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Inspection Summary


Overall summary & rating

Good

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manston Surgery on 27 April 2016. We also visited the branch site in Scholes as part of our inspection. The overall rating for the practice was good. However; we rated the practice as requires improvement for providing safe care The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Manston Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the issues that we identified in our previous inspection on 27 April 2016. This report covers our findings in relation to those requirements.

The practice has now met the legal requirements in the key question of safe and is now rated as good.

Our key findings were as follows:

  • The practice had comprehensive Standard Operating Procedures in place to support the staff working within the dispensary at the Scholes branch site.

  • The practice had a Standard Operating Procedure to cover the management of controlled drugs.

  • There was a system in place to routinely check stock medicines were within expiry date and fit for use. This was supported by a Standard Operating Procedure to govern the activity.

  • The practice had implemented a system to record near misses (a record of errors that had been identified and corrected before medicines had left the dispensary).

  • The practice had a system in place to record and investigate incidents. We saw minutes of meetings where these had been discussed.

  • There was a system in place to manage medicines safety alerts.

  • The practice had a documented record of when checks were carried out on the oxygen and defibrillator.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 March 2017

This inspection was conducted to review issues that were found at the comprehensive inspection carried out on 27 April 2016. The issues at the previous inspection included:

  • Standard Operating Procedures (SOP’s) were in place which covered some basic aspects of the dispensing process; however these were limited in both scope and detail.

  • The practice dispensed a small number of controlled drugs but did not have an SOP covering the management of these.

  • Staff did not routinely check stock medicines were within expiry date and fit for use as recommended in current guidance, and there was no SOP to govern this activity.

  • Staff did not keep a ‘near-miss’ record (a record of errors that have been identified and corrected before medicines have left the dispensary), however we saw some basic details of dispensing errors had been recorded.

  • A high number of significant incidents involving medicines had been recorded. The practice had not acted to adequately investigate these incidents and staff we spoke with were unaware of the details because learning had not been effectively shared to prevent reoccurrence.

  • There was no robust procedure in place to manage medicines safety alerts.

  • The staff we spoke with told us that regular checks were carried out to ensure the oxygen and defibrillator had been carried out. However, saw there was no formal record documenting these checks.

At this inspection on 9 March 2017 we found:

  • The practice had detailed Standard Operating Procedures in place to support the staff working within the dispensary at the Scholes branch site.

  • The practice had a Standard Operating Procedure to cover the management of controlled drugs.

  • There was a system in place to routinely check stock medicines were within expiry date and fit for use. This was supported by a Standard Operating Procedure to govern the activity.

  • The practice had implemented a system to record near misses (a record of errors that had been identified and corrected before medicines had left the dispensary).

  • The practice had a system in place to record and investigate incidents. We saw minutes of meetings where these had been discussed.

  • There was a system in place to manage medicines safety alerts.

  • The practice had a documented record of when checks were carried out on the oxygen and defibrillator.

Effective

Good

Updated 14 September 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.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 September 2016

The practice is rated as good for providing caring services.

  • The practice had a patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion.
  • Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care.
  • Patients we spoke with and the majority of comments we received were positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment. However two of the comment cards also contained negative feedback regarding attitude of staff.
  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 14 September 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds South and East Clinical Commissioning Group (CCG) and other local practices to review the needs of their patient population.
  • National GP patient survey responses and the majority of comments made by patients said they found it easy to make an appointment.
  • All urgent care patients were seen on the same day as requested.
  • The practice provided extended hours from 8am until 11am on Saturday mornings. In addition the practice also provided services from 11am until 3pm during winter months.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff. Learning from complaints also shared with other stakeholders.
  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions such as cancer and people with dementia.
  • The practice participated in the ‘Avoiding Unplanned Admissions’ (AUA) scheme which helped reduce avoidable unplanned admissions for vulnerable patients who were at high risk of hospital admission.
  • The practice hosted a lifestyle trainer who attended on a weekly basis to provide patients with motivational support relating to smoking cessation, alcohol and exercise.
  • The practice was participating in the ‘Year of Care’ programme. This approach encouraged patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians.
  • Due to a higher than average elderly population at the branch site, the practice hand delivered medication as and when required.
  • The practice offered a number of services that could be provided in the homes of elderly housebound patients. These included home based phlebotomy and health care assistant health checks and long term conditions management by the practice nurse.
  • The practice participated in the winter pressures scheme and provided additional appointments from 11am until 3pm during the winter months.

  • Spirometry screening was available for all smokers with the aim of early diagnosis of COPD. COPD is a name for a collection of lung diseases which cause difficulty breathing.

The practice nurse ran a smoking cessation service for patients to access.

Well-led

Good

Updated 14 September 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 it.
  • 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 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 had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 14 September 2016

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

  • All these patients had a structured review to check that their health and medicines needs were being met. This review was undertaken on an annual basis or more often when required.
  • The practice nurses had lead roles in the management of long term conditions.
  • The practice worked closely with other services in the management of housebound patients who had complex long term conditions, to ensure they received the care and support they needed. For example; the community matron, heart failure and respiratory nurses.

  • The practice was participating in the ‘Year of Care’ programme. This approach encouraged patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians.
  • The practice offered spirometry screening for all smokers with the aim of early diagnosis of Chronic Obstructive Pulmonary Disease (COPD).
  • The practice were involved in the winter pressures scheme and reviewed all patients with a long term condition within three days, following non elective discharge from hospital.
  • 95% of patients with diabetes, on the register, had a record of a foot examination and risk classification; which was higher than the CCG average 88% and England average 88%.
  • 100% of patient with diabetes, on the register, had received an influenza immunisation in the preceding seven months; which was higher than the CCG average 96% and England average 94%.
  • 87% of patients diagnosed with asthma had received an asthma review in the last 12 months; which was higher than the CCG and England averages of 75%.

Families, children and young people

Good

Updated 14 September 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 accident and emergency (A&E) attendances.
  • Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours. All children who required an urgent appointment were seen on the same day as requested.
  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group.
  • The practice hosted on site midwifery clinics.
  • The practice had a dedicated GP specialising in paediatrics.
  • The practice had a GP with special interests in contraception (including implants).
  • There was dedicated health information in the waiting room for teenagers.
  • Cervical screening, sexual health and contraceptive services were provided at the practice.

100% of eligible patients had received cervical screening compared to the CCG average of 99% and national average of 98%.

Older people

Good

Updated 14 September 2016

  • The practice offered proactive, personalised care to meet the needs of the 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.
  • The practice was participating in a scheme which helped reduce avoidable unplanned admissions for vulnerable patients, at high risk of hospital admission. Dedicated GP led clinics were held to review these patients.
  • Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.
  • The practice conducted a full review of all nursing home patients as part of the extended nursing home scheme, ensuring effective working relationships with local residential and nursing homes.
  • The practice nurses and health care assistants worked with the district nursing team to provide influenza vaccinations for all eligible patients, including housebound and care home patients.
  • The practice offered home based phlebotomy and health care assistant checks for elderly housebound patients.

Working age people (including those recently retired and students)

Good

Updated 14 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of these patients 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 provided extended hours appointments from 8am to 11am on Saturday mornings. In addition the practice also provided services from 11am to 3pm during winter months.
  • Telephone consultations were available if appropriate for patients at work
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
  • The practice offered work related medical assessments.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 September 2016

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

  • The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team. Patients and/or their carers were given information on how to access various support groups and voluntary organisations, such as Carers Leeds.
  • The practice participated in the directed enhanced service for dementia which aimed at ensuring patients received timely diagnosis and access to appropriate treatment, care and support.
  • 96% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG and national averages 88%).
  • Staff could demonstrate they had a good understanding of how to support patients with mental health needs or dementia.

People whose circumstances may make them vulnerable

Good

Updated 14 September 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 with a learning disability.
  • Patients who had a learning disability had an annual review of their health needs and a health action plan in place.
  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
  • We saw information displayed in the practice about various local support groups and voluntary organisations, which patients could access as needed.
  • The practice carried out regular reviews of care home patients.
  • Carers information was available in the waiting room for patients or their carers to access.
  • The practice had applied to join the Leeds Safe Place Scheme which is aimed at providing support to adults with learning disabilities cope with any incident that takes place whilst they are out and about.