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Inspection Summary


Overall summary & rating

Good

Updated 9 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Peeler House Surgery on 19 January 2017. The overall rating for the practice was good. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Peeler House Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 9 March 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 19 January 2017. This report covers our findings in relation to those requirements.

Overall the practice is rated as good.

Our key findings were as follows:

Recruitment procedures were in place and all necessary pre-employment checks had been carried out for newly recruited staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 April 2018

Effective

Good

Updated 14 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • There was limited evidence that audit was driving improvement in patient outcomes.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • There was no evidence that staff worked with the palliative care team to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 March 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.
  • 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 easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 14 March 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice moved to larger premises to better accommodate the growing patient list.
  • Patients 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 and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 March 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.
  • Some areas of governance in the practice required further establishing. The practice had a number of policies and procedures to govern activity, but some of these were undated and required review.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken. However we found a recent alert had not been actioned.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
Checks on specific services

People with long term conditions

Good

Updated 14 March 2017

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • 92% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months. This was similar to the CCG average of 90% and the national average of 89%.
  • 82% of patients with asthma, on the register, had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP questions. This was better than the CCG average of 76% and the national average of 75%.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and an annual review to check their health and medicines needs were being met.

Families, children and young people

Good

Updated 14 March 2017

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

  • There were systems in place 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 A&E attendances. Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Uptake for the cervical screening programme was 87% which was better than the CCG average of 80% and the national average of 76%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 14 March 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 14 March 2017

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 March 2017

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

  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 77% and the national average of 78%.
  • 100% of patients with psychoses have had a comprehensive, agreed care plan which was better than the CCG and national averages of 88%
  • We found no evidence the practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • We found no evidence the practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 14 March 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.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.