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Archived: Swingbridge Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swingbridge Surgery on 20 April 2016. Overall the practice is rated as good.

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

  • There was an effective system in place for reporting and recording significant events. Significant events, incidents and safety alerts were discussed at practice meetings and lessons learnt were shared.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. On review of the patient record system, we found three patients who were identified as a child in need however exceeded the age of 18.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • New guidelines were discussed at practice meetings and protocols and pathways were reviewed as appropriate. However, it was noted that minutes did not include who was responsible for completing actions and by when.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment and there was evidence of appraisals and personal development plans for all staff.

  • The practice had a training plan in place for all staff to ensure mandatory training was completed.

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

  • Patients said they were treated with care and respect and they had time within their appointments to consider options and decisions about their care and treatment.

  • We saw staff treated patients with kindness and maintained patient and information confidentiality.

  • The practice had changed their appointment system in response to patient feedback regarding access to routine appointments.

  • Patients said they sometimes found it difficult to make an appointment with a named GP, but were aware urgent appointments were available on the same day.

  • The practice had a clear vision to deliver good quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

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

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The partners encouraged a culture of openness and honesty.

The areas where the provider should make improvement are:

  • Safeguarding registers should be reviewed to ensure they are accurate and do not include persons that should no longer be on them.

  • Meetings should identify who is responsible for actions and the timescale for completion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Significant events, incidents and safety alerts were discussed at practice meetings and lessons learnt were shared.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. On review of the patient record system, we found three patients who were identified as a child in need however exceeded the age of 18.

  • The practice was visibly clean and had well embedded infection prevention and control procedures in place.

  • Risks to patients were assessed and well managed.

  • A comprehensive business continuity plan was in place and all staff were aware of it.

Effective

Good

Updated 19 July 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.

  • New guidelines were discussed at practice meetings and protocols and pathways were reviewed as appropriate. However, it was noted that minutes did not include who was responsible for completing actions and by when.

  • Clinical audits demonstrated quality improvement in patient services.

  • 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 practice had a training plan in place for all staff to ensure mandatory training was completed.

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

Caring

Good

Updated 19 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for several aspects of care.

  • Patients said they were treated with care and respect and they had time within their appointments to consider options and 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 maintained patient and information confidentiality.

Responsive

Good

Updated 19 July 2016

The practice is rated as good for providing responsive 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.

  • The practice had changed their appointment system in response to patient feedback regarding access to routine appointments.

  • Patients said they sometimes found it difficult to make an appointment with a named GP, but were aware urgent appointments were available on 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. Evidence showed the practice investigated and responded quickly to issues raised.

Well-led

Good

Updated 19 July 2016

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

  • The practice had a clear vision to deliver good quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

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

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

  • The practice proactively sought feedback from staff and patients, which it acted on.

  • The patient participation group was active and encouraged health promotion for all patients.

Checks on specific services

People with long term conditions

Good

Updated 19 July 2016

The practice is rated as good for the care of people with long-term conditions.

  • A long term conditions nurse / care coordinator was employed to lead on chronic disease management. Diabetic reviews included referrals on to other services, as appropriate.

  • The practice held INR clinics to aid in the delivery of warfarin management plans.

  • Patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was similar to the national average. For example, 77% of those diagnosed with diabetes had their blood sugar levels monitored in the previous 12 months compared to 78%.
  • 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.

Families, children and young people

Good

Updated 19 July 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.

  • The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 78% and the national average of 74%.

  • 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 employed a GP with a specialist interest in family planning.

  • Post natal checks were co-ordinated to be carried out at the same time as mother and baby attended for the first immunisation.

Older people

Good

Updated 19 July 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. This included personalised care plans.

  • The practice was responsive to the needs of older people; home visits, longer appointments and urgent appointments for those with enhanced needs.

  • Annual reviews, including medicine reviews, were completed by the GP for those patients residing in a residential or nursing home.
  • The practice took part in campaigns for flu, shingles and pneumonia, and offered house visits for the delivery of flu vaccinations for housebound patients.

Working age people (including those recently retired and students)

Good

Updated 19 July 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. This included same day emergency triage and GP telephone consultations.

  • The practice was proactive in offering online services, such as requesting repeat prescriptions and to book an appointment.

  • A full range of health promotion and screening was offered that reflected the needs for this age group. The practice also signposted patients to the citizens advice bureau, when appropriate.

  • A nurse led travel vaccination clinic was provided at the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 July 2016

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

  • 87% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

  • 90% of those with a diagnosis of schizophrenia, bipolar affective disorder or other had a comprehensive and agreed care plan in place, compared to the national average of 88%.

  • The practice had reviewed their records and worked with the clinical commissioning group to ensure all patients with a diagnosis of dementia had been identified.

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

  • The practice carried out dementia screening and where relevant referred patients to secondary care.

  • The practice worked in conjunction with the community mental health team and psychiatrist where it was relevant and mental health care plans were in place.

  • Newly diagnosed patients with a mental illness were seen at least fortnightly to monitor the effectiveness of their therapy.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 19 July 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, travellers and those with a learning disability. The practice had worked with the local council to ensure all patients with a learning disability had been identified.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice had a GP safeguarding lead and all staff were trained in safeguarding children and vulnerable adults.

  • A flexible appointment system was in place for vulnerable patients to reduce distress if attending the practice.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • 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.