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Inspection Summary


Overall summary & rating

Good

Updated 28 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Street Practice on 11 October 2016. 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 an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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 and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

  • Continue to monitor and ensure actions are taken to improve patient satisfaction with access to routine appointments and answering of the reception telephones.

  • Ensure that infection control standards are reviewed and maintained and that staff toilet facilities have hot water.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 June 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place 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 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 in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 28 June 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.

  • Clinical audits demonstrated quality improvement.

  • 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.

  • Five of the practice nurses were prescribers.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 28 June 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.

  • Comprehensive advice and signposting to a number of organisations that provided patient support was displayed in the waiting room alongside a patient information screen which provided health promotion advice.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 28 June 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 (CCG) to secure improvements to services where these were identified. For example, the practice took part in a local social prescribing initiative. This is where patients with non-medical issues, such as financial debt or loneliness, could be referred by a GP to a single hub for assessment to find which alternative service might be of benefit.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

  • The practice nurse consultant implemented a chronic obstructive pulmonary disease service and had set up a ‘Breathe Easy Support Group’ for patients locally. (COPD is the name for a collection of lung diseases, including chronic bronchitis and emphysema).

  • Patients can access appointments and services in a way and at a time that suits them. Patients could also request to be seen at a time preferable to them outside of generic clinic slots. However, patients advised that they often had to wait at least four weeks for a routine appointment with a named GP.

  • The practice participated in a CCG led initiative called Choice Plus which allowed additional emergency slots to be available for patients to be seen at an alternative local practice.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had secured new premises which had been purpose built and they were aiming to relocate by the end of 2016.

  • The practice GPs visited four local care homes on a fortnightly basis to see patients and carry out annual reviews, medication reviews and end of life planning.

  • The care home staff had received training to enhance patient care which was delivered by practice staff.

  • The practice was a C-card centre (a scheme designed to increase the access and availability to free condoms and chlamydia screening for young patients under 25).

  • There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met those needs. For example, the practice employed a practice pharmacist to support optimal medicines management for patients.

  • The practice held weekly sexual health drop in clinics for young patients. (A Department of Health initiative to encourage young people to utilise a friendly health service and has a set of criteria that health services must to meet to be accredited).Patients who used this service did not have to be registered at the practice.

  • 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 28 June 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 a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which 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 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.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 28 June 2017

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

  • Nursing staff had lead roles in chronic disease management and ran the following clinics: diabetes, asthma and chronic obstructive pulmonary disease (COPD). Longer appointments of 30 minutes were given for those clinics. Patients at risk of hospital admission were identified as a priority.

  • Performance in 2014/15 for overall diabetes related indicators was 90% which was below the clinical commissioning group (CCG) average of 95% and above the national average of 89%.

  • Diabetes was managed by a dedicated team at the practice with some of the practice nurses and a GP who had expertise in this area. Six monthly reviews with the nursing team were carried out with referral on to a GP if needed. All patients in this group were invited to an annual retinal screening appointment.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and 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 28 June 2017

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 91% which was above both the clinical commissioning group (CCG) average of 84% and the national average of 82%.

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

  • A midwife team held clinics at the surgery once a week.

  • The practice held weekly sexual health drop in clinics and had received a “You’re Welcome” award in recognition of the service they provided to young patients. (A Department of Health initiative to encourage young people to utilise a friendly health service and has a set of criteria that health services must to meet to be accredited).These patients did not have to be registered at the practice to be seen .

  • We saw positive examples of joint working with midwives, health visitors and school nurses, multi-disciplinary meetings attended by community staff were held every six weeks.

  • The practice offered a family planning and sexual health service with a fully qualified sexual health nurse and a GP with specialised interest in women’s health and family planning who assessed patient need, initiated treatments and offered ongoing monitoring of all family planning and sexual health needs.

Older people

Good

Updated 28 June 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

  • The practice visited four local care homes on a fortnightly basis to see patients and carry out annual reviews, medication reviews and end of life planning.

  • All patients over the age of 75 were invited or were visited by a GP for a comprehensive assessment, including long term chronic disease management, assessment for frailty and dementia screening, and individualised personal care planning.

Working age people (including those recently retired and students)

Good

Updated 28 June 2017

The practice is rated as good for the care of working-age patients (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 and screening that reflects the needs for this age group.

  • Extended hours appointments were available on Tuesday and Thursday evenings for working age patients to attend outside of working hours.

  • The practice offered telephone consultations for all patients which was useful for working age patients.

  • Patients were invited either to hypertension annual screening, or if aged over 40. patients were invited for a vascular health screening assessment.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 June 2017

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

  • 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (2014/15), which was above both the clinical commissioning group (CCG) average of 86% and the national average of 84%.

  • Overall performance for mental health related indicators in 2014/15 was 100% compared to the CCG average of 97% and national average of 82%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice hosted a weekly clinic led by a mental health gateway worker.

  • The practice carried out advance care planning for patients with dementia. Patients were invited to attend a specialised clinic for an annual review with a nurse. This clinic helped manage patients with complex care needs including dementia, frailty or multiple long term conditions.

  • 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 28 June 2017

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Patients and carers were invited to attend an annual review with a practice nurse who was experienced in learning disability and mental health assessments.

  • The practice offered longer appointments for patients with a learning disability and 91% of these patients on their register had received an annual health check and 81% had a written care plan in 2015/16.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • 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. The practice held quarterly multi-disciplinary meetings with the health visitor to discuss at risk children.