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Inspection Summary


Overall summary & rating

Good

Updated 29 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingswood Surgery on 14 June 2017. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

  • The ethos and culture of the practice was to provide a good quality service and care to patients.

  • Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • The practice was able to meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
  • Patients reported they were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.

  • The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

  • The practice had a culture of openness and honesty which was reflected in their approach to safety.

  • Risks to patients were assessed and well managed.

  • There were comprehensive safeguarding systems in place; particularly around vulnerable children and adults.

  • The practice sought patient views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the Paient Participation Group (PPG).

  • There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive

  • The practice was forward thinking, aware of future challenges and were open to innovative practice.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Continue to make improvements in response to the patient survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 August 2017

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed

  • There were systems in place for reporting and recording significant events. There was a nominated lead who dealt with them overall. Lessons learned were shared to ensure action was taken to improve safety in the practice.

  • There was a nominated lead for safeguarding children and adults. Comprehensive systems were in place to keep patients and staff safeguarded from abuse. We saw laminated posters displaying safeguarding information and contact details, in all the consulting and treatment rooms.

  • There were processes in place for the safe management of medicine. The practice received support from Harrogate and Rural District Clinical Commissioning Group (CCG) pharmacy team.

  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.

  • There was a nominated lead for infection prevention and control.

  • The clinicians had weekly meetings where they discussed a range of clinical issues and significant events, in a timely manner. Any learning was then shared with the practice team.

Effective

Good

Updated 29 August 2017

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the need of patients and delivered care in line with current evidence based guidance.

  • Staff worked with other health and social care professionals, to meet the range and complexity of people’s needs.

  • End of life care was delivered in a coordinated way.

  • Clinical audits were undertaken and could demonstrate quality improvement.

  • Published data from the Quality and Outcomes Framework (QOF) showed that patient outcomes had been local and national figures.

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

  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.

Caring

Good

Updated 29 August 2017

The practice is rated as good for providing caring services.

  • The practice had a strong patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion.

  • Data from the National GP patient survey showed that patients rated the practice comparable or slightly better than other local practices. Patient comments we received were positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • When a GP was notified of a patient’s death this was followed up with a telephone call or home visit to the next of kin by the clinician best known to the patient.

Responsive

Good

Updated 29 August 2017

The practice is rated as good for providing responsive services.

  • The practice worked with Clinical Commissioning Group (CCG) and other local practices to review the needs of their population.

  • National GP patient survey responses and the majority of comments made by patients and showed they found it easy to make an appointment.
  • The practice offered pre-bookable, same day and online appointments. They also provided telephone consultations.
  • Home visits and longer appointments were available for patients who were deemed to need them, for example housebound patients or those with complex conditions.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.

  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions, including those people living with dementia.

Well-led

Good

Updated 29 August 2017

The practice is rated as good for being well-led.

  • There was a clear leadership structure and a vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There were safe and effective governance arrangements in place. These included the identification of risk and policies and systems to minimise risk.
  • The provider had a good understanding of, and complied with, the requirements of the duty of candour. There were systems in place for reporting notifiable safety incidents and sharing information with staff to ensure appropriate action was taken.
  • The practice promoted a culture of openness and honesty.
  • Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. The practice proactively sought feedback from patients, the Patient Participation Group (PPG) and the NHS Friends and Family Test.
  • Staff informed us they felt well supported by the GP partners and practice management.
  • All staff had access to policies and procedures via the computer system.
Checks on specific services

People with long term conditions

Good

Updated 29 August 2017

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

  • The GPs had lead to check patients’ health care and treatment needs were being met.

  • The practice identified those patients who had complex needs. The practice ensured that those patients with life limiting conditions were on the palliative care register. These patients were reviewed at meetings to ensure the correct support and care was delivered.

  • The latest published QOF data (2015/16) showed the practice had achieved 97% of the total number of points available compared to a CCG average of 99% and a national average of 95%

Families, children and young people

Good

Updated 29 August 2017

The practice is rated as good for the care of families, children and young people.

  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group

  • Contraceptive services were available in the practice.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

  • Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals.

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

  • Immunisation rates were at or similar to the national rates for all standard childhood immunisations.

  • Systems were in place to follow up any children who had failed to attend for routine vaccinations.

  • Data showed that 79% of eligible patients had received cervical screening (CCG average 83% and national average 81%).

  • Appointments were available with both male and female GPs.

Older people

Good

Updated 29 August 2017

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

  • The practice provided proactive, responsive and care to meet the needs of the older people in its population.

  • The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.

  • The practice participated in Harrogate and Rural Clinical Commissioning Group (CCG) initiatives to reduce the rate of acute admission to hospital.

  • Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.

  • Patients were signposted to other local services for access to additional support.

Working age people (including those recently retired and students)

Good

Updated 29 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these patients 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 a range of health promotion and screening that reflected the needs for this age group.

  • Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.

  • Students were offered public health recommended vaccinations prior to attending university.

  • The practice utilised electronic booking of appointments, prescribing and telephone appointments to provide improved access for working people.

  • Some extended hours appointments were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 August 2017

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

  • The practice regularly worked with multidisciplinary teams in the case management of people in this population group,

    for example the local mental health team.

  • Longer appointments were available for patients with a mental health condition.

  • Patients and/or their carer were given information

    on how to access various support groups and voluntary organisations.

  • Staff had a good understanding of how to support patients with mental health needs or dementia and offered flexible appointments.

  • Where patients had been assessed as needing Deprivations of Liberty Safeguards, these were written in the patient’s clinical notes.

People whose circumstances may make them vulnerable

Good

Updated 29 August 2017

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

  • Staff knew how to recognise signs of abuse. They 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 could evidence a number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will work together to help to keep a child safe).

  • Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.

  • Longer appointments were offered to people with a learning disability.

  • The surgery had wheelchair access and a portable hearing loop

  • The practice encouraged carers to make themselves known to the practice

  • We saw there was information available on how patients could access various local support groups and voluntary organisations.