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Inspection Summary


Overall summary & rating

Good

Updated 23 March 2018

We carried out an announced comprehensive inspection at South Saxon House Surgery on 27 September 2017. The overall rating for the practice was good. The practice was also rated good for the effective, caring, responsive and well-led domains and all of the population groups. It was however rated as requires improvement for the safe domain. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for South Saxon House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At our inspection of 27 September 2017, we found that:

  • The system for recording and monitoring Medicines & Healthcare products

    Regulatory Agency

     (MHRA) alerts did not ensure that clinical action was always taken.

  • Not all external storage bins containing clinical waste were kept locked at all times.

  • Batch numbers, expiry dates and amounts used were not always recorded when local anaesthetic was used during minor surgical procedures.

At this inspection our key findings were as follows:

  • The systems for recording MHRA and other alerts ensured that the alerts and actions were recorded and acted upon.

  • All external clinical waste storage bins were locked at all times.

  • Batch numbers, expiry dates and amounts used were always recorded when local anaesthetic was used during minor surgical procedures.

Additionally we saw that:

  • The system for tracking and auditing histology specimens ensured that results were received and acted upon appropriately.

  • Alerts denoting a child at risk were also placed on family and other household members’ computer records as appropriate.

  • The practice had discussed areas in the GP national survey where results were below the local and national averages and were considering ways of addressing them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 March 2018

Effective

Good

Updated 21 November 2017

The practice is rated as good for providing effective services.

  • As the practice was newly registered at the current location, no data from the Quality and Outcomes Framework had been published so any data used as part of the inspection process was provided by the practice and was unpublished and unverified with no local or national comparators at the time of the inspection.

  • 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.

Caring

Good

Updated 21 November 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice slightly lower than others for some aspects of care.

  • Comment cards, discussion with patients on the day and friends and family test information that we reviewed 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.

Responsive

Good

Updated 21 November 2017

The practice is rated as good 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.

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

  • Information about how to complain was readily available and the complaints policy and procedures were in line with recognised guidance and contractual obligations for GPs in England.

Well-led

Good

Updated 21 November 2017

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

  • The practice had a clear vision and strategy to provide a friendly welcoming and safe environment to all their patients whilst also providing a high level of up-to-date clinical care. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt well 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. 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. We looked at two examples and saw evidence the practice complied with these requirements.
  • The GP provider 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 engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and staff were allowed protected time to complete courses.

Checks on specific services

People with long term conditions

Good

Updated 21 November 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.

  • The practice provided one stop clinics and screening clinics for patients with long term conditions. At these clinics all tests and consultations with the nurse and if necessary GP were carried out at the same appointment.
  • Unverified figures from the practice showed that 84% of patients with diabetes were reviewed in a face to face interview in 2016/2017. There were no published local or national comparators available at the time of the inspection.

  • 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, if appropriate the named GP arranged joint home visits with other professionals such as the occupational therapist, specialist cancer care nurse or physiotherapist when required.

Families, children and young people

Good

Updated 21 November 2017

The practice is rated as good 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. However although all children at risk had their computer records tagged with an alert although not all household members did.

  • Unverified and unpublished data shown to us by the practice showed Immunisation uptake rates for children of one year and under to be just over 80%. Immunisation uptake rates for children of two years were 96% up to 100% and for five years in a range from 87% to 97% for all standard childhood immunisations. There were no local or national comparators.

  • 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.

  • Unverified data from the practice for 2016/2017 showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 82%. There were no published local or national comparators available.

  • Safeguarding policies were in place with safeguarding being an agenda item on the monthly multi-disciplinary team meetings. Health visitor contact details were available to all GPs and staff to discuss child safeguarding concerns.
  • The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Older people

Good

Updated 21 November 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 involved patients and where appropriate carers in the review.

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

  • All local care homes on the practice list were visited weekly with additional visits as required.

  • 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 such as community nurses.

  • 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 21 November 2017

The practice is rated as good 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 for nurse appointments.

  • 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. There was a link on the website home page to a practice survey and patients were encouraged to leave comments and suggestions as to how the service and care could be improved

  • Evening appointments were available with the practice nurse.

  • Appointments could be booked or cancelled and repeat prescriptions ordered online.

  • 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.

  • Telephone appointments were available with each clinician during each surgery.

  • Patients were offered new patient health checks and health checks for 40 to 74 year olds.

  • The practice proactively offered exercise advice and referral to a local gym for those with a BMI >30.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 November 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • We saw unverified data from the practice that 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • We saw unverified data from the practice that 93% of patients diagnosed with mental health disorders had their care reviewed in a face to face meeting in the last 12 months.

  • 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.

  • A Mental Health Worker was available for counselling sessions in the practice every week.

People whose circumstances may make them vulnerable

Good

Updated 21 November 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. All patients that staff members perceived to be vulnerable were flagged up on the computer system.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. Palliative/End of Life Care provided by the GP provider with a register of patients to ensure effective care and support is provided to such patients/relatives in their own homes
  • 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 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 in normal working hours and out of hours. We saw examples where staff had raised safeguarding concerns.