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Inspection Summary


Overall summary & rating

Good

Updated 15 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Asad Zaman practice on 9 November 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. 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. 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 a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from patients, which it acted on. The practice had patient participation group which supported practice development.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • There was a strong team culture and the practice was cohesive and organised.

There were improvements the provider should make.

  • The practice should take action to address the lower than average ratings for national cancer screening.

  • The practice should consider how they can increase the number of carers registered at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 February 2017

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning were maximised and learning was based on analysis and investigation.
  • When things went wrong patients received 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. The practice held quarterly safeguarding meetings with health visitors

  • Risk management was comprehensive and well managed and recognised as the responsibility of all staff.

Effective

Good

Updated 15 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that the practice was performing highly when compared to practices locally and nationally.

  • The practice was pro-active in identifying patients at risk of an unplanned hospital admission and regularly reviewed their health. These patients were reviewed by the GP, care plans were updated and the GP visited the patient at home or they were sent an appointment to visit the practice. To support the reduction of A/E attendances, the screen in the waiting room informed patients what services they should contact for various conditions, for example over the counter remedies for ‘coughs and colds’, walk in centres and out of hour centres.

  • The practice had a structured system in place to ensure that all clinicians were up to date with both national and other locally agreed guidelines.

  • Clinical audits demonstrated quality improvement and were triggered by new guidance and learning from significant events.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff members throughout the practice had lead roles across a range of areas and were committed to working collaboratively.

  • The practice employed two specialist nurses for Diabetes and COPD management.

  • There was evidence of appraisals, personal development plans and succession planning for all staff.

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

Caring

Good

Updated 15 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published July 2016 showed patients rated the practice higher than others 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 patient and information confidentiality.

  • The practice worked with local support services such as citizen’s advice to provide advice and support to their patients.

  • The practice had promoted a ‘Social Prescription’ this is a process to identify and support vulnerable patients such as patients who are dealing with isolation and low levels of health and wellbeing. It provides GPs with the option of making non-medical referrals for patients alongside existing treatments.

  • The practice had information on the screen in reception giving patients advice on how to make the best use of the 10 minute consultation. Patients told us this had been very beneficial.
  • The practice should consider how they can increase the number of carers registered at the practice to ensure any health needs are identified and appropriate support is in place.

Responsive

Good

Updated 15 February 2017

The practice is rated as good 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. Clinical staff carried out home visits for patients that would benefit from these.

  • 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. Thirty minute appointments were available for vulnerable patients.

  • 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 were proactive in taking action to improve areas in the national GP survey that were below the local and national average.

  • The practice offered a range of clinical services which included care for long term conditions.

Well-led

Good

Updated 15 February 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.

  • Throughout our inspection we received positive feedback from staff. Staff spoke highly of the culture of the practice and were proud to be part of the practice team.

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

  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 15 February 2017

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

  • For the past two years, prior to QOF requirements the practice were proactive in the management of diabetes and had developed a register for pre-diabetic patients. There were 256 patients on the list 5.6% of the practice patient list.

  • The practice employed two specialist nurses for the management of Diabetes and COPD.

  • Performance for diabetes related indicators was 97% compared to the CGC average of 90% and the national average of 89%For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 96% compared to the CCG average of 89% and the national average of 88%.The percentage of patients with diabetes, on the register, who have had influenza immunisation was 97% compared to the CCG average of 93% and the national average of 94%.

  • 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.

Families, children and young people

Good

Updated 15 February 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.

  • Childhood immunisation rates for the vaccinations given to under two year olds ranged from 90% to100%, which were higher than the CCG and national average

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 78% and the 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, health visitors and school nurses.

Older people

Good

Updated 15 February 2017

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

  • The GP and the healthcare assistant visited all the patients that were housebound to provide the flu vaccination and a clinical examination.

  • Housebound patients and patients with long term conditions were provided with a dedicated/priority phone number to contact the practice, the ambulance service also had this number.

  • The practice maintained a palliative care register and held quarterly palliative care meetings that included reviews of patients with other conditions for example, dementia and heart failure.

Working age people (including those recently retired and students)

Good

Updated 15 February 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 a full range of health promotion and screening that reflected the needs of this age group.

  • 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.

  • Appointments could be booked over the phone, face to face and online. The practice offered extended opening hours on Mondays, Tuesdays, Thursdays and Fridays.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 February 2017

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

  • Performance for mental health related indicators was 100% compared to the CCG average of 92% and the national average of 93%. With 11% exception reporting which was similar to the CCG and national average.

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was similar to the CCG and national average.
  • The practice had identified 20 patients who were at risk of self-harm and worked closely with the mental health team to manage the care of these patients.

  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice carried out advanced 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 A&E 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 15 February 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.

  • Thirty minute appointments were offered 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.

  • 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.
  • The practice had identified 42 patients as carers (0.9% of the practice list), this was low in comparison to the patient list size of 4,600. The practice should consider how they can increase the number of carers registered at the practice to ensure any health needs are identified and appropriate support is in place.