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Inspection Summary


Overall summary & rating

Good

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

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

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. For example, timely prevention of a disclosure of confidential information over the phone was shared with all staff to highlight the issue.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice had a policy of reviewing patients with long-term conditions every six months.

  • Feedback from patients about their care was consistently and strongly positive.

  • The practice worked with other local providers to share best practice.

  • 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.

We saw an area of outstanding practice:

  • The practice took pride in the communitarian aspects of their work which they considered very important. For example, the senior GP had been writing monthly articles for the parish magazine for over 20 years. There was a strong culture of empowering patients and putting them at the centre of decisions about their care and treatment. We saw this reflected in their relationships, behaviour, attitudes and written material such as letters and the articles written for the parish magazine.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 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

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 21 July 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients.

  • The practice had a strong ethos of learning, including using data about their practice to review the effectiveness of their care and treatment.

  • We saw evidence they were early adopters of good practice initiatives, which they piloted to ensure there were benefits to their patients.

  • They had a range of specialised diagnostic equipment which reduced the need to refer patients to specialists, speeded up the diagnostic process and enabled them to give more information to patients which empowered them in the discussion about the best treatment approach.

  • The practice had arranged an afternoon pickup of specimens going to the testing laboratory in order to improve their flexibility and speed up the diagnostic process.

  • The practice took pride in the communitarian aspects of their work which they considered very important. For example, they had a community defibrillator on the wall in their car park and had arranged community training sessions in basic life support and use of the defibrillator.

  • 100% of patients with diabetes on the register had an influenza immunisation in the preceding 12 months (04/2014 to 03/2015) compared to the national average of 94%.

  • The practice had received a Platinum award for their work on smoking cessation from the local authority.

  • They had joined a local fuel poverty referral pilot program run by the local authority and other partners. Patients identified as being at risk were referred to the organisation by the practice.

  • 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.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 21 July 2016

The practice is rated as good for providing caring services.

  • The practice had a strong and visible ethos of empowering patients to be active participants in the management of their care. This was visible in the behaviour and attitudes of staff as well as their written and verbal communication.

  • We observed a strong patient-centred culture.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for almost all aspects of care. For example, 96% of patients said the last GP they spoke to was good at treating them with care and concern compared to the national average of 85%.

  • Feedback from patients about their care and treatment was consistently and strongly positive.

  • We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

  • Views of external stakeholders were very positive and aligned with our findings.

Responsive

Good

Updated 21 July 2016

The practice is rated as good for providing responsive services.

  • Patients can access appointments and services in a way and at a time that suits them. The practice policy was to give patients a same day appointment if that was what they wanted.

  • The practice operated a system which any member of staff, including reception staff, could activate for patients with particularly acute needs to speed up the practice response times over and above their commitment to seeing patients on the same day if that's what they wanted.

  • Patients could book telephone consultations via the on-line booking system.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care.
  • 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 21 July 2016

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

  • 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 this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • 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 practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • There was a strong focus on continuous learning and improvement at all levels

Checks on specific services

People with long term conditions

Good

Updated 21 July 2016

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

  • The practice had a policy of reviewing patients with long-term conditions every six months.

  • 91% of patients on the register with diabetes had a record of a foot examination in the last 12 months (04/2014 to 03/2015), compared to a national average of 88%.

  • Longer appointments and home visits were available when needed.

  • All patients with long-term condition had a named GP and a structured six month 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 21 July 2016

The practice is rated as good for the care of families, children and young patients.

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • 86% of patients with asthma on the register had an asthma review in the preceding 12 months that included an assessment of asthma control, compared to the national average of 75%

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • 83% of women aged 25 to 64 had a cervical screening test in the preceding five years compared to the national average of 82%.

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

  • The local community midwife held a clinic at the practice every week.

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

Older people

Good

Updated 21 July 2016

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

  • They offered a delivery of weekly dosette medicine boxes for the most vulnerable patients. The boxes were delivered by practice staff which had the additional benefit of ensuring these patients were seen at least once a week.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

Working age people (including those recently retired and students)

Good

Updated 21 July 2016

The practice is rated as good for the care of working age patients (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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • Extended surgery hours were offered on Tuesday from 6.30pm to 7pm.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 July 2016

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

  • 100% of patients with a psychosis had a comprehensive agreed care plan documented in their record in the preceding 12 months (04/2014 to 03/2015), which was better than the national average of 88%.

  • 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was better than the national average of 84%.

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

  • The practice 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.

  • A counsellor attended the practice for up to four sessions a week.

  • 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.

  • They worked in partnership with other organisations to support patients with substance misuse problems.

People whose circumstances may make them vulnerable

Good

Updated 21 July 2016

The practice is rated as good for the care of patients who circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability. We were told they had a number of canal boat travellers registered at the practice.

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

  • The practice regularly worked with multi-disciplinary teams 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.