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Archived: Bank House Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bank House Surgery on 4 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.
  • Verbal consent was obtained and recorded in patients records. However, written consent was not obtained for procedures such as the insertion of an intrauterine contraceptive device (IUCD).

  • 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.

We saw an area of outstanding practice:

  • The practice had introduced a new initiative where the Practice Nurse attended an annual late afternoon tea with the clients in three local residential care homes for patients with learning difficulties. After tea, the nurse conducted the annual review for patients and administered injections such as the flu vaccination. This initiative enabled the practice to get a holistic picture of their patients in their home environment; helped to build relationships and reduced the anxiety of the patients. It also overcomes problems such as arranging transport to appointments, carers being taken away from the home on escort duty and patients missing attendance at day centres.

There were areas where the provider should make improvements:

  • The provider should obtain written consent from patients prior to carrying out procedures such as the insertion of an intrauterine contraceptive device (IUCD).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 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 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 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes were above or comparable to the local and national averages. Exception reporting for most indicators was below the local and 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.

Caring

Good

Updated 11 January 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 the local and national averages 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 confidentiality of patient information.

  • The practice had identified 85 patients as carers (3% of the practice list). A patient liaison officer was available to provide advice, support and written information to direct carers registered at the practice to the various avenues of support available to them.

Responsive

Good

Updated 11 January 2017

The practice is rated as good for providing responsive services.

  • The practice had introduced a new initiative where the Practice Nurse attended an annual late afternoon tea with the clients in three local residential care homes for patients with learning difficulties. After tea she conducted annual reviews and administered injections such as flu vaccinations.

  • 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 were usually able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice had satisfactory facilities and was 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.

Well-led

Good

Updated 11 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 and procedures to govern activity and held regular staff 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 provider encouraged a culture of openness and honesty.

  • The practice had systems in place for the reporting and investigation of 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 practice had developed and introduced WE Care(Workforce and Employers Care). An initiative set up by  practice staff to provide an informal network for carers in the workforce across the organisation. The aim was to provide support to each other and share ideas as to how they could improve the experience of carers both for their employees and their patients.

  • The patient participation group was active and contributed to the development of the practice improvement programme.

  • 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 January 2017

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

  • GPs worked closely with practice nursing staff and community specialist nurses in the management of patients with long-term conditions.

  • Patients at risk of hospital admission were identified as a priority.

  • The practice performance rate for the Quality Outcomes Framework (QOF) diabetes related indicators was above the local and national average.  

  • Longer appointments and home visits were available when needed.

  • 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. These patients were discussed at the quarterly multi-disciplinary team meetings.

Families, children and young people

Good

Updated 11 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 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.

  • Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this. The practice had produced an information leaflet for young people explaining how to use the services provided by the practice.

  • The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages.

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

  • We saw positive examples of effective joint safeguarding working.

Older people

Good

Updated 11 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.

  • Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local and national averages.

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

Working age people (including those recently retired and students)

Good

Updated 11 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.

  • Extended hours appointments were available at the surgery one evening a week.

  • The practice was proactive in offering online services.

  • A full range of health promotion and screening services were provided that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 January 2017

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

  • 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local average of 83% and national average of 84%.

  • 100% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was above the local average of 84% 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 advised patients experiencing poor mental health how to access various support groups and voluntary organisations.

  • A counsellor provided a clinic at the surgery once a week.

  • 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 is a member of the Bromley Dementia Action Alliance (a movement formed to support and encourage communities and organisations to take action to assist people with dementia to live well and to reduce the need for crisis intervention.

    )

People whose circumstances may make them vulnerable

Outstanding

Updated 11 January 2017

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

  • The Practice Nurse attended an annual late afternoon tea with the clients in three local residential care homes for patients with learning difficulties. After tea she conducted annual reviews and administered injections such as flu vaccinations.

  • 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 and annual reviews for patients with a learning disability which was available through a home visit if requested to avoid stress to the patient. In the current year all patients on the learning disability register 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.