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Inspection Summary


Overall summary & rating

Good

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Maynard Court Surgery on 5 September 2017. Overall the practice is rated as good.

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

  • Significant events were fully investigated; if patients were involved they would receive support, honest explanations and apologies in line with the duty of candour. Learning was shared in clinical meetings, however there was no formal way of informing staff that were not at the meeting. Following inspection the practice implemented a system to ensure this was done.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Some of the clinical and non-clinical staff had not received updated infection control training. However, following inspection this training was arranged to occur within the week.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect.
  • Information about services and how to complain was available. Complaints were fully investigated.
  • Patients we spoke with 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 was restricted by the building they were based in however worked around this to provide appropriate facilities and services to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. It was evident that the practice complied with these requirements.
  • The practice had identified a low number of patients who were carers.

The areas where the provider should make improvement are:

  • Improve the identification of carers.
  • Improve the cascading of learning from significant events to relevant staff.
  • Review systems for ensuring staff complete updates on infection control training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 October 2017

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Incidents were fully investigated and learning disseminated through clinical meetings. Where staff were not present at a meeting there was no means to communicate learning to them, however following our inspection the practice set up mailing groups to ensure that minutes for all meetings would be sent to the relevant staff groups.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 2 October 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 average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits were completed and where quality improvement was not demonstrated, the practice was conducting a review and planning a future audit.
  • Some of the clinical and non-clinical staff had not received updated infection control training, however staff received other appropriate training. Following our inspection the practice sent us an action plan with addressed the lack of infection control training.
  • 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.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 2 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect. Scores were lower regarding patients’ involvement in their care and treatment, however the practice had taken action to improve this.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with compassion and respect, and maintained patient and information confidentiality.
  • Patient told us that staff were caring.
  • The practice had identified 34 patients as carers (0.9% of the patient population).

Responsive

Good

Updated 2 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile, and had identified that the majority of their patients were older people. They had used this understanding to meet the needs of its population by providing services such as 24 hr hour monitoring, spirometry and hosting a phlebotomist.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with 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.
  • We found that the practice tried to be flexible with patients and for the most vulnerable patients offered the ability to slot into cancellations, sit and wait, options to be seen at the beginning or end of surgery.
  • We were given several examples by patients of where the practice had proactively monitored their condition by ringing them or by completing opportunistic checks and vaccinations to avoid the patient having to return for another appointment.
  • The practice was restricted by the building they were based in however worked around this to provide appropriate facilities and services to treat patients and meet their needs.
  • Information about how to complain was available and evidence from four examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 2 October 2017

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 policies and procedures to govern activity.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews, attended staff meetings, and training opportunities. Although monitoring of essential training updates required closer review.
  • The provider was aware of the requirements of the duty of candour. We saw evidence throughout the day that the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice patient participation group (PPG) had not been operational for a period but the practice was attempting to revive interest in this. There were some core members of the PPG still engaged who gave us examples of how the practice responded to feedback.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

People with long term conditions

Good

Updated 2 October 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Nationally reported data showed that outcomes for patients for long-term conditions were in line with other practices within the Clinical Commissioning Group (CCG) and nationally. For example, numbers of patients with diabetes receiving appropriate reviews were in line with the CCG and national average for the majority of indicators.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for 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 2 October 2017

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

  • We found there were systems to identify, monitor and follow up children living in disadvantaged circumstances and/or who were at risk.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Children’s’ asthma reviews were scheduled either in school holidays or outside of school hours.
  • A room was available which parents could use to change nappies or for mothers to breast-feed, should they prefer to do this in private.

  • Clinical staff had an understanding of Gillick competence and Fraser guidelines.
  • The practice worked with midwives, health visitors to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics. The practice had emergency processes for acutely ill children and young people.

Older people

Good

Updated 2 October 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • 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.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice discussed how their needs could be met holistically with local health and social care services.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, advice on healthy eating.

Working age people (including those recently retired and students)

Good

Updated 2 October 2017

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

  • The needs of this population had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible, for example, extended opening hours on two days.
  • The practice offered as a full range of health promotion and screening that reflected the needs for this age group. These included, well woman and well man checks.
  • Nationally reported data showed that outcomes for patients for uptake of cervical smears were in line with other practices within the Clinical Commissioning Group (CCG) and nationally.
  • The practice offered the electronic prescription service. This service allows patients to choose or ‘nominate’ a pharmacy to get their medicines from; the GP then sends the prescription electronically to the nominated place.
  • The practice offered a range of online services such as online booking and repeat prescription ordering.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 October 2017

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

  • 79% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which was in line with the CCG and national average.
  • 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan in their notes, which was higher than the CCG and national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to support patient that may be in crisis with their mental health.
  • Staff interviewed had an understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 2 October 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.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered urgent appointments for those patients who needed them.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.
  • The practice offered longer appointments for patients with a learning disability.