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Inspection Summary


Overall summary & rating

Good

Updated 8 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queen Road Surgery on 1 August 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. Improvements were made to the quality of care as a result of complaints and concerns.

  • 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.

  • 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.

    We saw one area of outstanding practice:

A bespoke digital software tool was used by staff at the practice to improve safety and clinical outcomes and, in addition, enabled the practice to monitor recruitment and training. The system recorded all staff training and monitored the expiry dates clinical staff’s professional registrations. Searches were regularly run at the practice which highlighted staff who required training or which professional registrations needed to be checked. The system also enabled the practice pharmacist to ensure compliance with medicines safety alerts and that patient medicines were optimised in accordance with current best practice. In addition the practice used the software to analyse patient data to ensure those with long term conditions were identified, coded and called in for periodic reviews. As a result of the software’s analysis which looked at risk factors and patient medicines, the practice increased the number of patients on their asthma register by 29% and those on their pre diabetic register by 118% between April 2016 and August 2017. The software had also been used to generate information used for an audit of diabetic patients which show a significant increase in patients who had blood sugar levels within the optimal range.

The areas where the provider should make improvement are:

  • Discuss the system used to triage patients with staff to ensure that all staff are aware of their roles and responsibilities.

  • Take steps to ensure that Patient Group Directions include the practice name when these are renewed.

  • Consider storing all practice policies in a single location to ensure that staff are able to access these easily.

  • Continue to review staffing levels in the administrative team to ensure that there are sufficient numbers of staff.

  • Take steps to monitor and mitigate risks to staff and patients including the risk of legionella.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 September 2017

The practice is rated as good for providing safe services.

  • From the 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. However we were told by one staff member that they would refer patients to a pharmacist for minor ailments without the patient first being triaged by a clinician.

  • 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 good arrangements in place in respect of the management of medicines. However we found that none of the nurses Patient Group Directions (PGDs) had been completed with the practice’s name.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 8 September 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 8 September 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 some aspects of care and were comparable for most others.

  • 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 8 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 participated in a locality wide initiative delivering holistic health assessments to patients over 65 who were housebound or who had not attended the practice in 18 months and for all patients over the age of 80 years old. The aim of the assessment was to develop a care plan which addressed both the health and social needs of these patients through provision of support by the practice, other healthcare organisation and agencies in the voluntary sector.

  • 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 the examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 8 September 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 both within the practice and in the wider corporate organisation that oversaw activities at this location. Staff felt supported by management. The practice had policies and procedures to govern activity and held regular meetings where governance issues were discussed. Governance meetings were also held at the corporate level. Information regarding significant events and best practice were fed back to senior management and learning or improvement work was cascaded back to individual practice level.

  • 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, annual performance reviews and attended staff meetings and training was encouraged for staff at all levels by AT Medics who provided job specific in house training at all levels of the organisation.

  • The provider was aware of the requirements of the duty of candour. We saw evidence the practice had system in place to ensure compliance with these requirements.
  • Leadership both local within the practice and in the wider corporate organisation 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. Staff training was a priority.

Checks on specific services

People with long term conditions

Good

Updated 8 September 2017

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

  • Staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments were offered for patients with long term conditions which clinicians used to undertake reviews and draft care plans.
  • The practice performed in line with local and national averages in respect of the management of diabetes.
  • 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.
  • The practice used bespoke IT software created by AT medics to improve identification of patients with long term conditions. For example between April 2016 and August 2017 the number of patient identified as pre diabetic increased by 118%.
  • 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 8 September 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.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Staff 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 would provide support for premature babies and their families following discharge from hospital.
  • Preconception advice was offered to patients with long term conditions including those with epilepsy and diabetes.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice hosted community midwives and worked health visitors to support this population group.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • A bespoke ante and post-natal care planning template created by AT Medics to ensure that pregnant women and those who had just given birth had their needs fully assessed and supported. The ante natal template calculated risk in pregnancy, assessed FGM and safeguarding risk within the family and assessed the mental health of expectant mothers. The template also prompted GP to check for gestational diabetes and MMR status. Post-natal care template again assessed mental health and ensured that complications resulting from pregnancy were assessed and acted upon. The practice planned to share the templates with other practices in the wider locality once they had thoroughly tested them.

Older people

Good

Updated 8 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 offered proactive, personalised care to meet the needs of the older patients in its population. The practice participated in a locality initiative whereby comprehensive reviews were undertaken and care plans drafted for patients over the age of 65 who were housebound or who had not attended the practice in a significant period of time or who were aged over 80. This aimed to address both patient’s health and social needs. One hour appointments were offered for these assessments.

  • 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 with other with local care services. For example the practice would liaise with a local geriatrician over the telephone and discuss patients at community multidisciplinary team meetings.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 8 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, extended opening hours.

  • 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.

  • Patients could also be referred to the local primary care extended access service which provided appointments from 8 am to 8 pm seven days per week.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 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.

  • 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited by text, call and letters for reviews and sent reminders to increase the likelihood of attendance.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. Reviews were undertaken on a monthly basis.

  • Performance for other mental health indicators was comparable to local and national averages.

  • 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. Longer appointments were offered to those deemed to have limited capacity.

People whose circumstances may make them vulnerable

Good

Updated 8 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 those with a learning disability. We were told that homeless patients could register at the practice.
  • 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. Carers for these patients were invited to attend and offered an assessment.
  • 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.