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Inspection Summary


Overall summary & rating

Good

Updated 30 August 2017

Letter from the Chief Inspector of General Practice

John Street Medical Practice was acquired by Hope Citadel Healthcare in October 2016. We carried out an announced comprehensive inspection on 18 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined 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.
  • Some members of staff were trained translators in response to the ethnicity of the practice population.
  • 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 said they found it easy to make an appointment with a GP 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.

We saw areas of outstanding practice:

  • The practice employed focused care workers who were able to provide social and medical care for patients in need. Staff were also able to access counsellors if they required them.

  • English lessons for female patients were provided by the focused care worker which would build confidence and help patients integrate into the community and increase employability.

The area where the provider should make improvement is:

  • Identify patients caring for others and offer support as required.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 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 introduced clearly defined systems and processes to minimise risks to patient safety. As the provider was new to the practice these processes had yet to be embedded, however staff were aware of them.
  • 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 30 August 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QoF) which showed patient outcomes was not available as this is a new provider. The practice was able to provide up to date data held on their clinical system which showed mixed results for QoF when compared to local and national averages.
  • 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 a plan in place for all GPs and staff to receive 360 degree appraisals and personal development plans in the coming months.
  • 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.
  • The practice had routine appointment times with a GP of 13 minutes. The practice had yet to measure the benefit and impact that this had on its patients.

Caring

Good

Updated 30 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed mixed results when patients rated the practice 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.
  • The practice held a register of patients and their families receiving focussed care. All patients on this register had personalised health and social care plans.
  • 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 30 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 three of the receptionists were trained translators and were used to translate when appropriate as most of its patients were Bengali speaking.
  • The practice provided a class for female patients to learn English which would build confidence and help patients integrate into the community and increase employability.
  • The practice had a good skill mix of staff which included a nurse prescriber and focused care workers who were able to provide social and medical care for patients in need. Staff were also able to access counsellors, if they required them.
  • 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 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 evidence from six examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 30 August 2017

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

  • Hope Citadel Healthcare had acquired the practice in October 2016 and 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 provider had introduced new 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.
  • Staff had received inductions and attended staff meetings and training opportunities. Appraisals were planned to take place in the coming months.
  • The provider was aware of the requirements of the duty of candour.
  • The GPs and management 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 were attempting to recruit for a patient participation group but to date had received no responses.
  • 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.
  • Hope Citadel employed a counsellor who was available to offer a confidential counselling service to patients and support to the GPs and staff.
Checks on specific services

People with long term conditions

Good

Updated 30 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.
  • Data from the Quality and Outcomes Framework was unavailable for this new provider as the practice had been acquired in October 2016, published data would not be available until late 2018. However, they were able to show us that 91% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the national average of 87%.
  • 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 30 August 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.
  • Care plans were in place for complex families and the practice worked closely with other agencies to resolve issues such as substance abuse, housing, debt, domestic violence and mental health. The practice were able to give us examples of positive outcomes for this group of patients.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • 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 30 August 2017

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

  • The practice had very few elderly patients with 7% of the total patient list aged over 65 years.

  • 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 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.
  • The provider held internal meetings regarding these patients but they were not attended by any other agency despite being invited.

Working age people (including those recently retired and students)

Good

Updated 30 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.
  • 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.
  • The focused care worker assisted families with housing issues and the completion of documentation.
  • English speaking classes were held for female patients which would help build confidence and increase chances of employability including volunteer roles.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 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 advance care planning for patients living with dementia.
  • The practice told us that to date, 24% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 83%.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The provider employed a counsellor for patients who required this service.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The practice told us that to date 76% of patients experiencing poor mental health had an agreed care plan which was below the national average of 89%.
  • 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 30 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, asylum seekers, travellers and those with a learning disability.
  • The practice staff included a focused care worker who provided social and medical care to its patients in need of this support. The practice were able to provide examples where they had assisted patients in finding homes and helped other patients with the benefits system.
  • 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.