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Inspection Summary


Overall summary & rating

Good

Updated 6 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spring Terrace Health Centre on 13 July 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 an effective system for reporting and recording significant events.

  • Risks to patients and staff were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

  • The provider was taking action to improve access, following feedback from some patients that they experienced difficulties getting through to the practice by telephone and obtaining an appointment.

  • All staff were actively engaged in monitoring and improving quality and patient outcomes. They were highly committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

  • Services were tailored to meet the needs of individual people and were delivered in a way that provided flexibility, choice and continuity of care.

  • Patients said they were treated with compassion, dignity and respect.
  • Information about how to complain was available and easy to understand.

  • 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 well supported by the management team. Effective governance arrangements were in place, which focussed on delivering good quality care.

  • There was a clear vision and strategy for the development of the practice and staff were committed to providing their patients with good quality care and treatment.

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

  • Where appropriate, take action to reduce exception reporting rates for those clinical indicators where their QOF performance was below the England average.

  • Continue to take steps to improve patient telephone access, and appointment availability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 September 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting on and learning from significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned when things went wrong and shared with staff to support improvement.

  • There was an effective system for dealing with safety alerts and sharing these with staff.

  • The practice had clearly defined systems and processes that helped keep patients safe. Individual risks to patients had been assessed and were well managed. Required employment checks had been carried out for staff recently appointed by the practice.

  • The premises were clean and hygienic and, overall, effective infection control processes were in place.

Effective

Good

Updated 6 September 2017

The practice is rated as good for providing effective services.

  • Staff were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion. This included providing advice and support to patients to help them manage their health and wellbeing.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF), and their performance in relation to national screening programmes, to monitor and improve outcomes for patients. The QOF data, for 2015/16, showed the previous provider had obtained 99.4% of the total points available to them for providing recommended care and treatment. This was above the local clinical commission group (CCG) average of 97.1% and the England average of 95.3%.But, the practice’s exception reporting rate was 4.8% above the local CCG and England averages.

  • The practice had a comprehensive screening programme and their performance was similar to the national averages in relation to breast, bowel and cervical screening.

  • Patients’ needs were assessed and care was planned and delivered in line with current evidence based guidance.

  • Quality improvement activities, including clinical audits, were carried out to improve patient outcomes.

  • Staff worked effectively with other health and social care professionals to ensure the range and complexity of patients’ needs were met.

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

Caring

Good

Updated 6 September 2017

The practice is rated as good for providing caring services.

  • There was a strong, visible, person-centred culture. Staff treated patients with kindness and respect, and maintained patient and information confidentiality. Patients we spoke with, and most of those who had completed a Care Quality Commission comment card, were very happy with the quality of the care and treatment they received from clinical staff.

  • Data from the NHS National GP Patient Survey of the practice, published in July 2016, showed patient satisfaction levels regarding the quality of GP and nurse consultations were either above, or similar to, the local CCG and national averages.

  • Information for patients about the range of services provided by the practice was available and easy to understand.

  • Staff had made arrangements to help patients and their carers cope emotionally with their care and treatment.

Responsive

Good

Updated 6 September 2017

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations when planning how services were provided, to ensure they met patients’ needs. Services were tailored to meet the needs of individual people and were delivered in a way that provided flexibility, choice and continuity of care.

  • Whilst most patients we spoke with, as well as most of those who completed CQC comment cards, expressed no concerns in relation to getting through to the practice on the telephone and obtaining a routine appointment, a small number of patients raised concerns with us about this prior to and during the inspection. The NHS National GP Patient Survey of the practice, published in July 2016, showed that patient satisfaction levels regarding telephone access and appointment availability, were significantly lower than the local CCG and national averages. (However, these results relate to a period of time before the new provider was responsible for running the service and before the new provider had introduced changes to improve access.) We found the new provider was taking action to improve telephone access to the practice and appointment availability. They had introduced a new centralised appointment system, to help ensure that when patients contacted the practice to request an appointment, they received the most appropriate clinical response to their needs. The effectiveness and impact of the new appointment system was being closely monitored and action taken to address operational issues as they arose.

  • 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. There was evidence the practice treated all complaints seriously and took whatever action they could to address them.

Well-led

Good

Updated 6 September 2017

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

  • The practice had a very clear vision and strategy to deliver high quality care and promote good outcomes for patients.

  • There was a clear leadership structure and staff felt well supported. The practice had an effective governance framework, which supported the delivery of their strategy and good quality care. This included arrangements to monitor and improve quality and identify risk, to help keep patients safe.

  • The practice actively sought feedback from patients via their patient participation group, but recognised that more could be done to develop the group.

  • There was a very strong focus on, and commitment to, continuous learning and improvement at all levels within the practice.

  • The new provider was aware of, and had complied with, the Duty of Candour regulation. The provider, the GPs and practice lead encouraged a culture of openness and honesty, and ensured that lessons were learned following significant events.

Checks on specific services

People with long term conditions

Good

Updated 6 September 2017

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

  • The QOF data, for 2015/16, showed the practice had either performed above or, similar to, the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Patients with long-term conditions were offered annual reviews, to check that their health needs were being met and they were receiving the right medication. Longer appointments and home visits were available when needed.

  • The practice had strong arrangements in place for meeting the needs of patients with diabetes. They had achieved 100% of the total QOF points available to them, for providing recommended clinical care to patients diagnosed with diabetes. This was 6.2% above the local CCG average and 10.1% above the England average.

Families, children and young people

Good

Updated 6 September 2017

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

  • There were systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, the midwife attached to the practice held a weekly baby clinic which was also attended by one of the GPs. Monthly multi-disciplinary safeguarding meetings were held, where the needs of vulnerable children and families were discussed. All staff had completed safeguarding training that was relevant to their roles and responsibilities.

  • Appointments were available outside of school hours and the practice’s premises were suitable for children and babies. A good range of health promotion leaflets was available in the patient waiting area, including information about the practice being breastfeeding friendly.

  • The practice had a comprehensive screening programme. Nationally reported information showed the practice’s performance was similar to the national averages. For example, the uptake of cervical screening by females aged between 25 and 64, attending during the target period, was similar to the national average, 73.1% compared to 76.1%.

  • The practice offered a full range of childhood immunisations. For example, data provided by the practice showed that the immunisation rates, for the vaccinations given to children under two and five years of age, were over 90%.

Older people

Good

Updated 6 September 2017

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

  • The Quality and Outcome Framework (QOF) data, for 2015/16, showed the practice had either performed above or, similar to, the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

  • The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care. GP staff provided a twice-monthly surgery at a large local nursing home, to help promote the health of patients living there.

  • Staff worked in partnership with other health care professionals to ensure that older patients received the care and treatment they needed.

  • The practice participated in regular multi-disciplinary meetings where the needs of high risk patients were discussed, and plans put in place to meet them.

Working age people (including those recently retired and students)

Good

Updated 6 September 2017

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

  • The QOF data, for 2015/16, showed the practice had performed either above, or similar to, the CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. Long-term conditions appointments were provided outside of clinic times, to make it easier for working age patients to attend.

  • The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of their patients. For example, patients were able to use on-line services to book appointments and request repeat prescriptions.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 September 2017

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

  • The practice’s overall performance for the QOF mental health related indicator was above the England average (100% compared to 92.8%).

  • Clinical staff carried out opportunistic dementia screening and completed care plans, to help make sure patients with dementia received appropriate support and treatment.

  • Patients with mental health needs were offered an annual health review and were provided with advice about how to access various support groups and voluntary organisations. They were also able to access ‘talking therapies’ which help meet the needs of patients with a range of mental health problems.

People whose circumstances may make them vulnerable

Good

Updated 6 September 2017

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

  • The practice took active steps to reduce emergency admissions into hospital, by engaging with the local admission avoidance care planning process.

  • Staff actively collaborated with other health and social care staff to meet the needs of vulnerable patients.

  • The practice maintained a register of patients with learning disabilities, which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen.

  • Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff were aware of how to contact relevant agencies in normal working hours and out-of-hours.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Arrangements had been made to meet the needs of patients who were also carers.