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Inspection Summary


Overall summary & rating

Good

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dalton Surgery on 7 September 2016. Overall the practice is rated as good.

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

  • The practice had processes in place for recording significant events. Learning from these events was shared during clinical governance meetings which were held eight weekly. An informal discussion was held at the time of any significant event and plans put into place to carry out any required actions. Staff told us the practice encouraged the reporting of significant events.
  • Risks to patients were assessed and 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 told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. We saw that one of the consulting rooms did not provide privacy curtains or screening.
  • 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. We saw that letters responding to complaints did not contain full details of action taken as a result of the complaint. The letter did not include details of the NHS Parliamentary Ombudsman.
  • 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 limitations with regard to their premises.Staff told us their workloads were increasing due to a recent influx of patients from nearby practices which had closed. However they made the best use possible of the facilities available to them.
  • Staff told us they felt supported by the GP partners and practice manager. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Improve their documentation to reflect more fully how complaints are dealt with in the practice.

  • Review the arrangements for cleaning fabric privacy curtains in consulting rooms in line with national patient safety agency (NPSA) guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 October 2016

The practice is rated as good for providing safe services.

  • Processes were in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice. We saw that informal discussion and planning took place following significant events. Full team meetings were held eight weekly where lessons learned were disseminated and shared.

  • When things went wrong patients received reasonable support, truthful information, and a written apology.

  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and managed.

Effective

Good

Updated 4 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with 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 assess need, plan care and deliver treatment plans to improve outcomes for patients.

Caring

Good

Updated 4 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. Due to the size restrictions of the patient waiting area some conversations at the reception desk could be overheard. We saw the practice had taken steps to mitigate this, by playing background music in the waiting area. In addition self-check in facilities were available for patients to use.

Responsive

Good

Updated 4 October 2016

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 (CCG) to secure improvements to services where these were identified. For example the practice worked with the CCG pharmacist to monitor prescribing patterns and follow current guidelines for prescribing.

  • Patients said they found it easy to make an appointment with a named GP or nurse, and there was continuity of care, with urgent appointments available the same day.

  • The practice had limitations with regard to their premises.However they made good use of the facilities available to them.

  • Information about how to complain was available and easy to understand. The practice demonstrated they responded to complaints in a timely manner in an open and transparent way. We saw that letters sent to patients following a complaint did not always contain clear details of actions the practice had taken as a result of the complaint. We also saw the letter did not contain details of the NHS Parliamentary Ombudsman. The practice told us they would review their processes in relation to this. Lessons learned were shared informally at the time of the complaint. Formal sharing of lessons learned was carried out at the eight weekly clinical governance meeting.

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Well-led

Good

Updated 4 October 2016

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

  • The practice had a clear vision and strategy to provide high quality accessible care in a safe responsive professional and courteous manner. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a leadership structure and staff told us they felt supported by the GP partners and practice manager. The practice had a number of policies and procedures to govern activity and held eight weekly 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. This information was shared with staff informally at the time of the incident and any necessary actions taken. More formal, widespread sharing and lessons learned were discussed at the clinical governance meeting.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • All staff had received an appraisal in the last 12 months. Staff were encouraged to develop and progress in their roles.

Checks on specific services

People with long term conditions

Good

Updated 4 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.

  • 79% of patients with diabetes, on the register had a recorded blood pressure which was within normal limits completed in the preceding 12 months, compared to the CCG average of 77% and the national average of 78%.

  • 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 4 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and described examples to demonstrate this.

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

  • Eight weekly meetings were held with health visitors and school nurses. These enabled the practice to work collaboratively with these services to plan care and deliver treatment plans for children in vulnerable circumstances, or those with additional needs.

Older people

Good

Updated 4 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 had patients in a number of nursing and residential homes close to the practice. These homes were visited regularly by the advanced nurse practitioner from the practice to monitor their needs and ensure timely response to any health concerns identified.

  • Before the inspection we sought feedback from one residential home and one nursing home for older people who had residents registered with the practice. They both told us they were very happy with the service provided by the practice. They told us their residents were treated with kindness and respect; all had a named GP and were able to receive home visits from GPs when required. They told us patients who were approaching the end of their lives were treated in a sensitive and appropriate manner, with involvement from carers and relatives when necessary.

  • The practice nurse maintained a register of older and vulnerable patients at risk of unplanned hospital admission. They oversaw their care, made regular contact to review their needs, and made contact following hospital admission and discharge.

  • At the time of our visit 11 patients were on the palliative care (end of life care) register. Staff told us they maintained regular contact with this group of patients and responded quickly to changing need. The practice had been part of an early working group which led to the now widely adopted ‘Gold Standard Frameworks’ (GSF). GSF is a systematic evidence based approach to providing the best possible care to all patients approaching the end of life.

Working age people (including those recently retired and students)

Good

Updated 4 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 acknowledged. The practice offered extended opening hours, from 7.30 am on Tuesday, Wednesday and Friday, and until 7pm on Monday, Wednesday and Thursday. This made it easier for working people to access appointments at a time convenient to them.

  • The practice was encouraging patients to register for online access. At the time of our inspection we saw that 679 people (10% of the practice population) had registered for online access.

  • Patients were able to receive text reminders of appointments. Test results were also available by text message.

  • The practice had developed a smart phone ‘app’ which enabled patients to receive information about the practice and book and cancel appointments by means of a QR (quick read) code.

  • The practice offered a full range of health promotion and screening reflecting the needs of this age group.

  • 82% of eligible women had completed a cervical screening test in the preceding five years compared to the local average of 86% and the national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 October 2016

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

  • 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local and national averages of 85% and 84% respectively.
  • 100% of patients with schizophrenia or other psychoses had a comprehensive care plan agreed and documented within the preceding 12 months compared to the local average of 89% and the national average of 89%.
  • 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 advance care planning for patients with dementia.
  • The practice gave patients experiencing poor mental health information about local support services.
  • 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. All staff had been trained as ‘Dementia Friends’.

People whose circumstances may make them vulnerable

Good

Updated 4 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 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 was registered as a ‘Safe Place’. This identified the practice as a place for people with a learning disability to access support if they encountered difficulties whilst they were away from home.

  • Before the inspection we sought feedback from a residential home for adults with learning disability who had residents registered at the practice. They told us they received a good service from the practice, with access to appropriate medicines and treatments in a timely way. They told us the GPs were willing to see their residents at home or in the surgery, whichever was most appropriate.

  • The practice informed vulnerable patients 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 provided GP services to a nearby women’s refuge which provided short to medium term accommodation for women and their children fleeing violent or dangerous situations.

  • The practice had identified 101 patients (2% of the practice population) as unpaid carers. This group of people were offered an annual health check, a seasonal flu vaccination and were signposted to local support agencies, such as ‘Carers Count’.