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Dr Gillian Gertner Good Also known as Rosslyn Hill Practice

Inspection Summary


Overall summary & rating

Good

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 7 March 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.
  • Data showed that the practice was performing consistently better than expected when compared with similar services.
  • Feedback from patients about their care was consistently positive.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said it was easy to make an appointment, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice team had clearly-defined roles and staff felt supported by the Provider.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice was aware of and complied with the requirements of the Duty of Candour.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was an active patient participation group.

The practice should –

  • Continue to review patients’ access to the service, particularly regarding practice opening hours.
  • Continue with work to identify patients who are carers and update its records accordingly.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 May 2016

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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology.
  • 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 11 May 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all staff were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices in the local area and nationally. This included data collated by the local Healthwatch team which showed the practice to be the top performer in the CCG area in relation to clinical figures for cancer, diabetes, chronic diseases, cardiovascular disease and dementia.

  • Flu vaccination rates were above local and national averages. The practice was the highest achiever among the CCG practices relating to vaccinations of at-risk patients and pregnant women and the fourth highest for patients aged over-65.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. For example, an audit of Repeat Dispensing to optimise repeat prescriptions led to improvement of 52%, the highest achievement among the local practices.

  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 11 May 2016

The practice is rated as good for providing caring services.

  • Results from the National GP Patient Survey were comparable with local and national averages.

  • 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 11 May 2016

The practice is rated as good for providing responsive services.

  • 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.

  • Results from the GP patients’ survey suggested that practice opening hours was a concern for some patients. The practice was monitoring this and taking action to address the concerns, for example by encouraging the uptake of telephone consultations.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Although there were no posters providing information on how to make a complaint, we saw that forms were available in the reception area and were provided upon request. The form was 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 11 May 2016

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 this.
  • 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 knowing about 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 11 May 2016

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

  • The practice maintained a register of 53 patients on the diabetes register, of whom 50 (94%) had received an annual eye check and foot check.

  • Nine out of 10 patients on the practice’s heart failure register had had a medication review.

  • Longer appointments were routinely made to review patients with long-term conditions and home visits were available when needed.

  • The flu vaccination rate for at risk patients was higher than the national average, for example for diabetic patients the rate was 96% and for patients with chronic obstructive pulmonary disease it was 100%.

  • All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the Provider worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 11 May 2016

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. Immunisation rates were relatively high for all standard childhood immunisations.
  • The percentage of patients with asthma on the register who had an asthma review in the preceding 12 months was above the national average.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The rate of uptake for cervical screening tests was above the national average.
  • 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, health visitors and social workers.

Older people

Good

Updated 11 May 2016

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

  • The practice kept a register of 38 patients identified as being at high risk of admission to hospital. All of whom had had their care plans reviewed.
  • 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.
  • Records showed that 200 (90%) of the 222 patients prescribed more than four medications had received a structured annual review.
  • Records showed that 29 (40%) of 72 patients had been offered cognition testing. The practice had identified that further work could be done and was inviting patients for the test as well as offering the testing opportunistically when patients attended the surgery.
  • The flu vaccination rates for older people were above the local and national averages.
  • Data showed the practice had administered shingles vaccinations to 87% of eligible patients aged over-70.

Working age people (including those recently retired and students)

Good

Updated 11 May 2016

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.

  • Records showed that 617 patients (85% of those eligible) had had a blood pressure check.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 May 2016

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

  • All seven patients on the dementia register had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average, and evidence showed that advanced care planning was carried out for all.

  • The practice maintained a register of 26 patients with schizophrenia, bipolar affective disorder and other psychoses; 22 of whom had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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 11 May 2016

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

  • The practice maintained registers of vulnerable adults (12 patients); vulnerable children and homeless patients, who were able to register at the practice address to receive health care related correspondence.
  • The practice had a register of four patients with learning disabilities, all of whom had had an annual assessment and care plan review.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.