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Inspection Summary


Overall summary & rating

Good

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Hill View Surgery on 24 November 2015. A breach of legal requirements was found, in that not all risks relating to infection control, significant events and medicines were effectively managed. Also, the practice had not undertaken an appropriate check with the Disclosure and Barring Service, prior to a clinical member of staff starting work.

Overall the practice was rated as good; in view of the above the practice was rated as requires improvement for providing safe services.

After the comprehensive inspection, the practice wrote to us to say what action they had, and were taking to meet the legal requirements in relation to the breach.

We undertook a desk based review on 17 August 2016 to check that the provider had completed the required actions, and now met the legal requirements. This report only covers our findings in relation to those requirements. We did not visit the practice as part of this review. 

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hill View Surgery on our website at www.cqc.org.uk.

This review found that the provider had taken appropriate action to meet the legal requirements.

  • The practice was rated as good for providing safe services.
  • The systems to assess and manage risks relating to infection control, significant events and medicines had been strengthened to ensure the services are safe. 

  • The Disclosure and Barring Service (DBS) and chaperone policy had been reviewed, to ensure the practice obtained appropriate checks for all staff

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 September 2016

The practice is rated as good for providing safe services.

  • The Disclosure and Barring Service (DBS) and chaperone policy had been reviewed, to ensure the practice obtained appropriate checks for all staff. The practice had obtained a DBS check for all staff in line with the policy.  

  • The systems to assess and manage risks relating to infection control, significant events and medicines had been strengthened to ensure the services are safe.
  • Learning from significant events had been embedded to prevent events from reoccurring. 

Effective

Good

Updated 18 February 2016

The practice is rated as good for providing effective services.

  • 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.

  • Clinical audits were undertaken. For example, recent action taken as a result of audit of high dose opiate prescribing led to an overall reduction in the volume of opiates being prescribed. (Opiates are pain killing medicines)

  • Data showed most patient outcomes were similar to the locality. For example,

  • The practice was aware of its performance and had identified areas for improvement. For example the practice demonstrated improvement in performance in respect of diabetes.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and special interests.

  • 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 people’s needs.

Caring

Good

Updated 18 February 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. For example, 90% of patients said the GP gave them enough time compared to the CCG average of 86% and the national average of 87%.

  • Patients told us they were treated with care and concern by staff and that their privacy and dignity was respected. Feedback from comments cards aligned with these views.

  • The practice provided information for patients which was accessible and easy to understand.

  • We observed that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 18 February 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example the practice had recently submitted proposals to NHS England in order to secure improved premises for its patients.

  • The practice offered flexible services to meet the needs of its patients. For example, the practice offered extended hours appointments until 8pm one evening per week.

  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders including the patient participation group (PPG).

  • All of the patients we spoke with said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.

Well-led

Good

Updated 18 February 2016

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

  • The practice had a vision to deliver high quality care. Staff were clear about the vision and their responsibilities in relation to this. The practice had a developed a five year plan which outlined its aims for the future.

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

  • The practice had a wide range of policies and procedures to govern activity and these were regularly reviewed and updated.

  • The partners and practice manager encouraged a culture of openness and honesty, and staff felt supported to raise issues and concerns.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was well established and met regularly. The PPG worked closely with the practice to review issues including appointment access and waiting times.

  • There was a focus on learning and development within the practice. The practice was a teaching practice and aimed to become an approved training practice.

Checks on specific services

People with long term conditions

Good

Updated 18 February 2016

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Care plans were in place for the patients identified as being at risk of admission.

  • The practice demonstrated that improvements had been made in respect of its management of diabetes. For example, the practice had already exceeded its performance for diabetes related indicators with over three months until the end of the reporting year.

  • 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 people 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 18 February 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.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • 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 86.7% which was comparable to the CCG and national average.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.

  • We saw good examples of joint working with midwives and health visitors.

  • A female GP provided a service to fit coils and contraceptive implants.

  • A monthly baby clinic was run from the practice where a GP, practice nurse and a member of the health visiting team was available.

Older people

Good

Updated 18 February 2016

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

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

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

  • The practice worked effectively with the multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met. The percentage of people aged 65 or over who received a seasonal flu vaccination was 72.1% which was in line with the national average of 73.2%.

Working age people (including those recently retired and students)

Good

Updated 18 February 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 access to telephone appointments.

  • The practice offered extended hours appointments one evening per week to meet the needs of this population group.

  • The practice was proactive in offering online services and all GP appointments were offered through the online booking system

  • Health promotion and screening was provided that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 February 2016

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

  • 82.5% of patients with a mental health condition had a comprehensive care plan documented in their records in the previous 12 months which was in line with the CCG average of 81%.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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 where they may have been experiencing poor mental health.

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

People whose circumstances may make them vulnerable

Good

Updated 18 February 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 those with a learning disability. The practice records indicated they had 13 patients on the learning disability register and all of these patients had received an annual review.

  • They offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice 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.