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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sloan Practice, which is one of the four Extended Access Hub sites across Sheffield, on 23 October 2017. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting, recording and actioning significant events. However, it was not evident how lessons learned from significant events were disseminated and shared with staff working across the Hub sites.

  • The service had clearly defined and embedded systems to minimise risks to patient safety.

  • 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.

  • CQC comment cards and the NHS friends and family survey data showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

  • Patients we spoke with were very satisfied with the availability and timeliness of their appointments.

  • Improvements were made to the quality of care as a result of complaints and concerns.

  • The premises had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The service sought feedback from patients, which it acted on.

We saw one area of outstanding practice:

  • The service offered physiotherapy appointments. Patients could book directly into these appointments via their own GP practice. Provider data between July and September 2017 showed that 90% of patients seen with joint pain had required only one appointment for self management advice. The physiotherapist could refer patients directly through the local musculoskeletal pathway if appropriate.

The areas where the provider should make improvement are:

  • Review how learning and development from significant events and complaints could be fedback and shared to staff working across the four Hub sites.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 2017

The practice is rated as good for providing safe services.

• From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events and action was taken to improve safety in the service. However, it was not evident how lessons learned from significant events were disseminated and shared with staff.

• The service manager told us that if things went wrong with care and treatment, patients would be informed of the incident, receive reasonable support, truthful information, a written apology and would be told about any actions to improve processes to prevent the same thing happening again.

• The service had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.

• Staff demonstrated that they understood their responsibilities regarding safeguarding and all had received training on safeguarding children and adults relevant to their role.

• The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 14 December 2017

The practice is rated as good for providing effective services.

• Staff were aware of current evidence based guidance.

• Clinical audits demonstrated quality improvement.

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

• There was evidence of induction for staff. Staff who were due an appraisal within the last 12 months had received one and those who had been employed for less than 12 months had one scheduled.

Caring

Good

Updated 14 December 2017

The practice is rated as good for providing caring services.

• Survey information we reviewed and CQC comment cards showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

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

Responsive

Good

Updated 14 December 2017

The practice is rated as good for providing responsive services.

• The service understood its population profile and had used this understanding to meet the needs of its population.

• Patients we spoke with were very satisfied with the availability and timeliness of their appointments.

• The service offered physiotherapy appointments. Patients could book directly into these appointments via their own GP practice. Provider data between July and September 2017 showed that 90% of patients seen with joint pain had required only one appointment for self management advice. The physiotherapist could refer patients directly through the local musculoskeletal pathway if appropriate.

• The premises had good facilities and was well equipped to treat patients and meet their needs.

• Information about how to complain was available and evidence from four examples reviewed showed the provider responded quickly to issues raised. However, it was not evident how lessons learned from complaints were disseminated and shared with staff.

Well-led

Good

Updated 14 December 2017

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

• The service 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 standard operating procedures (SOPs) and policies and procedures to govern activity and held regular governance meetings with the management team and board. We did not see evidence of a structure that allowed for lessons to be learned and shared following significant events and complaints. We saw evidence of some staff bulletins but most staff we spoke with told us they had not had sight of these.

• 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 and had access to training updates.

• The provider was aware of the requirements of the duty of candour.

• The service sought feedback from patients through the NHS friends and family test.

• There was a focus on continuous improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 14 December 2017

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

• Patients with long-term conditions would be monitored and managed by their usual GP. However, the service offered supplement appointments for some long-term conditions, for example, asthma to improve the monitoring and management of these conditions by offering access in the evening and at weekends.

• Nursing staff had lead roles in offering asthma reviews and had a plan to start undertaking diabetic reviews in the near future and staff were currently being recruited for this. Patients’ care plans were updated to reflect any additional needs.

Families, children and young people

Good

Updated 14 December 2017

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

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The premises were suitable for children and babies. Monitoring data undertaken by the provider indicated that 28.5% of attendees at the Hub sites were under the age of 15.

• Arrangements were in place to safeguard children from abuse. These arrangements reflected relevant legislation and local requirements. Policies were accessible to all staff and outlined who to contact for further guidance. There was a lead GP for safeguarding and all staff had received training on safeguarding children relevant to their role.

• The service provided cervical cytology for patients who could not attend during the working day.

• The practice had emergency processes for acutely ill children and young people.

Older people

Good

Updated 14 December 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 service was not commissioned to provide home visits as this service was offered by the Sheffield GP out of hours service.

• Where older patients had complex needs, the practice shared summary care records with local care services as appropriate.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 14 December 2017

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

• The service operated evenings and weekends 52 weeks a year to provide patients who could not attend an appointment during the day choice and flexibility when booking an appointment. The service offered continuity of care as consultations were recorded directly into the patients’ medical record.

• The service offered urgent same day appointments to see a GP and access to nurses and healthcare assistants for routine care, for example blood tests, ear syringing, blood pressure checks, removal of sutures and dressing changes. The service also offered first contact appointments with a physiotherapist for musculoskeletal problems, for example, joint pain. The service had audited this and data showed that 90% of patients seen with joint pain were dealt with at the first appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2017

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

• The service had considered the physical health needs of patients with poor mental health. For example the service was in the process of developing its skill mix to respond to mental health needs across the locality by providing a primary mental health appointment for those who could not attend their own general practice during working hours.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

People whose circumstances may make them vulnerable

Good

Updated 14 December 2017

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

• The practice offered longer appointments for all patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed 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 when required.