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Inspection Summary


Overall summary & rating

Good

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roseworth Surgery on 14 April 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
  • Feedback from patients about their care was positive. Patients reported that they were treated with compassion, dignity and respect.
  • The practice had obtained good National GP Patient Survey results in relation to appointment availability and experience and ease of making an appointment. 93% of patients described their experience of making an appointment as good compared to the CCG average of 75% and the national average of 73%.
  • Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
  • The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
  • The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes in response to feedback. For example, comments received via the practice suggestion box had led to a review of the practice search and recall system to ensure patients with comorbidities were invited to one annual review
  • The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 98.6% of the point’s available (local clinical commissioning group average 96.7% and national average 94.7%)
  • Information about services and how to complain was available and easy to understand.
  • The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.
  • Practice staff were aware of, and complied with Duty of Candour requirements.

We saw an area of outstanding practice:

  • Patients who lived outside of the practice catchment area but who worked in the area were able to register with the practice.

However there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

  • Ensure that a risk assessment is in place detailing why it has not been felt necessary for all staff to undertake a Disclosure and Barring Service (DBS) check.
  • Consider replacing the carpeting in one of the nurse’s consultation rooms with easy to clean flooring.
  • Consider ways of more proactively identifying and supporting carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 July 2016

The practice is rated as good for providing safe services.

Nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. Risks to patients were generally assessed and well managed.

Lessons were shared to make sure action was taken to improve safety in the practice.

When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, and verbal or written apologies.

The practice was clean and hygienic and good infection control arrangements were in place. However, the practice did have carpeted flooring in one of the nurse’s consultation rooms which could present an infection control risk.

There was evidence of effective medicines management and the medicines we checked were in date and stored appropriately. The practice had an effective system in place to monitor the use and movement of blank prescriptions.

Comprehensive staff recruitment and induction policies were in operation. However, not all staff had received Disclosure and Barring Service (DBS) checks and there was no evidence of any risk assessments detailing why this was not felt to be necessary. Chaperones were available if required and staff who acted as chaperones had undertaken appropriate training and were DBS checked.

Effective

Good

Updated 18 July 2016

The practice is rated as good for providing effective services.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. Arrangements had been made to support clinicians with their continuing professional development. There were systems in place to support multi-disciplinary working with other health and social care professionals in the local area. Staff had access to the information and equipment they needed to deliver effective care and treatment and had received training appropriate to their roles.

Data from the Quality and Outcomes Framework showed patient outcomes were better than local clinical commissioning group (CCG) and national averages. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 99.6% of the point’s available (local CCG average 95.5% and national average 94.7%).

Achievement rates for cervical screening and the majority of childhood vaccinations were higher than, or comparable with, local and national averages. For example, at 89.1%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the national average of 81.8%. Childhood immunisation rates for the vaccinations given to two year olds ranged from 96.7% to 98.4% (compared with the CCG range of 94.8% to 97.2%). For five year olds this ranged from 92.2% to 98% (compared to CCG range of 91.4% to 100%).

There was evidence of clinical audit activity and improvements made as a result of this. Staff received annual appraisals and were given the opportunity to undertake both mandatory and non-mandatory training.

Caring

Good

Updated 18 July 2016

The practice is rated as good for providing caring services.

Patients we spoke with during the inspection and those that completed Care Quality Commission comment cards said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about the service was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Results from the National GP Patient Survey published in January 2016 were higher than or comparable with local CCG and national averages in respect of providing caring services. For example, 96% of patients who responded to the survey said the last GP they saw or spoke to was good at listening to them (CCG average 91% and national average 89%) and 89% said the last nurse they saw or spoke to was good at listening to them (CCG average 92% and national average was 91%).

Results also indicated that 94% of respondents felt the GP treated them with care and concern (CCG average 88% and national average of 85%). 89% of patients felt the nurse treated them with care and concern (CCG average 92% and national average 91%).

Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 18 July 2016

The practice is rated as good for providing responsive services.

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 that the practice responded quickly to issues raised. Trends and themes arising from complaints and significant events were identified and implementation of lessons learned monitored appropriately. The practice used the local CCGs Safeguard Incident and Risk Management (SIRMS) to report significant events. This enabled not only the practice but the CCG to identify recurrent issues and those requiring urgent remedial action or response.

The practice’s scores in relation to access in the National GP Patient Survey were higher than local and national averages. Then most recent results (January 2016) showed that 95% of patients were able to get an appointment to see or speak to someone the last time they tried (CCG average 85%, national average 85%). 98% found it easy to get through to the surgery by phone (CCG average 78%, national average 73%). 78% said they usually waited 15 minutes or less after their appointment time (CCG average 68%, national average of 65%).

The practice offered extended opening hours up to 7.45pm one night per week when nurse and GP appointments were available. As the practice was a member of a GP federation with other GP practices in the area their patients were able to access additional services at other practices, such as a leg ulcer dressing service.

The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

The practice offered a number of additional services. This included a phlebotomist, in house ambulatory blood pressure monitoring, electro cardiograms and endometrial pipelle biopsy service.

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 had a business plan which included issues such as contracts, viability, premises and recruitment and retention of staff.

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 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. An active patient participation group was in operation

There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

Older people

Good

Updated 18 July 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 97.9% and the England average of 97.9%.

Patients over the age of 75 were offered an annual health review and the practice operated an in house search and recall system to ensure older people were followed up proactively and appropriately.

The practice had a palliative care register and held monthly multi-disciplinary meetings to discuss and plan end of life care.

The practice had identified that they had 87 patients at high risk of admission to hospital and had taken steps to ensure that they had a GP consultation during which comprehensive care plans were drawn up which were then reviewed every six months.

Due to the relatively high number of older patients the practice, together with other practices in their local area, had been successful in obtaining funding from their local clinical commissioning group to provide additional support to their older patients. This resulted in older patients now being able to benefit from social prescribing support from Age UK and another charitable organisations able to offer support with social isolation and poor management of long term conditions and enable older people to live independently in the local community.

The practice had taken steps to ensure that their older patients were offered in-house training on the use of online services such as booking appointments and requesting repeat prescriptions.

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.

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review which was either six monthly or annually dependent on their condition. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered an annual comorbidity review. The practice had identified 22% of their patient population as being over 65 with a comorbidity. A system was in place to follow up on patients who failed to attend review appointments.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example:

  • The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 3.4% above the local CCG average and 2.6% above the national average.
  • The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 3% above the local CCG average and 4% above the national average
  • The practice had obtained 100% of the points available to them in respect of hypertension (2.2% above the local CCG average and 2.2% above the national average).
  • The practice had obtained 99.7% of the points available to them in respect of diabetes (7.7% above the local CCG average and 10.5% above the national average).

The practice was part of a cluster arrangement with three other local practices. Together they had been successful in obtaining funding for a pilot scheme. This had enabled them to employ a nurse to visit patients with long term conditions at home with a view to helping them avoid unplanned admission to hospital.

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.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 96.7% to 98.4% (compared with the CCG range of 94.8% to 97.2%). For five year olds this ranged from 92.2% to 98% (compared to CCG range of 91.4% to 100%).

At 89.1%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the national average of 81.8%.

The practice had developed a young people policy and sent all younger patients a letter on their 16th birthday explaining their services and issues relating to consent.

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice offered ‘between practice’ contraceptive services which meant that patients from other practices could access contraceptive services at Roseworth Surgery and vice versa.

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 met. The practice is open from 8.30am to 6pm on a Monday, Tuesday, Thursday and Friday (appointments from 8.30am to 5.45pm) and from 7am to 7.45pm on a Wednesday (appointments from 7am to 7.30pm).

The practice offered minor surgery, cervical screening, antenatal care, childhood health surveillance and immunisations and travel immunisation advice. Patients who lived outside of the practices catchment area but who worked in the area were able to register with the practice.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging appointment confirmation and reminder service was available.

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 make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were able to request longer appointments and were invited to attend the practice for an annual review.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice had developed a protocol for carers and ensured that any carer they identified was given a carers pack with details of relevant support services.

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).

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. At 83.6% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 2.4% below the local CCG and 0.4% below the national averages.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.