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Inspection Summary


Overall summary & rating

Good

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Second Street Surgery on 15 September 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
  • Feedback from patients about their care was consistently positive and results of the National GP Patient Survey in relation to this were higher than local and national averages. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was comparable with local clinical commissioning group and national averages.
  • Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
  • The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
  • The practice had proactively sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
  • The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was higher than local and national averages.
  • Information about services and how to complain was available and easy to understand.
  • The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

We saw some areas of outstanding practice:

  • The practice participated in a telephone support service scheme to ensure vulnerable and other relevant patients were able to access regular support to help them make positive changes in their lives. This was a voluntary service created as part of an informal arrangement with three other practices in the area and with financial support from a local charity and enabled patients referred to the service to receive weekly telephone or skype calls for up to 12 weeks to offer support on issues such as isolation and loneliness

  • The practice had identified a member of staff as a primary care navigator to ensure there was a holistic approach to ensuring a patient’s medical and social needs were met and patients discharged from hospital were well supported. This included ensuring relevant patients were signposted to appropriate support services such as a befriending service, or practice telephone support service.
  • The practice identified carers and ensured they were offered an annual health check and influenza vaccination and signposted to appropriate advice and support services. The practice had worked with a local carer’s charity to aid the identification of their young carers. They were able to demonstrate that they were the highest Carer Pathway referrer in the Gateshead area for the period April 2015 to September 2015.

However, there were also areas where the provider should make improvements. Importantly, the provider should:

  • Continue to promote and seek membership for a patient participation group.
  • Regularly review the length of time patients wait to be called in for their appointments
  • Ensure the cord mechanisms on vertical blinds in communal and clinical areas are tethered to prevent the risk of accidental choking for young children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 November 2016

The practice is rated as good for providing safe services.

Nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. Risks to patients were assessed and well managed.

Lessons were shared to make sure action was taken to improve safety in the practice. When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, and verbal or written apologies.

The practice was clean and hygienic and good infection control arrangements were in place. However, the practice should ensure the cord mechanisms on vertical blinds in communal and clinical areas are tethered to prevent the risk of accidental choking for young children.

The arrangements for managing medicines, including emergency drugs and vaccinations, in the practice kept patients safe.

Comprehensive staff recruitment and induction policies were in operation and staff had received Disclosure and Barring Service (DBS) checks where appropriate. Chaperones were available if required and staff who acted as chaperones had undertaken appropriate training.

Effective

Good

Updated 3 November 2016

The practice is rated as good for providing effective services.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. Arrangements had been made to support clinicians with their continuing professional development. There were systems in place to support multi-disciplinary working with other health and social care professionals in the local area. Staff had access to the information and equipment they needed to deliver effective care and treatment and had received training appropriate to their roles.

Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with local clinical commissioning group (CCG) and national averages. The practice used the QOF as one method of monitoring effectiveness and were able to demonstrate that they had achieved 98.9% of the points available to them for 2015/16 (results not yet published). The last published results, which related to 2014/15 indicated that the practice had obtained 98.2% of the point’s available (local CCG average 95.5% and national average 94.7%).

Achievement rates for cervical screening, influenza vaccination and the majority of childhood vaccinations were mixed but generally lower than local and national averages. For example, at 78%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was below the CCG average of 81% and national average of 82%. Childhood immunisation rates for the vaccinations given to two year olds ranged from 16.7% to 100% (compared with the CCG range of 64.7% to 93.5%). For five year olds this ranged from 57.1% to 85.7% (compared to CCG range of 90.1% to 97.3%).

There was evidence of clinical audit activity and improvements made to patient care and patient outcomes as a result of this.

Staff received annual appraisals and were given the opportunity to undertake both mandatory and non-mandatory training.

Caring

Good

Updated 3 November 2016

The practice is rated as good for providing caring services.

Patients we spoke with during the inspection and those that completed Care Quality Commission comments cards said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about the service was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Results from the National GP Patient Survey published in July 2016 were better than, or comparable with local CCG and national averages in respect of providing caring services. For example, 100% of patients who responded to the survey said the last GP they saw or spoke to was good at listening to them (CCG average 91% and national average 89%) and 92% said the last nurse they saw or spoke to was good at listening to them (CCG average 93% and national average was 91%).

Results also indicated that 99% of respondents felt the last GP they saw or spoke with treated them with care and concern (CCG average 88% and national average of 85%). 96% of patients felt the nurses treat them with care and concern (CCG average 93% and national average 91%).

The practice identified carers and ensured they were offered an annual flu vaccination and signposted to appropriate advice and support services. At the time of our inspection they had identified 57 of their patients as being a carer (approximately 1.9% of the practice patient population). The practice were able to demonstrate that they were the highest Carer Pathway referrer in the Gateshead area for the period April 2015 to September 2015.

Responsive

Good

Updated 3 November 2016

The practice is rated as good for providing responsive services.

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 that the practice responded quickly to issues raised and identified themes arising from them.

The practice’s performance in relation to access in the National GP Patient Survey were comparable with local and national averages. For example, the most recent results (July 2016) showed that 94% of patients found it easy to get through to the surgery by phone (CCG average 79%, national average 73%) and 87% were able to get an appointment (CCG average 85% and national average 85%).

The practice was able to demonstrate that they continually monitored the needs of their patients and responded appropriately. The practice had become involved in a number of initiatives to improve services.

The practice implemented suggestions for improvements and made changes to the way they delivered services as a consequence of feedback from patients. For example, they had recruited a health care assistant and an additional receptionist and created more book on the day appointments in response to patient feedback. However, the practice did not have a patient participation group.

The practice were committed to either trying to secure new premises or extend and improve their current premises which were felt to be too small to offer a full range of services.

Well-led

Good

Updated 3 November 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 practice had a comprehensive three year business plan which documented priorities such as succession planning, staff recruitment, premises and patient demographics.

The provider was aware of and complied with the requirements of the Duty of Candour regulation. The GP and practice manager 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.

The practice sought feedback from staff and patients, which it acted on. They did not have an 'actual'  patient participation group but did have a 'virtual' group consisting of four patients whose opinion was sought by letter and email.

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

Checks on specific services

People with long term conditions

Good

Updated 3 November 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review and the practice had commissioned an external provider to ensure that the recall system for long term conditions was efficient and robust. Patients with multiple long term conditions were offered an annual comorbidity (multiple condition) review when possible in their birthday month. These reviews were conducted as a home visit when required to ensure the same quality of care for housebound patients.

The QOF data for 2015/16 provided by the practice showed that they had achieved good outcomes in relation to the conditions commonly associated with this population group. For example:

  • The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma.
  • The practice had obtained 100% of the points available to them in respect of hypertension.

Care plans were in place for patients most at risk of deteriorating health. Patients with certain long term conditions such as asthma and chronic obstructive pulmonary were issues with rescue packs to prevent an exacerbation of their condition.

Families, children and young people

Good

Updated 3 November 2016

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

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

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

Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 16.7% to 100% (compared with the CCG range of 64.7% to 93.5%). For five year olds this ranged from 57.1% to 85.7% (compared to CCG range of 90.1% to 97.3%)

At 78%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was lower than the CCG average of 81% and national average of 82%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice.

The practice had appointed a Young People’s Champion who had been involved in designing a young patients section of the practice website and a young people’s practice information leaflet.

Older people

Good

Updated 3 November 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 provided by the practice (the data had not yet been published) showed the practice had achieved good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients experiencing heart failure, stroke and transient ischaemic attack and for secondary prevention of coronary heart disease.

The practice health care assistant had the dual role of being the practice primary care navigator. This role involved a holistic approach to ensuring a patient’s medical and social needs were referred or signposted to appropriate support services such as a befriending service, or practice telephone support service. The role also involved ensuring that patients discharged from hospital received a telephone call within three days of discharge to ensure that they were receiving appropriate post discharge support.

The telephone support service is a voluntary service created as part of an informal arrangement with three other practices in the area and with financial support from a local charity. This enables patients referred to the service to receive weekly telephone or Skype calls for up to 12 weeks to offer support on issues such as isolation and loneliness.

Working age people (including those recently retired and students)

Good

Updated 3 November 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 met. The surgery was open from 9am to 5.30pm and 6.30pm to 7.45om on a Monday; 9am to 5.30pm on a Tuesday, Wednesday and Friday and 9am to 12 midday on a Thursday. Appointment availability with a GP was generally available from 9.30am to 12.15pm then from 3pm to 5.30pm. However, a GP was always on site between 8am and 9.30am and 12.15pm to 3pm and on Thursday afternoons to deal with urgent appointment, advice and home visit requests. Patients registered with the practice were also able to access pre bookable appointments with a GP at one of three local health centres from 8am and 8pm on a weekday and 9am to 2pm on a weekend.

The practice offered sexual health and contraception services, travel advice, childhood immunisation service, minor surgery, antenatal services, smoking cessation advice and long term condition reviews. They also offered new patient and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available which was used to remind patients of their appointments. Pre-bookable telephone consultations were available on request.

From the end of September 2016 the practice were introducing a 24 hour per day/seven day per week service called patient partner which would enable patients to book, cancel and rearrange appointments using an automated telephone service.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 November 2016

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

QOF data for 2015/16 provided by the practice showed that they had achieved the maximum score available for caring for patients with dementia, depression and mental health conditions:

Patients experiencing poor mental health were invited for an annual review with the health care assistant and GP which covered health surveillance, preventative advice and social prescribing. Patients were also signposted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

The practice manager acted as the practice mental health champion and had previous experience of working with and supporting patients with mental health issues. The practice nurse acted as the dementia champion for the practice and ensured that support and advice was available for patients with dementia and their family and carers.

People whose circumstances may make them vulnerable

Good

Updated 3 November 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including 9 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination. The practice were the highest carer pathway referrer in the Gateshead area for the period April 2015 to September 2015.

Vulnerable patients, including those experiencing bereavement, homeless patients and veterans, were able to access support through the practice telephone support service.