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Archived: Sutton Valence Surgery Outstanding

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Inspection Summary


Overall summary & rating

Outstanding

Updated 30 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sutton Valence Surgery on 23 August 2017. Overall the practice is rated as outstanding.

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

  • There was an open and transparent approach to safety and a system for reporting and recording significant events. The practice shared learning from safety incidents with other nearby practices on a regular basis.
  • The practice 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.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. The results from the survey were significantly higher than national and local averages.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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 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 practice proactively sought and acted upon feedback from staff and patients.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There were areas of outstanding practice.

  • The practice supported elderly patients living independently to engage in regular physical activity. The practice provided provision such as a walking for health group and a beginner cycling for health group. The practice recognised that this also helped to reduce social isolation in this population group.

  • There was a weekly medicines delivery round to housebound, usually elderly patients. This was carried out by a member of the PPG, or in their absence by the principal GP.

  • The practice had a substantial number of patients from Romani Gypsy and travelling communities. They adjusted the appointments system to make it easier for patients from those communities to access healthcare.

  • The practice had pronunciation guidance for staff for commonly cited Polish and Bulgarian names.

There was one area where provider should make improvements:

  • Review procedures for the recording of minor surgery operations to ensure that all relevant details are included.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 November 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; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • 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.
  • The practice had staff member who acted as the Freedom to Speak up Guardian and the staff we spoke with knew their identity and function.
  • There was a record of “near miss” events at the dispensary. These were analysed and reported on annually.
  • The GPs met with other local GPs monthly they discussed recent safety alerts, best practice and near misses and safety events across all the practices so that opportunities to learn from external safety events were identified.

Effective

Good

Updated 30 November 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above the national averages.
  • 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 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.
  • The record of minor surgery did not include all the necessary details

Caring

Good

Updated 30 November 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice significantly higher than others for all aspects of care. The survey information showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • There was a system to help ensure that all carers were contacted, at least annually, to check whether their needs had changed and how, if possible, the practice could support them.
  • The practice encouraged and supported a local voluntary car service, which provided transport for patients in the rural community to help them access health services.
  • One of the members of the patient participation group had a weekly medicines delivery round. This entailed taking medicines to housebound, rurally isolated, usually elderly patients. When the services was not available, for example because of annual leave, the principal GP undertook the round.

Responsive

Outstanding

Updated 30 November 2017

The practice is rated as outstanding for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population
  • 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. Data from the national GP patient survey showed the practice results scored extremely highly for continuity of care and access to services.
  • The practice had high number of patients from the traveller community. Arrangements for appointments for them were adjusted to reflect both the literacy difficulties and cultural preference of that community.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and evidence from two examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 30 November 2017

The practice is rated as outstanding 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 planned approach to succession planning which involved all the staff.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. The practice proactively reviewed governance and performance management arrangements. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. The system for recording complaints and significant events required the practice to consider the issue of duty of candour and to record a decision.
  • There was a culture of openness and honesty. The practice had a staff member who acted as the Freedom to Speak up Guardian and the staff we spoke with knew their identity and function.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 engaged with the patient participation group. For example staff and the PPG had cooperated to produce a patients’ charter for the practice.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
Checks on specific services

People with long term conditions

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients 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.

  • Performance for diabetes related indicators was similar to the clinical commissioning group (CCG) and national averages. For example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 75% compared with the national and local average of 77%.
  • There were early and ongoing conversations with these patients about their end of life care as part of their wider treatment and care planning.
  • The practice achieved 100% of QOF points for asthma, atrial fibrillation, cancer, chronic obstructive pulmonary disease, depression, dementia, heart failure and hypertension. In all these cases the practice results were higher than the clinical commissioning group (CCG) and national averages. Exception reporting, at seven per cent, was lower than the national and local averages
  • 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.
  • 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

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems 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.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. There was a weekly midwife clinic. The practice followed up on missed child immunisations by telephone.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of older patients.

  • 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • 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 shared summary care records with local 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 through the support provided by the Healthy Walking and Healthy Bicycling groups.
  • All patients over the age of 85 years old were offered a face-to-face review annually.
  • There was a weekly medicines delivery round to housebound, usually elderly patients. This was carried out by a member of the PPG, or in their absence by the principal GP.
  • The practice provided a weekly ward round at the local nursing home to manage on-going problems.
  • Older patients were contacted by telephone or visited following hospital discharge.

Working age people (including those recently retired and students)

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
  • 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.
  • GPs took blood samples from patients’ in early morning commuter clinics if they had difficulty attending phlebotomy appointments because of their working hours.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients experiencing poor mental health (including people with dementia).

  • The practice carried out advance care planning for patients living with dementia.
  • Twenty three out of 25 patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (92%), which is higher than the national average (84%).
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • Performance for mental health related indicators was similar to the clinical commissioning group (CCG) and national averages. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have an agreed care plan during the preceding 12 months was 100% compared with the CCG average of 92% and the national average of 89%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • 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 follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. The practice was a member of the Dementia Action Alliance a group which connects organisations and individuals, shares best practice and takes action on dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 30 November 2017

The factors that led to the practice being rated as outstanding overall applied to all the population groups, therefore the practice is rated as outstanding for the care of patients whose circumstances may make them vulnerable

  • The practice held a register of patients living in vulnerable circumstances including homeless people and 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 longer appointments for patients with a learning disability.
  • 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 we spoke with 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.
  • The needs of vulnerable patients were discussed at the weekly practice meeting to ensure their needs were met.
  • The practice had a substantial number of patients from Romani Gypsy and travelling communities. They adjusted the appointments system to make it easier for patients from those communities to access healthcare.