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Inspection Summary


Overall summary & rating

Good

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trent Valley Surgery on 6 December 2016. Overall the practice is rated as good. The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection in June 2015. At a further inspection in March 2016, some improvements were found, following which the practice was rated as requires improvement overall but remained in special measures.

Following the most recent inspection we found that overall the practice was now rated as good and significant improvements had been made and specifically, the ratings for providing a safe service had improved from inadequate to good. The rating for providing a caring service had improved from good to outstanding.

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

  • The practice had made further significant improvements since our last inspection and the new staffing structure was working effectively.

  • The most recent results from the national GP patient survey published in July 2016 ranked the practice seventh in England.

  • Feedback we received from patients reflected positively about the staff and said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The new system which had been introduced at our previous inspection was now embedded and we saw that learning was disseminated and identified actions were implemented.
  • The practice had a number of policies and procedures to govern activity, all of which had been reviewed.
  • The practice had sought feedback from patients and the recently formed patient participation group was developing.
  • Risks to patients were assessed and well managed (with the exception of legionella).

  • 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.
  • Information about services and how to complain was available and easy to understand.
  • Patients expressed high satisfaction with the appointment system and said they found it easy to make an appointment with a named GP and that 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.
  • The leadership structure had strengthened further and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

  • To ensure that daily resets of vaccination fridges are recorded.
  • To review arrangements for mitigating the risk of legionella.

  • To formalise supervision arrangements relating to the nurse prescriber.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 January 2017

The practice is rated as good for providing safe services.

  • There was a comprehensive and 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.

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

  • Risks to patients who used services were assessed and well managed with the exception of legionella.

Effective

Good

Updated 12 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above the local and national average.

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

  • There was a comprehensive and extensive programme of clinical audits which demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • We saw evidence of appraisals for staff with identified development plans.

Caring

Outstanding

Updated 12 January 2017

The practice is rated as outstanding for providing caring services. Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care. In the most recent results the practice had been ranked seventh in England. For example:

  • 99% said the GP gave them enough time (CCG average 90%, national average 87%).

  • 100% said they had confidence and trust in the last GP they saw (CCG average 95%, national average 95%)

  • 100% said the last nurse they saw or spoke to was good at listening to them compared to the CCG average of 94% and national average of 91%.

  • 100% said the last nurse they saw or spoke to give them enough time compared to the CCG average of 95% and national average of 92%.

  • 100% said they found the receptionists at the practice helpful (CCG average 90%, national average 87%)

Feedback from patients about their care and treatment was consistently positive and we observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, a member of staff regularly helped two vulnerable patients with understanding their correspondence and contacted a local housing charity on their behalf to make sure their needs were being met.

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

  • 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.

  • Information for patients about the services available was easy to understand and accessible. The practice offered information in different formats in line with the Accessible Information Standard.

Responsive

Good

Updated 12 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with NHS England and the Clinical Commissioning Group to secure improvements to services where these were identified.

  • Patients said they 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.

Well-led

Good

Updated 12 January 2017

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

  • Since our inspection in March 2016 we found that the new management structure was now embedded and working effectively.
  • The practice had a vision to deliver high quality care and promote good outcomes for patients. All staff were clear and committed about their responsibilities in relation to this.
  • The practice had a number of policies and procedures to govern activity which had all been reviewed.
  • The practice sought feedback from patients and the newly formed patient participation group (PPG) was developing.
  • A schedule of regular staff meetings had been implemented with comprehensive minutes available.

Checks on specific services

Older people

Good

Updated 12 January 2017

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.

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

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with or above local or national averages.

  • The practice had a high percentage of older patients, notably aged between 65 and 75. The practice had looked at the needs of this patient group to look at further options to improve services for them.

People with long term conditions

Good

Updated 12 January 2017

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.

  • Performance for atrial fibrillation and chronic obstructive pulmonary disease indicators was better than the CCG and national average with the practice achieving 100 % of points in these areas. However performance for diabetes related indicators was lower than the CCG and national average with the practice achieving 86% of points in this area.

  • 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 12 January 2017

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. 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.

  • The practice’s uptake for the cervical screening programme in 2015-2016 was 82%. This was an improvement on the previous year and above the national average.

  • Appointments were available outside of school hours.

Working age people (including those recently retired and students)

Good

Updated 12 January 2017

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. They had trialled extended opening hours but the uptake had been limited.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 12 January 2017

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 offered longer appointments for patients with a learning disability.

  • 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.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 12 January 2017

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

  • Members of staff had undertaken ‘Dementia Friends’ training to enable them to better understand and support patients with dementia.

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

  • 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.