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Inspection Summary


Overall summary & rating

Good

Updated 7 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Canberra Old Oak Surgery on 29 June 2017. Overall the practice is rated as good. The practice was rated good for providing safe, effective, caring, responsive and well-led services.

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 and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • There were effective systems to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence guidelines and other locally agreed guidelines.
  • Staff were proactively supported to acquire new skills and had access to appropriate and bespoke training to meet their learning needs and to cover the scope of their work.
  • 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.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • 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. Examples we reviewed showed the practice complied with these requirements.
  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local and national healthcare providers to share best practice.

We saw areas of outstanding practice:

  • The practice benefited from a corporate business intelligence tool which provided access to bespoke searches relevant to medicines management and effective care. This enabled the practice to readily identify when follow up tests and screening were due in the management of patients with long term conditions and those experiencing poor mental health. The practice demonstrated that the system and continuous patient recall had improved compliance of tests and screening in the eight months they had managed the practice. Data for 2016/17 showed the practice as the second highest achiever in the GP locality network for the nine diabetes key processes, with a 13% improvement since taking over the practice in August 2016.
  • Staff had access to a suite of bespoke training materials to cover the scope of their work and meet their learning needs. This included access to a corporate learning and development portfolio featuring face-to-face, web-based and blended training programs tailored for each staff role. For example, fortnightly web-based training for healthcare assistants and nurses’ development support, bi-monthly development for practice management, fortnightly consultant led development program for clinicians and monthly face-to-face training for the physician associate and pharmacist. All staff at the practice, including receptionists undertook annual mandatory training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

The areas where the provider should make improvement are:

  • Review the effectiveness of storing emergency equipment and medicines in two separate locked locations.
  • Review the arrangements in place for when prescriptions issued for collection at the practice or nominated pharmacy are not collected.
  • Continue to monitor and act in response to patient feedback including the national GP patient survey findings to drive improvements where applicable.
  • Consider highlighting through available resources the bi-lingual skills of staff members.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 September 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.

Effective

Good

Updated 7 September 2017

The practice is rated as good for providing effective services.

  • Unpublished Quality and Outcome Framework (QOF) data 2016/17 showed that the practice had achieved the maximum number of points available for all of the clinical indicators measured.

  • Our findings at inspection showed that there were effective systems to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence guidelines and other locally agreed guidelines.
  • Clinical audits demonstrated quality improvement.
  • Staff were proactively supported to acquire new skills and had access to appropriate and bespoke training to meet their learning needs and to cover the scope of their work.
  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local and national healthcare providers to share best practice.
  • 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 7 September 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed the practice was mostly comparable with CCG and national averages for its satisfaction scores on consultations with GPs and nurses.
  • Survey information 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 7 September 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. For example, the practice had a higher prevalence of diabetes compared to the CCG average and implemented effective processes to ensure these patients were managed appropriately.
  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions as part of their care planning.
  • 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 four examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 September 2017

The practice is rated as good for providing well-led services.

  • 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.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • 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. This included arrangements to monitor and improve quality and identify risk.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • The practice was aware of the requirements of the duty of candour. In three examples we reviewed we saw evidence the practice complied with these requirements.
  • The practice leaders 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. Training was a priority and was built into staff rotas. Staff had access to a suite of bespoke training materials to cover the scope of their work and meet their learning needs.
  • Staff had received inductions, annual performance reviews and attended staff meetings.
Checks on specific services

People with long term conditions

Outstanding

Updated 7 September 2017

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

  • There was a systematic approach to long-term disease management with all the members of the team trained to contribute towards improved outcomes for patients.
  • Clinical staff including the practice pharmacist, physician associate and nursing team had specific roles in long-term disease management support.
  • Unpublished Quality and Outcomes (QOF) data for 2016/17 showed that the practice had exceeded the upper target range for all indicators relating to long-term conditions and achieved 100% in each.
  • The practice benefited from a corporate business intelligence tool which provided access to bespoke searches identifying when follow up tests were required for patients with long-term conditions. The practice had evidence to show that the system and continuous patient recall system had improved compliance of tests in the eight months they had managed the practice.
  • Data for 2016/17 showed the practice as the second highest achiever in the GP locality network for the nine diabetes key processes with a 13% improvement, since taking over in August 2016. Similar improvements were shown to have been achieved in patients diagnosed with hypertension with an 8% increase of those treated to target.
  • The practice used risk stratification tools to identify patients with long-term conditions at risk of unplanned hospital admission and invited them for annual review to create avoidance admissions care plans aimed at reducing the risk. Data showed that there had been a 25% increase in uptake since taking over the practice.
  • 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

Good

Updated 7 September 2017

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

  • 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.
  • All staff had received training on female genital mutilation (FGM) including identification or reporting of cases where suspected.
  • Immunisation rates were high for all standard childhood immunisations with a 90% plus achievement rate in the first quarter of 2017/18 and demonstrated a significant improvement in the uptake rate of 36% since taking over the two merged practices in August 2016.
  • 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, the practice provided shared antenatal and postnatal care with the midwifery and health visiting team.
  • The practice referred women/families to a local centre for children and families who provided support for those in pregnancy or adopting children. The service offered parent infant psychotherapy, support on parent-infant relationships such as difficulties bonding or post-natal depression.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • The practice provided contraceptive and sexual health services.

Older people

Good

Updated 7 September 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 used risk stratification tools to identify older patients at risk of unplanned hospital admission and invited them for review to create integrated care plans aimed at reducing that risk.
  • All patients over the age of 75 years had a named GP and received prioritised access.
  • The practice offered regular health checks for patients over 75 years, dementia and chronic disease screening and in-depth medication reviews.
  • 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 shared summary care records with local care services. For example, they used co-ordinate my care to share information about older patients receiving end of life care to relevant 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, the practice worked in partnership with the local Age UK branch to support elderly patient access.

Working age people (including those recently retired and students)

Good

Updated 7 September 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, Saturday morning appointments, daily telephone consultations and extended hour appointments during weekday evenings and weekends within the GP locality network.
  • The practice was proactive in offering a variety of online services as well as a full range of health promotion and screening that reflected the needs of this population group. Since taking over the two merged practices in August 2016, the number of patients registered for on line services had increased from approximately 300 to nearly 600 patients, providing them access to services that did not require attendance at the practice.
  • The practice could refer patients to the local health trainer service team who supported people to improve lifestyle choices and reduce the risk of chronic disease.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 September 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.
  • Unpublished QOF data for 2016/17 showed that all of the patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was 50% higher than the previous year’s achievement as separate practices prior to them merging in August 2016.
  • The practice maintained a register of patients experiencing poor mental health and they were invited for annual health checks and quarterly medication reviews.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice benefited from a corporate business intelligence tool which provided access to bespoke searches identifying when follow up tests were required for patients prescribed medicines used to manage mental health conditions.
  • Unpublished QOF data for mental health related indicators 2016/17 showed that the practice had achieved 100% in those measured.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • A virtual clinic attended by clinical staff and specialist consultant was used to discuss complex cases and implement agreed management plans followed up by the practice.
  • 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 used videos in different languages which had been produced by the provider in conjunction with a local social enterprise organisation, to help Muslim patients experiencing poor mental health understand the support that was available.
  • 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 7 September 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 homeless people, those with a learning disability and patients receiving palliative care.
  • Longer appointments were made available for vulnerable patients.
  • Patients with a learning disability were invited for annual health checks and medication review with 77% completed in the last year.
  • 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.
  • All staff at the practice including receptionists undertook annual mandatory training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.