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Inspection Summary


Overall summary & rating

Good

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 5 May 2016. We set a requirement in relation to Safe Care and Treatment. The practice sent in an action plan informing us about what they would do to meet legal requirements in relation to the following;

  • Robust processes were not in place to assess the risk of and prevent, detect and control the spread of infection. The practice did not have a robust legionella risk assessment and did not ensure infection control audits were completed.
  • Dispensary staff did not have training appropriate to their role and had not received annual competency assessments.

During the initial inspection we also found areas where improvements should be made:

  • The practice should record on their clinical system children who fail to attend hospital appointments by using the appropriate coding.
  • Ensure thermometers used to record refrigerator temperatures are validated and calibrated annually to ensure their accuracy.
  • Ensure all standard operating procedures are finalised and implemented.

The practice told us these issues would be addressed by December 2016 and have provided us with evidence to show they had taken the action to address these concerns.

We undertook a desk top review on 5 December 2016 to make a judgement about whether their actions had addressed the requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 January 2017

At the last inspection on 5 May 2016 we found that:

  • Effective processes were not in place to assess the risk of and prevent, detect and control the spread of infection. The practice did not have a robust legionella risk assessment and did not ensure infection control audits were completed.
  • Dispensary staff did not have training appropriate to their role and had not received annual competency assessments.

During the initial inspection we found areas where improvements should be made:

  • The practice should record on their clinical system children who fail to attend hospital appointments by using the appropriate coding.
  • Ensure thermometers used to record refrigerator temperatures are validated and calibrated annually to ensure their accuracy.
  • Ensure all standard operating procedures are finalised and implemented.

Our focused inspection on 5 December 2016 found that:

The practice is rated as good for providing safe services.

  • The practice had safe and effective systems in place and had implemented more efficient processes to assess the risk of and prevent, detect and control the spread of infection. The practice had a legionella management protocol, a risk assessment and a legionella water temperature testing report.
  • The practice had commenced an annual competency assessment to be carried out during the staff member’s appraisal. A bar code accuracy checking system had been installed in the dispensary.
  • The practice updated their child safeguarding policy to include planned actions where a child failed to attend a hospital appointment.
  • The practice purchased data loggers to monitor the various medical refrigerators and monitored the temperature of the rooms the refrigerators were sited in. The nurses and dispensers downloaded the refrigerator temperature data each month in addition to the daily checks and the practice manager regularly downloaded the report. The thermometers were calibrated annually with the other practice equipment.

This report should be read in conjunction with the full inspection report from 5 May 2016.

Effective

Good

Updated 18 July 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 for the locality and compared to the national average.
  • Staff assessed patients’ 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 July 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice above average for several aspects of care.
  • The practice had identified 150 patients as carers (2.4%). Carers’ forms were available on the practice website and also on the new patient registration form. Carers were referred to various charities and support groups. The practice did not have an icon on the clinical computer system to easily establish if the patient was a carer.
  • 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 18 July 2016

The practice is rated as good for providing responsive services.

  • Patients said that urgent appointments with a GP were available on the same day.
  • Practice staff reviewed the needs of their local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • 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 18 July 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 this.
  • 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 practice 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 knowing about 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 strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 18 July 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.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. QOF is a system intended to improve the quality of general practice and reward good practice. Data from 2014/2015 showed that the performance for asthma related indicators was 100% which was above the CCG average by 2% and the England average by 3% with a 1% exception reporting which was below the CCG average by 7.2% and the England average by 6.8% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). Performance for diabetes related indicators was 76% which was below the CCG and the England average by 14% with a 5.9% exception reporting which was below the CCG average of 12.9% and the England average of 10.8%.
  • The practice had an annual recall system for patients with asthma and diabetes and the nurses set up more frequent recalls if the patients needed them. The practice offered a 30 minute appointment for patients with a new diabetes diagnosis.
  • Longer appointments and home visits were available to patients 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 18 July 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. Children and young people’s safeguarding meetings were held regularly with health visitors and safeguarding was a standing agenda for the weekly GPs’ meetings. GPs were safeguarding level three trained (safeguarding children and young people).
  • Immunisation rates were generally in line with the CCG average for the 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice had a priority system for unwell children to be seen within 24 hours.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. The midwifery team used a room at the practice for weekly antenatal care.
  • The practice had a private room available for mothers who were breast feeding and baby changing facilities.
  • The practice took part in the Chlamydia screening programme.

Older people

Good

Updated 18 July 2016

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice would contact all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
  • The practice offered health checks for patients aged over 75.
  • GPs regularly visited patients in one care homes and two residential homes and liaised with the home managers.
  • 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, end of life care. The practice had 23 patients on their palliative care register and they worked closely with their nursing teams and ensured proactive end of life planning.

Working age people (including those recently retired and students)

Good

Updated 18 July 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 had extended hours on alternate Tuesdays and Thursdays until 8pm with GPs, nurses and healthcare assistants/phlebotomists. They offered telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Appointments could be booked in advance or on the same day.
  • The practice offered online appointments and prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.
  • The practice’s uptake for the cervical screening programme was 84%, which was above the CCG and England average by 2% with a 1.2% exception reporting which was below the CCG exception reporting average of 7.9%.
  • The practice offered minor surgery on site.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 July 2016

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

  • The practice carried out advance care planning for patients with dementia. 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average by 11% and the England average by 11% with a 9.1% exception reporting which was below the CCG and England average by 1%.
  • Performance for mental health related indicators was 100% which was above the CCG and England average by 7% with a 9.7% exception reporting which was below the CCG exception reporting average of 13%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they might have been experiencing poor mental health including patients seen during out of hours.
  • 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 18 July 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 homeless people, travellers and those with a learning disability. They had identified 16 patients with a learning disability and 12 had received an extensive health check in the previous 12 months so far. The practice referred patients to various support services.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.
  • The practice should record on their clinical system children who fail to attend hospital appointments by using the appropriate coding.