Archived: The Surgery

Updated 1 March 2017

The Surgery is situated within a purpose built health centre in Rotherham. Car parking and disabled access is provided. The practice also has a seperately registered surgery called Bellows Road which patients from the The Surgery can access. We visited both sites during the inspeciton.

The practice provides Personal Medical Services (PMS) for 5,700 patients across both sites in the NHS Rotherham Clinical Commissioning Group (CCG) area. Enhanced services are provided and include those for patients living with dementia.

The practice has a slightly higher than average 45 to 70 year old patient population and is situated in one of the fifth more deprived areas nationally.

The practice is owned by a male GP who is supported by a salaried GP and visiting locum GPs as required.

The GPs work across both sites and both GPs have late opening surgeries on a Monday evening at Bellows Road.

The GPs are supported by two nurse practitioners, a practice nurse and two health care assistants. There is a practice manager who is supported by administrative staff and a reception team.

The practice is open at The Surgery 8am to 6pm except on Wednesday when it is open 8am to 12pm.

Appointments are available Monday to Friday from 9am to 11am with a duty doctor and a nurse practitioner at a drop in clinic. Booked appointments are available Monday to Friday from 4pm to 6pm for GPs and 2pm to 5.30pm for nurse practitioners. The practice is closed on a Wednesday afternoon.

Patients can also access appointments at the Bellows Road site. Bellows Road surgery has late evening surgeries for pre-booked appointment slots for those patients from either surgery who cannot attend during the day. These are available every Monday from 6.30pm until 8pm.

When The Surgery is closed the patients can contact Bellows Road Surgery practice. Out of hours services are provided by NHS 111 service.

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery on 7 December 2016. Overall the practice is rated as Requires Improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The systems and processes to assess and address risks to patients were not implemented well enough to ensure patients were kept safe. For example, in areas such as infection prevention and control, fire safety, storage of vaccines and recruitment.

• 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 dignity and respect but they sometimes felt they were not listened to or involved in decisions about their care.
• Information about services and how to complain was available and easy to understand although the procedure required updating. 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 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 although cleaning of the premises required improvement.
• 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 practice had recognised the challenges relating to their practice and the management team were aware they had areas for improvement. They had recently implemented The NHS Institute for Innovation and Improvement’s Productive General Practice programme to assist them to improve.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Improve systems for the management of safety alerts to ensure all alerts are actioned in a timely manner commensurate with risk and a record of actions taken is maintained. Review and implement the actions in the Department of Health estates and facilities alert January 2015 relating to blinds and blind cords to minimise the risk of serious injury due to entanglement.

• Review the infection prevention and control risk assessment and improve infection prevention and control (IPC) processes and monitoring systems in line with The Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance. Maintain the practice in a clean condition.

• Implement systems for the management and storage of blank prescription forms in line with NHS Protect; security of prescription forms guidance, 2013.

• Implement systems to ensure the cold chain is maintained in the vaccine storage fridge. Ensure appropriate action is taken and a record of the action taken is maintained when temperatures are outside the recommended ranges in line with Public Health England; Protocol for ordering, storing and handling vaccines 2014. Take action to mitigate risks related to vaccines which have been stored outside the recommended ranges and report to the relevant organisations.

• Consistently implement the practice recruitment policy and procedure and ensure all appropriate recruitment checks are completed prior to employment.

• Complete a fire risk assessment and put processes in place to ensure the fire equipment, such as the fire alarm, is in working order. Ensure the fire door at the bottom of the stairs can be closed, signage for all final exit doors is provided and the storage arrangements for oxygen are risk assessed. Provide a warning sign in all areas where liquid nitrogen is stored.

The areas where the provider should make improvement are:

• Review the chaperone policy and procedure and put procedures in place to ensure this is implemented consistently.

• Review the Legionella risk assessment to assess if all mitigating actions have been implemented to minimise on-going risk.

• Emergency equipment should be checked at least weekly in line with recommendations by the Resuscitation Council. (UK) guidelines.

• Put processes in place to ensure all staff have an annual appraisal.

• Maintain records of staff induction training.

• Review and improve patient satisfaction in relation to GP consultations.

• Update the complaints procedure with the Parliamentary Health Services Ombudsman contact details for escalation of complaints.

• Review the storage security arrangements for patient records.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement 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.

• Performance for diabetes related indicators was 99%, which was 15% better than the CCG average and 9% better than the national average.

• 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.

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement 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 A&E attendances. Immunisation rates were relatively high for all 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.

• The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 83% and the national average of 82%.

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

• We saw positive examples of joint working with midwives and health visitors.

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement 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.

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the care of people experiencing poor mental health (including people living with dementia).

• Performance for mental health related indicators was 97%, which was 6% better than the CCG average and 4% better than the national average.

• 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 advance 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 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.

Updated 1 March 2017

The provider is rated as requires improvement for safety, caring and for well-led and good for effective and responsiveness. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the care of people who 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 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.