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Inspection Summary


Overall summary & rating

Good

Updated 24 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Townhill Surgery on 24 August 2016. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Townhill Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 29 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements, in relation to the breaches in regulations that we identified in our previous inspection on 24 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

  • Disclosure and Barring Service (DBS) checks were conducted on all new clinical members of staff, prior to starting employment.

  • Disclosure and Barring Service (DBS) checks were conducted on all existing members of staff, irrespective of their role.

  • The practice had placed posters in the waiting area, in an effort to identify carers or patients with caring responsibilities.

  • The practice had designed and produced a carers form, to identify carers or patients with caring responsibilities during their registration process.

At our previous inspection on 24 August 2016, we rated the practice as requires improvement for providing safe services as Disclosure and Barring Service (DBS) checks were not carried out on staff who were acting as chaperones.

In addition, we also found that the practice needed to develop an appropriate way of identifying carers, in order to offer more support.

At this inspection we found that Disclosure and Barring Service (DBS) checks had been carried out on all members of staff, and the practice had taken steps to identify carers or patients with caring responsibilities. Consequently, the practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 April 2017

The practice had taken appropriate action and is now rated good for the provision of safe services.

  • When we inspected the practice in August 2016, we found that appropriate Disclosure and Barring Service (DBS) checks were not carried out for staff undertaking chaperoning duties. Furthermore, the practice did not have an appropriate way of identifying carers, in order to offer more support.

At the inspection on 29 March 2017, the practice had demonstrated significant improvements in governance arrangements. For example:

  • The practice had taken steps to improve systems, processes and practices in place to keep patients safe and safeguarded from abuse. All staff, including those who acted as a chaperone had received a Disclosure and Barring Service (DBS) check.
  • Furthermore, the practice had ensured that all clinical staff, prior to starting employment had received a Disclosure and Barring Service (DBS) check.
  • Steps were taken to identify carers or patients with caring responsibilities within the practice.

Effective

Good

Updated 7 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the 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 7 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey 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.

Responsive

Good

Updated 7 October 2016

The practice is rated as good for providing responsive services.

  • 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.

  • 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 7 October 2016

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.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety 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 patient participation group was active.

  • There was a focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 7 October 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Nationally published data around the management of patients with diabetes showed that the practice was comparable to other practices.

  • 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 7 October 2016

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 relatively high 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, and we saw evidence to confirm this.

  • Nationally reported data showed that the practice had a comparable number of exceptions compared to the national average for women aged 25 – 64 whose notes recorded that a cervical screening test had been performed in the preceding five years.

  • 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 and health visitors.

Older people

Good

Updated 7 October 2016

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.

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

  • The practice offered domiciliary phlebotomy and INR blood testing for those who were unable to visit the practice.

Working age people (including those recently retired and students)

Good

Updated 7 October 2016

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 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.

  • Weekend appointments with GPs, nurses and healthcare assistants had been introduced to allow patients who were unable to attend health checks and appointments throughout the week to book an appointment at a convenient time.

  • The practice offered 24 hour blood pressure monitoring and ECG testing for patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 2016

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

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    92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, which is comparable to the national average.

  • 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice was registered as a dementia friendly practice.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 7 October 2016

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 travellers, patients with addictions and 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.

  • 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.