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Dr Richard Hyslop Good Also known as The Cole House Surgery

Inspection Summary


Overall summary & rating

Good

Updated 5 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Hyslop on 27 August 2015. Overall, the practice is rated as good for providing safe, effective, caring, responsive and well led services.

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.
  • Information about how to complain was available and easy to understand
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision about providing a quality and caring service in a safe way.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 November 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were robust safeguarding measures in place to help protect children and vulnerable adults from the risk of abuse. There were enough staff to keep people safe.

Effective

Good

Updated 5 November 2015

The practice is rated as good for providing effective services. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. NICE is the organisation responsible for promoting clinical excellence and cost-effectiveness. They produce and issue clinical guidelines to ensure that every NHS patient gets fair access to quality treatment.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity to provide services and promoting good health for all patients. Staff had received training appropriate to their roles and any further training needs had been identified and planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams to improve outcomes for patients.

Caring

Good

Updated 5 November 2015

The practice is rated as good for providing caring services. We observed throughout the inspection that members of staff were courteous and very helpful to patients both attending at the reception desk and on the telephone, and that people were treated with dignity and respect. Patients were very complimentary about the practice and commented that staff were very friendly, that they received excellent care from the GP and the nurse, and could always get an appointment when they needed one. Staff told us that both the GP and the practice nurse responded to patients’ needs and often this meant arranging to see patients after the practice had closed.

Staff told us that patients had been supported throughout particularly difficult times and described to us a number of occasions when they had done this. For example, there had been times when patient referrals for access to specific support had been made but had not been immediately available to them. The GP and nurse had often supported patients through a mental health crisis or safeguarding issue as a result. They had monitored and supported the patient during and after their crisis by giving them time or counselling to help them make progress.

Results from the national GP patient survey 2014 showed the practice scored well above average results in relation to patients’ experience and the satisfaction scores on consultations with the GP and the nurse; 97% said the GP was good at listening to them compared to the Clinical Commissioning Group (CCG) average of 89% and national average of 89%; 100% said they had confidence and trust in the last GP they saw compared to the CCG average of 95% and national average of 95%; 98% said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 86% and national average of 85%; 90% said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 91% and national average of 90%; and 100% of patients said they found the receptionists at the practice helpful compared to the CCG average of 85% and national average of 87%.

Eleven patients told us they were treated with compassion and were involved in decisions about their care and treatment. They commented they had nothing but praise for the GP, who they said was dedicated to the patients. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Patients completed 43 comment cards which gave positive comments about the standard of care received. Patients were very complimentary about the practice and commented that staff were very friendly, that they received excellent care from the GP and the nurse, and could always get an appointment when they needed one.

Responsive

Good

Updated 5 November 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found they were able to make an appointment with the GP and that there was continuity of care, with urgent appointments available the same day.

Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 5 November 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group (PPG) and responded to feedback from patients about ways that improvements could be made to the services offered. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 5 November 2015

The practice is rated as good for the care of people with long-term conditions. The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients diagnosed with a long term condition had a named GP and a structured annual review to check that their health and medicine needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 5 November 2015

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 of abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances.

Childhood immunisation rates were similar to or higher than the local Clinical Commissioning Group (CCG) averages, with 100% take up for 14 of these.

The practice nurse carried out six week baby checks as well as post-natal checks for mothers. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.

Appointments were available outside of school hours and the premises were suitable and accessible for children, with changing facilities for babies. We saw good examples of joint working with midwives, health visitors, school nurses and district nurses. The practice also offered a number of online services including booking appointments and requesting repeat medicines.

Older people

Good

Updated 5 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice also arranged blood tests for patients at home where they were unable to get to the hospital. Health checks were carried out for all patients over the age of 75 years.

Working age people (including those recently retired and students)

Good

Updated 5 November 2015

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 offered weekly evening extended hours so that patients could access appointments around their working hours. We learned that the GP stayed at the end of the day to make sure all patients needing to be seen on the same day received an appointment.

The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs for this age group. The practice nurse had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advanced care planning and annual health checks for patients with dementia and poor mental health. The GP and practice nurse understood the importance of considering patients ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.

The practice had completed care plans for a high proportion of its patients experiencing poor mental health (90% compared with the national average of 86.04%) and was proactive in monitoring their smoking and alcohol status in addition to their general health.

The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

For example, there had been times when patient referrals for access to specific support had been made but had not been immediately available to them. The GP and nurse had often supported patients through a mental health crisis as a result. They had monitored and supported the patient during and after their crisis by giving them time or counselling to help them make progress. The GP and practice nurse told us they would always see the patient and give them time whether they had an appointment or not.

People whose circumstances may make them vulnerable

Good

Updated 5 November 2015

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 patients with a learning disability. For example, the practice had carried out annual health checks and offered longer appointments for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments.

Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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.

Staff told us that patients had been supported throughout particularly difficult times and described to us a number of occasions when they had done this. For example, we were told about safeguarding issues had occurred where the GP and the practice nurse had provided support and counselling over and above usual provision to ensure patients remained safe from the risk of harm. This had often been out of hours or when surgeries had ended for the day. There had been a number of times when the GP had visited patients on their way home as part of the support they provided.