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Trevelyan House Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grafton Medical Partners on 9 November 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 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. Most 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 could make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Some patients reported difficulty getting through to the practice on the telephone.
  • 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.

We saw several areas of outstanding practice:

  • The practice provided the over 75s with an information pack which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

  • The practice organised a Christmas Jumper Day and a raffle, the proceeds were used to fund transport for older patients who experienced difficulties in getting to and from the practice.

The areas where the provider should make improvement are:

  • Ensuring all staff, including locums, have role specific training.

  • Ensure the new phone system is introduced and continue to monitor patient feedback in relation to accessing the service.

  • Ensure complaints are responded to in line with the practice’s own policy.

  • Ensure policies and procedures are kept up to date with relevant contact details.

  • Review the process for identifying carers and the support that is provided for them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 January 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 defined systems, processes and practices in place to keep patients safe and safeguarded from abuse, however not all staff members had received training in basic life support or fire training. The practice had organised before the inspection for staff to attend training on 30 November 2016.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 30 January 2017

The practice is rated as good for providing effective services.

  • 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.

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

Caring

Good

Updated 30 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (which groups all three Grafton Medical Partners practices in Wandsworth) showed patients rated the practice as below average 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 30 January 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 commissioned a citizens advice service weekly for all Grafton Medical Partners’ Wandsworth patients, due to the level of social needs required by the practice’s population group, they offered general advice on a range of issues including housing and benefits

  • Some patients said they found it hard to make an appointment with a named GP however there was continuity of care, with urgent appointments available the same day. Some patients reported difficulty with getting through to the practice on the telephone.

  • 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; however the practice did not always follow its policy and acknowledge complaints within three days.

Well-led

Good

Updated 30 January 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, however some of these needed to be updated, for example the fire and health and safety policy had out of date staffing details. Not all policies procedures were followed for example the complaints policy.

  • Regular governance meetings were held.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.

  • 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 30 January 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.

  • There were 1688 patients on the diabetes register.

  • Performance for diabetes related indicators was comparable. For example, 68% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 78%.

  • 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.

  • The practice provided an in-house anticoagulation (anticoagulation is the monitoring for patients on medicines such as Warfarin that helps prevent blood clots.

Families, children and young people

Good

Updated 30 January 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 Accident and Emergency (A&E) attendances.

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

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

  • Cervical screening had been carried-out for 92% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%.

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

  • We saw positive examples of joint working with midwives, and health visitors.

  • The practice was able to refer to a local service for family planning treatment and information if family planning services were not accessible at one of the other Grafton Medical Partners practices.

  • The practice had an in-house AQP (Any Qualified Provider) ultrasound service, meaning patients could aThere were appointments up to 7.30pm

  • The practice offered double appointments for parents with young children.

Older people

Good

Updated 30 January 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.

  • The practice had a dedicated telephone line between 10am and 12pm named the ‘Blue Star Line’ for patients aged 75 and over or those on the practice’s avoiding unplanned admissions register, to ensure swift access to appointments.

  • The practice employed an in-house pharmacist to assist with medicine reviews, many of which supported elderly patients.

  • An information pack for the 75’s was provided, which included a booklet produced in conjunction with the Patient Participation Group (PPG), entitled ‘Local Services for Older People’. This contained detailed information about support and welfare services, social services, voluntary organisations and support for ethnic minority groups.

  • The practice had an in-house phlebotomy service with a dedicated phlebotomist.

  • The practice organised a Christmas Jumper Day and a raffle, the proceeds were used to fund transport for older patients who experienced difficulties in getting to and from the practice.

  • Annual health checks were offered to patients over 75.

Working age people (including those recently retired and students)

Good

Updated 30 January 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 and screening that reflects the needs for this age group.

  • The practice provided extended hours and was open until 8pm four evenings a week and every Saturday morning 9am to 1pm.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 January 2017

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

  • Seventy seven percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.

  • Performance for mental health related indicators was in line with the CCG and national averages for the number of patients who had received an annual review, which was 90% compared to the CCG average of 91% and national average of 88%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • 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.

  • The practice provided access to in-house counselling, psychotherapy and group therapy at another Grafton Medical Partners practice in Tooting as well as being able to refer to local psychological therapy services.

People whose circumstances may make them vulnerable

Good

Updated 30 January 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.

  • For 2015/16, the practice had identified 97 patients on the learning disabilities register and 57 had received an annual check, which was 59%.

  • There were longer appointments available for vulnerable patients including those requiring translation services and those with a learning disability.

  • The practice offered face-to-face and telephone interpreting services for patients whose first language was not English, and for sign language.

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

    The practice commissioned a citizens advice service weekly due to the level of social needs required by the practice’s population group. They offered general advice on a range of issues including housing and benefits.

  • 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.