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Somerset Family Health Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Somerset Family Health Practice on 5 July 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.
  • 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 could get an appointment when they needed one with urgent appointments available the same day. However patients told us getting through by telephone was difficult and the practice had identified this as requiring further action. The practice scored below average on the national GP patient survey for access.
  • 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 proactively sought feedback from patients, which it acted on.

The areas where the provider should make improvement are:

  • The practice should ensure that all staff members are clear about the duty of candour and their responsibilities. The practice should have a written policy and procedure for reference.
  • The practice should carry out an annual audit of infection control in the practice to ensure that it is meeting current infection control guidelines.
  • The practice should investigate areas where its performance was unusual, for example in some of its exception reporting.
  • The practice should aim to increase the uptake for cancer screening programmes among eligible patients.
  • The practice should continue to work to improve patient experience of booking an appointment and the ease of getting through to the practice by telephone.
  • The principal GP should ensure that all staff have a structured annual appraisal and are given sufficient support to complete agreed personal development goals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology.
  • Some staff were unclear about the duty of candour but told us that the practice was open and transparent with patients and we saw evidence of this.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Most risks to patients were assessed and well managed. The practice had procedures in place to protect patients and staff from the risk of infection but had not carried out a recent audit.

Effective

Good

Updated 14 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes tended to be at or above average.
  • Practice exception reporting rates for some indicators including diabetes and cervical screening, were high compared to other practices in the area.
  • 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 14 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice positively. The practice's results were comparable to the national average.
  • Patients said they were treated kindly and with respect. Patients reported being involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • The practice had systems in place to protect patient confidentiality.

Responsive

Good

Updated 14 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with NHS England and Clinical Commissioning Group to secure improvements to services where these were identified.
  • 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 14 December 2016

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

  • The practice had a vision and strategy to put patients first and deliver high quality care for patients.
  • There was a clear leadership structure. The practice had policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The principal GP encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents. Some staff were unclear about the duty of candour however.
  • The practice monitored its performance but had not investigated areas where its performance was unusual, for example in some of its exception reporting.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
Checks on specific services

People with long term conditions

Good

Updated 14 December 2016

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

  • Longer appointments and home visits were available when needed.
  • The practice ran case finding searches for patients with increased risk factors for long term conditions. Prevalence rates for several long term conditions were higher than the local average as a result.
  • Patients with long-term conditions were offered an annual review to check their health and medicines needs were being met. The practice provided parallel appointments for certain reviews such as diabetes so patients could see the health care assistant, nurse and GP as appropriate.
  • The prevalence of diabetes locally was high. In 2015/16, 93% of diabetic patients had blood sugar levels that were adequately controlled compared to the CCG average of 77% and the English average of 78%.
  • Nursing staff were trained to carry out diabetes, asthma and chronic obstructive pulmonary disease (COPD) reviews.
  • Patients at risk of hospital admission were identified as a priority. For those patients with the most complex needs, the named GP worked with relevant  professionals, community health and social services teams to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 14 December 2016

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

  • Appointments were available outside of school hours and the premises were suitable for children and babies. Baby changing facilities were available.
  • The practice prioritised young children and babies for urgent or same-day appointments. Parents we spoke with said they were able to obtain appointments for young children without difficulty.
  • The practice provided child immunisations. Immunisation rates were high for all standard childhood immunisations. The practice followed up children who did not attend for immunisation.
  • 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.
  • In 2015/16, 85% of practice patients with asthma had an asthma review in the preceding 12 months compared to the national average of 76%

Older people

Good

Updated 14 December 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 included an alert for staff on the patient record for patients known to have enhanced needs.
  • Patients at increased risk of dementia or falls were screened or assessed and referred to the relevant specialist teams.
  • The practice provided the seasonal flu vaccination for patients over 65 and the shingles and pneumococcal vaccinations for eligible older patients.
  • The practice maintained a palliative care register and as a team regularly reviewed patients on this list.

Working age people (including those recently retired and students)

Good

Updated 14 December 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 and was open until 6:30pm every weekday.
  • The practice offered telephone consultations daily which were particularly useful for working patients.

  • The practice offered a full range of health promotion and screening services appropriate for this group including catch up immunisations for children and students. 

People experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2016

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

  • In 2015/16 all patients diagnosed with dementia had their care reviewed in a face to face meeting within the last 12 months.
  • The practice screened patients for dementia and had increased its prevalence rate. Patients identified as at risk were referred to the local memory clinic. Patients with dementia were offered regular reviews at the practice.
  • 94% of patients diagnosed with psychosis had a comprehensive, agreed care plan documented in the record, within the last 12 months, which is in line with the national average of 89%.
  • The practice hosted a monthly clinic with a mental health worker for patients who required additional support, for example following discharge from acute care. The practice was successfully supporting a number of patients with enduring mental health problems in primary care as part of this programme. 
  • The practice was aware of the raised risk of post traumatic stress disorder (PTSD) and social isolation in some groups of patients, for example asylum seekers. The practice had a number of these patients from Sri Lanka and assessed their mental health with standardised screening tools translated into Tamil.

People whose circumstances may make them vulnerable

Good

Updated 14 December 2016

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

  • The practice offered longer appointments for patients with a learning disability and other complex needs.
  • The practice regularly worked with other health care professionals for example health visitors, in the management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations, for example patients who became homeless.
  • 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.