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Archived: Church Street Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 2 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Church Street Surgery on 29 June 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 a system in place for reporting and recording significant events.
  • 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.
  • Information about services and how to complain was available.
  • Patients we spoke with or received comments from told us that 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 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 had implemented the year of care approach for management of long term conditions and had performed over and above the Clinical Commissioning requirements by using this approach not only for diabetes, but for other long term conditions including pre-diabetes, Chronic Obstructive Pulmonary Disease (COPD) and Cardiovascular Disease.
  • The practice had worked to increase awareness and use of online services for patients. This had resulted in an increase of 13.2% (from 5.3% in May 2016 to 18.5% in June 2017). The practice had also been invited to the Clinical Commissioning Group managers meeting to support other practices in raising awareness.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 August 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 arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 2 August 2017

The practice is rated as good for providing effective services.

  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement. Learning from audits was shared across the practice.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • 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 in the process.

Caring

Good

Updated 2 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • 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.
  • Results from the practice’s friends and family test demonstrated that 96% of patients were extremely likely or likely to refer this practice to a family member or friend.
  • 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 2 August 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 introduced and widely promoted online services, SMS appointment reminders and installed WiFi within the practice.
  • 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 or received comments from 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 available via information leaflets in reception.

Well-led

Good

Updated 2 August 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 clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular 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.
  • The provider was aware of the requirements of the duty of candour. Staff we spoke with during the inspection were able to evidence a good understanding.
  • The partners 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.
Checks on specific services

People with long term conditions

Good

Updated 2 August 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 held a register of people with a long term condition and all patients were recalled for a review in line with national guidance related to that particular condition.
  • The practice had adopted the Year of Care model for management of patients with a number of long term conditions. The Year of Care model aimed at encouraging patients to understand their condition and select their own personal health and lifestyle targets.
  • 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.
  • 87% of patients with diabetes, on the register, had a record of a foot examination and risk classification. This was higher than the CCG average of 83% and national average of 81%.
  • 84% of patients with diabetes, on the register, had received an influenza immunisation in the preceding eight months.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

Families, children and young people

Good

Updated 2 August 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.
  • Immunisation rates were relatively high for all standard childhood immunisations.

Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice hosted a midwife service one half day per week, patients were assigned to the midwife at the point of confirmed pregnancy to be monitored and for the mother to be supported throughout.
  • The practice worked with 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 2 August 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 to ensure the patient’s wishes were discussed and that the patient was at the centre of decisions about their care.
  • The practice carried out annual reviews for all patients aged 75 years and over.
  • The practice carried out memory checks opportunistically when patients at risk of dementia attended the practice.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • A pharmacist attended the practice on a weekly basis to review care home residents who had been newly admitted, or who had a recent hospital discharge. The pharmacist also reviewed patients taking six or more medicines and who required a medication review.
  • Where older patients had complex needs, the practice shared summary care records with other 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.
  • The practice was working in collaboration with other local practices to develop a frailty service.

Working age people (including those recently retired and students)

Good

Updated 2 August 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, the practice offered extended hours from 7.15am on Wednesday mornings.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 August 2017

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

  • The practice carried out advanced care planning for patients living with dementia.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. All patients were offered an annual review (or more frequently if required), referring where appropriate to specialised services.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice had achieved 97% against the dementia indicators in the 2016/17 Quality and Outcomes Framework (QOF). The 2016/17 data was yet to be verified or published.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice had achieved 100% against the mental health indicators in the 2016/17 Quality and Outcomes Framework (QOF).
  • Patients at risk of dementia were asked about memory concerns when attending the practice and referred to the memory clinic if required.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 2 August 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 annual reviews for all patients with a learning difficulty and adapted information for patients to improve their understanding of the review process. Information was available in easy read formats.
  • 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 regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice provided services to a local residential service providing accommodation to ex-offenders on a probation licence or community order.
  • 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.