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Inspection Summary


Overall summary & rating

Good

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 'The Pembridge Villas Surgery' on 21 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services to the six population groups we inspect - People whose circumstances may make them vulnerable; Older people; People with long-term conditions; Families, children and young people; Working age people (including those recently retired and students); and People experiencing poor mental health (including dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

  • Risks to patients were assessed and well managed.
  • 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 good skill mix amongst the GPs with some clinicians having specialised areas of expertise.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment and were complimentary about the practice’s walk-in service as this accommodated patients who required urgent appointments the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff during practice meetings, appraisals, and away days.
  • A practice had an active patient participation group (PPG). The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the PPG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 August 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 who used services were assessed and well managed, such as those relating to infection control, medicines management, and business continuity. Portable equipment had been calibrated and tested for safety. There were enough staff to keep patients safe. Staff who performed chaperone duties had received training and understood their responsibilities when acting as chaperones.

Effective

Good

Updated 13 August 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams and regular meetings were held. There was evidence of completed clinical audits to improve patient outcomes, and this information was shared with staff during practice meetings.

Caring

Good

Updated 13 August 2015

The practice is rated as good for providing caring services. Data from the national patient survey 2015, a patient satisfaction survey carried out by the practice, and results from the Friends and Family Test showed that patients rated the practice well for several aspects of care. For example, the practice was rated above the CCG and national averages for patient satisfaction on consultations with the GPs and nurses. 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 13 August 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

The majority of patients we spoke with were satisfied with the appointments system, and in particular the availability of the walk-in clinics. Patients confirmed that they could see a doctor on the same day if they felt their need was urgent although this might not be with the GP of their choice.

The practice had sought feedback from staff, patients, and the patient participation group, and had acted upon that feedback. 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 13 August 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 designated staff led in specific areas such as safeguarding, infection control and complaints. Staff felt management were approachable and supportive. The practice had a number of policies and procedures to govern activity and governance issues were discussed during the monthly practice meeting. 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 patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 13 August 2015

The practice is rated as good for the care of people with long-term conditions. The percentage of patients at the practice with a long standing health condition (34.8%) or with health related problems in daily life (34.6) was lower when compared to the national averages (54% and 48.8% respectively).

Nursing staff assisted the GPs in chronic disease management. Patients with long term conditions were invited to a structured annual review to check that their health and medication needs were being met. The practice held clinics for patients with long term conditions such as chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease (CKD) and coronary heart disease (CHD), and followed National Institute for Health and Care Excellence (NICE) guidance around treatment for these groups of patients.

For those people with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 13 August 2015

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

The practice had more children aged 0 to 4 (7.5%) than the England average of 6%. There were less children aged 5 to 14 (5.7%) and under 18 (6.7) when compared to the national averages of 11.4% and 14.8% respectively. The income deprivation level affecting children was 19 compared to the national average of 22.5.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, health visitors were attached to the practice and attended multidisciplinary meetings to discuss children at risk. There was a designated nurse who led on child protection, and all staff were aware of their responsibilities for safeguarding children.

Antenatal and postnatal care was offered as part of a shared care programme with the hospital, and a comprehensive information pack was given to women as part of their antenatal care. The practice offered a weekly baby clinic with the GPs and a health visitor, and the nurses provided childhood immunisations. Performance for all standard childhood immunisations was above average for the locality. Appointments were available outside of school hours and the premises were suitable for children and babies.

The practice also offered advice on contraception and sexual health, and chlamydia screening was routinely offered to patients aged 16-25 years during their new patient check-up.

Older people

Good

Updated 13 August 2015

The practice is rated as good for the care of older people. The practice had a lower percentage of patients over the age of 75 (2.4%) when compared to the national average (7.6%). The income deprivation level affecting older people was 21 compared to the national average of 22.5.

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. Patients aged 85 or over were offered an annual health check, and all patients over the age of 75 had named GP. The practice was responsive to the needs of older people, and offered home visits for those with enhanced needs. Clinical staff had close working relationships with district and palliative care nurses to discuss care planning for patients who required extra support. They also signposted patients who required further advice and care to social care services, and voluntary groups.

Working age people (including those recently retired and students)

Good

Updated 13 August 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had a predominantly young adult population between the ages of 25 and 44. The number of patients in paid work or full-time education was higher than the national average, 69.2% compared to 60.2%.

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. Daily walk-in clinics were available in the morning and afternoon, except on Wednesdays when there was only a morning session. Extended hours were available for booked appointments from 18:30 to 20:00 on Monday, Tuesday, Wednesday and Thursday evenings, and on Wednesday morning from 08:00 to 08:30.

The practice offered online facilities to book appointments and request repeat prescriptions. Telephone consultations were available for patients who found it difficult to access the practice. There was a range of health screening programmes (including cervical and bowel cancer screening), and NHS health checks (for patients aged 40-75) that reflected the needs for this age group. Health promotion advice was offered and health promotion material was available at the practice and on the website.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 August 2015

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

Annual physical checks and mental health reviews were offered to patients on the mental health register, and data from the quality and outcomes framework (QOF) showed that 90.8% of these patients had a care plan which had been reviewed in the last 12 months.

The practice carried out dementia reviews and some clinical staff had received additional training on how to care for people with mental health needs and dementia. The practice regularly worked with multi-disciplinary teams, including community psychiatric nurses and counsellors in the case management of people experiencing poor mental health. Patients were offered referral to emotional support services such as an in-house counselling clinic, a community mental health service, and a drug and alcohol addiction service.

People whose circumstances may make them vulnerable

Good

Updated 13 August 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 housebound patients, carers, and those with a learning disability.

The percentage of patients with a caring responsibility was lower than the national average at 12.8% compared to 18.2%. The practice’s computer system alerted GPs if a patient was a carer, and carers were offered health checks, the flu vaccination, and referred to various support services.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. We were told that the practice also supported patients from a local women’s shelter that were fleeing domestic violence. 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 looked after patients with learning disabilities from a local care home. There was a named GP for these patients, and patients were also given the choice to see any GP at the practice. Longer appointments and an annual health checks were offered to patients with a learning disability.

The practice recognised the needs of homeless patients by offering them an extended registration health check which included screening for mental health problems, drug and alcohol issues, and infectious diseases. The practice also looked after 25 patients who were previously homeless but were now living in supported housing. These patients were allowed to register with the practice despite their supported housing being located outside of the geographical boundaries for the practice. The GPs had a good knowledge of the health challenges experienced by homeless patients, and three GPs had further experience of working in another practice which provided healthcare services specifically for homeless people.