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Inspection Summary


Overall summary & rating

Good

Updated 23 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Edith Cavell Surgery on 23 November 2016. Overall the practice is rated as good.

  • 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. 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 practice held annual virtual clinics for respiratory, cardiovascular and diabetes patients.
  • The practice provided outreach services on health promotion at the local library annually, to promote health awareness and encourage early detection and treatment of diseases.
  • The practice was open seven days a week.

We saw several areas of outstanding practice:

  • The practice had launched an interactive on-line messaging system called “message my GP”. Any patient who sent a message to the GP would be responded to within 24 hours.
  • The practice provided a “frontline clinic” where a GP sat in reception on a daily basis and triaged patients, this improved patient access in a variety of ways.

  • The practice had identified that some patients from the Muslim community were apprehensive about seeking support for mental health related issues. To address this it worked in partnership with a charity and produce a video, specially aimed at Muslim patients to address the mental health stigma. The aim of the service was to provide a different method of support to patients and highlight the awareness of depression and getting help. The video was widely rolled out and played at over 50 practices around London.

The areas where the provider should make improvement are:

  • Review patient survey scores in relation to patient involvement in decision-making.

  • Continue to identify carers to ensure appropriate support can be offered.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 March 2017

The practice is rated as good for providing safe services.

  • There was a comprehensive effective system in place for reporting and recording significant events, staff understood their responsibilities to raise concerns.

  • 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.

  • Medicines were well managed, there was emergency equipment including a defibrillator and oxygen.

Effective

Good

Updated 23 March 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.

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

  • Dashboards were used as a method to benchmark and compare the practice with other AT Medics practices as well as Clinical Commissioning Groups (CCG) and national audits.

  • Every year respiratory, cardiovascular (with an atrial fibrillation, heart failure or hypertension focus) and diabetes virtual clinic were held whereby consultants would review patients.

Caring

Good

Updated 23 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the average with 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.

  • In 2015 the practice held a dedicated carers event week in honour of the Nurse Edith Cavell who the practice was named after.

  • The practice hosted a carers coffee afternoon, in conjunction Lambeth Carers Hub, providing partnership working in the locality, signposting and promoting carers.

  • The practice provided outreach services on health promotion at the local library annually, to promote health awareness and encourage early detection and treatment of diseases.

Responsive

Outstanding

Updated 23 March 2017

The practice is rated as outstanding 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.

  • 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.

  • 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.

  • The practice had a predominantly working age population profile and was open between 8am and 8pm Monday, Tuesday, Wednesday and Friday, Thursday 8am to 1pm, Saturday and Sunday 9am to 12pm.

  • The practice actively sign posted and promoted on-line service ranging from booking appointments, ordering repeat prescriptions, messaging GPs, obtaining test results and patients could have access to their medical records.

  • The practice worked in partnership with a charity, specially aimed at Muslim patients to address the mental health stigma, and produced a number of videos in different languages (Somali, Urdu and Bengali/Sylheti) to help patients understand what support is available, the video had been rolled out to 50 other practices.

  • The practice provided a “frontline clinic” where a GP sat in reception on a daily basis and triaged patients.
  • The practice had launched an interactive on-line messaging system called “message my GP”. Any patient who sent a message to the GP would be responded to within 24 hours.
  • The practice looked after a women’s hostel, and took the initiative to work with the health inclusion team, including the community nursing team. They visited disadvantaged patients such as night workers, offered blood tests, and hepatitis B vaccinations for patients who did not want to come to the surgery.

Well-led

Good

Updated 23 March 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. Several staff members had been given the opportunity to progress from reception roles to management positions.

  • The practice conducted several on-line training role play videos to aid non-clinical staff in dealing with patients in different circumstances ranging from how to deal with a complaint to obtaining a sick note, to signposting patients for different services.

Checks on specific services

People with long term conditions

Good

Updated 23 March 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.

  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 83%, which was 3% above the CCG average and 3% above the national average. The exception rate for the practice was 7%, the CCG was 9% and national rate was 12%.

  • 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.

  • Every year respiratory, cardiovascular (with an atrial fibrillation, heart failure or hypertension focus) and diabetes virtual clinics were held whereby hospital consultants would review patients.

  • Patients were monitored through an internal dashboard, with weekly targets to check achieved number of patient recalls and target blood test results.

Families, children and young people

Good

Updated 23 March 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. We saw evidence to confirm this.

  • Cervical screening had been carried out for 82% of women registered at the practice aged 25-64, which was comparable to the CCG average of 80% 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.

  • Same day appointments were always offered to children.

  • Patients on the Child Protection and Child In Need register were reviewed quarterly, and individualised plans were created.

Older people

Good

Updated 23 March 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.

  • Primary Care Navigators were used to support patients by providing options to prevent loneliness, depression and isolation, using services such as Age UK, befriending services and bereavement services.

  • Flu vaccinations were offered to all over 65s. The percentage of uptake was in line with the CCG rates.
  • Health assessments were carried out for older patients.

Working age people (including those recently retired and students)

Outstanding

Updated 23 March 2017

The practice is rated as outstanding 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 reflected the needs for this age group.

  • On-line access was available to patients to book appointments and request repeat prescriptions.

  • Extended hours were offered four days a week from 6.30pm to 8pm and on the weekend from 9am to12pm.

  • Telephone appointments and e-consultations were available, as well as an on-line messaging system which was responded to within 24 hours.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 23 March 2017

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

  • 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months,

  • 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.

  • Quarterly mental health reviews, as well as annual physical health checks were conducted.

  • The practice worked in partnership with a charity, specially aimed at Muslim patients, and produced a series of multi-lingual video based educational resources to address the mental health stigma, the aim of the service was to provide a different method of support to patients.

People whose circumstances may make them vulnerable

Good

Updated 23 March 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.

  • The practice offered longer appointments for patients with a learning disability. There were eighteen patients on the practice register; six had received an annual review.

  • 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.

  • Interpreters were offered, the practice website and arrivals kiosk was accessible and displayed information in a range of languages.

  • Two women’s hostels were looked after by the practice.

  • An onsite substance misuse counsellor visited weekly.