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Inspection Summary


Overall summary & rating

Good

Updated 11 January 2017

We carried out an announced comprehensive inspection at Dr Rahil's Surgery 17 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Data showed that outcomes for patients at this practice performed better when compared to local and national data.

  • Feedback from patients about their care was consistently and highly positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Staff felt well supported in their roles and had undergone a regular appraisal of their work.
  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and responded to them compassionately and constructively.
  • The practice had a clear vision which had quality and safety as its top priority.
  • The practice had strong and visible clinical leadership and governance arrangements.

There were areas where the practice could make improvements. The practice should

  • Prioritise the replacement of fabric covered chairs in consulting rooms.

  • Provide chaperone training and updated policy guidance to staff.

Letter from the Chief Inspector of General Practice

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. Staff learnt from significant events and this learning was shared across the practice.

  • When things went wrong patients received support and an 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. Risks to patients were assessed and well managed.

  • The practice had a well-established staff team and staff recruitment checks had been carried out appropriately.

  • Systems for managing medicines were effective and the practice was equipped with a supply of medicines to support people in a medical emergency.

Effective

Good

Updated 11 January 2017

The practice is rated as good for providing effective services.

  • Patients’ needs were assessed and care was planned and delivered in line with best practice guidance.

  • The practice monitored its performance data and had systems in place to improve outcomes for patients. Data showed that outcomes for patients at this practice performed better when compared to local and national data. Staff worked alongside other health and social care professionals to understand and meet the range and complexity of patients’ needs.

  • Clinical audits were carried out to drive improvement in outcomes for patients.

  • Staff felt well supported and they had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

Caring

Good

Updated 11 January 2017

The practice is rated as good for providing caring services.

  • Patients gave us very positive feedback about the caring nature of staff. They told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

  • We saw that staff treated patients with kindness and respect, and maintained confidentiality. We noted that staff and clinicians were proud to work for the practice.

  • When we spoke with patients they told us they felt privileged to be patients at the practice and described how well cared for they felt when attending the practice.

  • Data from the national patient survey showed that patients rated the practice higher than others locally and nationally for all aspects of care. For example, for being treated with care and concern. This aligned with what patients told us and their positive experiences.

  • Information about the services provided was made readily available to patients.

  • The practice maintained a register of patients who were carers in order to tailor the services provided. The practice had a carers champion who supported patients to access support.

Responsive

Good

Updated 11 January 2017

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of the local population and worked in collaboration with partner agencies to secure improvements to services where these were identified and to improve outcomes for patients.

  • The appointment system was very responsive to patients’ needs.

  • Patients told us they found it easy to get an appointment. The majority of patients could get an appointment for the same day or the following day if required.

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

  • Information about how to complain was available and 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 vision and strategy to deliver high quality care and promote the very best 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. Levels of staff engagement were high, with staff speaking of how they were proud to work at the practice.

  • There were systems in place to govern the practice and support the provision of good quality care. This included arrangements to identify risks and to monitor and improve quality.

  • The provider encouraged a culture of openness and honesty and complied with the requirements of the duty of candour.

  • There was a strong focus on development and improvement linked to outcomes for patients.
Checks on specific services

People with long term conditions

Good

Updated 11 January 2017

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

  • The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

  • Data from 2014 to 2015 showed that the practice was performing above average in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes.

  • For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Longer appointments and home visits were available when needed. We saw that staff knew the practice population well and ensured any patients needing longer appointments had access to these when necessary.

  • The practice provided an in house phlebotomy service five days per week and patients were able to have blood collected at the practice.

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 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 above average 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.

  • Data for rates of cervical screening by the practice showed the percentage of women receiving this intervention was higher than local and national averages, at 84%. (Clinical Commissioning Group average (CCG) 83% and national average 81%).

  • Premises were suitable for children and babies and baby changing facilities were available.

  • Babies and young children were always offered an appointment as a priority and appointments were available outside of school hours.

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 and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

  • Patients over the age of 75 had a named GP and had received a structured annual review to check that their health needs were being met.

  • Care planning was carried out for patients with dementia care needs.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above average when compared to local and national averages.

  • Uptake of the flu vaccine amongst older patients was above average, with 90% of patients receiving the vaccine.

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 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. Online services included the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

  • Screening uptake for people in this age range was above national averages. For example 100% of females aged 50-70 had been screened for breast cancer in the last three years which was above the national average.

  • Extended hours appointments were provided until 8pm one evening per week each Wednesday.

  • Telephone consultations were provided daily. This was advantageous for people in this group as it meant they did not always have to attend the practice in person.

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).

  • Data about how people with mental health needs were supported showed that outcomes for patients using this practice were above average compared to local and national averages. For example, data showed that 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This compared to a national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. The GP is a specialist Mental Health Practitioner.

People whose circumstances may make them vulnerable

Good

Updated 11 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 those with a learning disability. The practice offered longer appointments for patients with a learning disability.

  • 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.

  • The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available for those that required them.

  • 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.