than the CCG average and 1.7% higher than the national average. Exception reporting was 4.1% which was 7.8% lower than the CCG average and 3.8% lower than the national average.

  • The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) was 150/90 mmHg or less was 88.5% which was 5.7% higher than the CCG average and 5.6% higher than the national average. Exception reporting was 2.7% which was 1.4% lower than the CCG average and 1.2% lower than the national average.

  • The percentage of patients with COPD who had had a review, undertaken by a healthcare professional was 94% which was 6.4% above the CCG average and 4.4% the national average. Exception reporting was 2.4% which was 12.5% lower than the CCG average and 9.1% lower than national average.

  • Patients had a named GP and the practice had a system in place for recalling patients for a structure 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.

Families, children and young people

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • 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.

  • 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.

  • The practice’s uptake for the cervical screening programme was 86% which was higher than the CCG average of 78% and the national average of 74%.

  • Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • The Practice had 700 boarding school pupils of Uppingham School as patients. They provided specific clinics and access to this group of young people.

Older people

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • 6% of patients registered with the practice were over 80 years of age and 1.1% over 90 years of age.

  • The practice offered proactive, personalised care to meet the needs of 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.

  • 2.7% of patients who had been assessed as being at risk which was higher than the required national average of 2%.

  • The practice had a programme of risk-stratified proactive care planning, with designated doctors for each of the five care homes where patients registered with the practice lived.

Working age people (including those recently retired and students)

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this patient group.

  • 95% of patients who responded to the national GP survey said the last appointment they got was convenient. This was higher the CCG average of 92% and national average of 92%.

  • 78% of patients who responded to the national GP survey feel they don’t normally have to wait too long to be seen. This was higher than the CCG average of 59% and national average of 58%.

  • The practice encouraged patients to attend national screening programmes for bowel and breast cancer screening. The practice had an uptake of 68% of those eligible for bowel screening which was higher than the CCG average of 64% and national average of 58%.

  • The practice had an uptake of 83% of those eligible for breast screening which was the same as the CCG average but higher than the national average of 72%.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice offered guided self-referral to for common mental health problems. The practice had a mental health coordinator who reviewed patients through a recall system.

  • Healthcare professionals specialising in drug and alcohol misuse visited the practice to see patients.

  • They provided advice packs for patients diagnosed with dementia and offered support through the dementia advisor for those going through the diagnostic pathway. Practice staff had undergone Dementia Friends training.

  • 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 83% and national average of 84%.

  • The practice held a ‘Memory Matters’ dementia event in August 2015 which provided advice for people with dementia, carer support and screening memory assessments; it resulted in three new diagnoses and referrals.

  • The practice had been recognised for the work they had done and had received a Dementia Champions award.

  • 90% of patients who had been diagnosed with depression had their care reviewed in the last year.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 23 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 29 September 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • The practice offered 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 looked after a specialist residential home for people with Prader-Willi Syndrome. For this vulnerable group and their carers the practice provide designated sessions in a safe familiar environment of a branch surgery, as well as a GP annual review at their residence.

  • 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 and the documentation of safeguarding concerns.