You are here

Inspection Summary


Overall summary & rating

Good

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Short and Partners on 10 November 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 for reporting and recording significant events and learning from these was discussed and shared at practice meetings.
  • Risks to patients were assessed and well managed.
  • Infection prevention and control was well managed within the practice, with staff members being identified to take responsibility for specific aspects of the process.
  • Some areas of the practice required maintenance attention, for example, carpet in a consulting room and the female toilet area, however, the practice had raised these issues and were waiting for action to be taken.
  • 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.
  • Wound care was well managed at the practice as was anticoagulation, (anticoagulants are medicines that help thin the blood and prevent blood clots) with two clinics held each week and home visits for patients with reduced mobility or age related concerns.
  • The trainee and locum induction pack at the practice was detailed and helped to ensure that new staff were aware of the provision at the practice and in the local area, where to look for support and how to raise concerns.
  • Four members of the staff team were trained to manage diabetes; including insulin initiation (insulin initiation is the process for starting patients with diabetes on 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 found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
  • Data from the national GP patient survey rated the practice higher than the clinical commissioning group (CCG) and the national average for telephone access.
  • The practice had good facilities, had made good use of all available space, and was 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 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 improvement are:

  • Continue to focus on securing improvements to the maintenance of the building and the replacement of the fabric chairs in the shared waiting area.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system 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. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had systems, processes and practices to help keep patients safe and safeguarded from abuse, including a designated safeguarding lead GP, appropriate training for all staff members and a low threshold for reporting concerns.
  • Risks to patients were assessed and well managed including those related to infection prevention and control.

Effective

Good

Updated 23 December 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.
  • Wound care was well managed at the practice as was anticoagulation.
  • Four members of the staff team at the practice were trained to manage diabetes, including insulin initiation.
  • There was evidence of appraisals for staff employed at the practice for over a year.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. For example, multi-disciplinary meetings were held on a quarterly basis.

Caring

Good

Updated 23 December 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 telephone accessibility.
  • Patient’s views gathered at inspection showed that they felt they were treated with compassion, dignity and respect and involved in decisions about their care and treatment.
  • We observed that staff treated patients with kindness and respect and maintained patient confidentiality.
  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 23 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local patient population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, four members of the staff team had trained in diabetes care to help ensure that this long term condition was well managed.
  • Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day, with extended hours being provided at the practice on a Saturday morning.
  • There were longer appointments available for patients with a learning disability and for those who required them, including longer times for patients who required an interpreter.
  • Children under five and elderly patients of over 70 were secured a same day appointment when required.
  • The building was accessible for less mobile patients and there were disabled access toilets and baby change facilities.
  • The practice had good facilities and although originally the service was built to house five GPs and now had eleven, they had made good use of all available space and were 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 23 December 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 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 worked with the practice to identify areas for improvement.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 23 December 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.

  • Four members of the staff team at the practice were trained to treat and manage diabetes, including insulin initiation. There were formal diabetes clinics twice each week at the practice.
  • The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 85% which was higher than the CCG average of 77% and the national average of 78%.
  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 83% which was higher than the CCG average of 76% and the national average of 78%.
  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 97% which was higher that the CCG average of 87% and the national average of 88%.
  • An Anticoagulation clinic was held twice weekly at the practice.
  • 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 23 December 2016

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

  • There were systems 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 high for all standard childhood immunisations.
  • Staff members told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 83% which was comparable to the CCG average of 87% and the national average at 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 23 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 patient population, for example, end of life care and dementia care management.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Older people had a dedicated GP for continuity of care, however, they were also able to see any GP of their choice.
  • Quarterly multi-disciplinary meetings were held to discuss the care and treatment needs of patients, including end of life care.
  • The practice had responsibility for the care of patients at three residential care homes.

Working age people (including those recently retired and students)

Good

Updated 23 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 patient population, those recently retired and students had been identified and the practice had adjusted the services it offered to help 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.
  • Extended hours appointments were offered weekly on a Saturday morning, which were bookable in advance.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 December 2016

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

  • 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 82% and the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 100% which was higher than the CCG and national average of 90%.
  • 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 advanced 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 had a system 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 23 December 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 people living 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.