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Inspection Summary


Overall summary & rating

Good

Updated 26 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Crescent Surgery on 25 May 2017. The overall rating for the practice was Good. However, a breach of regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified, and we rated the practice as requires improvement for providing safe services. The full comprehensive inspection report published July 2017 can be found by selecting the ‘all reports’ link for The Crescent Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based follow up inspection, we looked at photos, certificates, audits, minutes of meetings and policies, carried out on 30 January 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 25 May 2017. This report covers our findings in relation to those requirements.

The practice is rated as Good for providing safe services.

Our key findings were as follows:

  • The practice assessed the risk of, and preventing, detecting and controlling the spread of infections, including those that are health care associated.

  • Staff were following a cleaning schedule.

  • Mops and buckets were colour coded.

  • Disposable curtains were used in the nurses’ room.

  • Orange top sharps bin were used in the GP and nurse rooms, and a poster was displayed in both rooms explaining the difference in colour coded sharp bins.

  • An infection control audit had been conducted in November 2017.

  • The healthcare assistant had undertaken infection control training.

  • A meeting had taken place which discussed key staff members, sharps bins and a cleaning schedule for all staff.

  • The service had updated their policy on the storage of medicine.

  • The 2017 GP patient survey results for access to appointment showed 89% of patients found it easy to get through on the phone local 72% national 81%. 80% of respondents were satisfied with the surgery's opening hours 74% local 76% national. 86% of patients were able to get an appointment 85% local 84% national. 87% of patients say the last appointment they got was convenient local 81% national 81%.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 26 February 2018

Effective

Good

Updated 31 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • 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 31 July 2017

The practice is rated as good for providing caring services.

  • 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 31 July 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 sometimes found it difficult to get an appointment and there was a lack of continuity of care, however urgent appointments were 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 available and evidence from five examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 31 July 2017

The practice is rated as good 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 leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity governance meetings were held regular.

  • 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 annual performance reviews and there were training opportunities. Not all staff attended staff meetings, however there was a communication folder which contained all minutes and staff were encouraged to read this.

  • Not all staff knew key responsible staff members, for example a member of staff reported they never knew who the practice manager was.

  • The provider was aware of the requirements of the duty of candour. In one example we reviewed we saw evidence the practice complied with these requirements.
  • The lead GP 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, this was recently established December 2016 by the lead GP.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

Checks on specific services

People with long term conditions

Good

Updated 31 July 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.

  • Performance for diabetes related indicators was comparable to the local and national average:

  • 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 31 July 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.

  • 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 practice provided support for premature babies and their families following discharge from hospital.

    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.

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

Older people

Good

Updated 31 July 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 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 worked closely with a hospice to support end of life care and provide bereavement support.

  • 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 we saw leaflets in reception about Dementia and Alzheimer.

Working age people (including those recently retired and students)

Good

Updated 31 July 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, and flexible.

  • 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.

  • Extended hours provision had not been offered for the three months prior to the inspection.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 July 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.

  • 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.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 31 July 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, travellers and those with a learning disability.

  • The practice offered longer appointments and extended annual reviews for patients with a learning disability. One hundred percent (5 patients) with a learning disability had received a health check in the last year.

  • 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 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.