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Inspection Summary


Overall summary & rating

Good

Updated 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rothesay Surgery on 28 July 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 in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed. Staff were aware of their responsibilities in helping to safeguard and protect patients.

  • 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.
  • The practice held regular staff and clinical meetings where learning was shared from significant events and complaints.
  • They worked well with the multidisciplinary team to plan and implement care for their patients.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had higher than average survey results for patient satisfaction.
  • 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 contact the practice by telephone and to arrange an appointment with a named GP.There was continuity of care, with urgent appointments available the same day.
  • The practice had made alterations to the building to offer good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. 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 area where the provider should make improvement are:

  • Develop systems and continue to identify and support more carers in their patient population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. They were discussed at practice meetings and lessons learned shared with staff.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, an explanation and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. All staff had received appropriate training for their role and were aware of how to recognise signs of abuse. Any concerns were shared with community service staff and discussed at multidisciplinary team meetings.
  • Risks to patients were assessed and well managed. The practice undertook risk assesments and completed actions following these. Appropriate levels of staff were managed by a rota system.
  • Staff had received training appropriate to their role and relevant pre-employment checks had been completed. Personel files were complete and in order.
  • The practice had a comprehensive business continuity plan in place and a copy of the plan was kept off site.

Effective

Good

Updated 10 February 2017

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. For example The percentage of patients with diabetes, on the register, with a record of a foot examination in the preceding 12 months was 99% above the CCG average of 90% and the national average of 89%.
  • 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 understand and meet the range and complexity of patients’ needs. The community midwife and health visitors held weekly clinics at the practice.
  • Verbal consent for procedures was documented in the patients’ record.

Caring

Good

Updated 10 February 2017

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. Results from the national GP patient survey in July 2016 showed patients felt they were treated with compassion, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses. For example:96% of patients said the GP was good at listening to them compared to the Bedfordshire clinical commissioning group (CCG) average of 87% and the national average of 89%
  • 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. This was available in the waiting area, on the practice website and social media pages.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 24 patients who were carers (approximately 0.9% of the practice list). The practice had amended the new patient questionnaire forms to include caring responsibilities.

Responsive

Good

Updated 10 February 2017

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 to secure improvements to services where these were identified.
  • Patients said they found it easy to get an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. For example, 91% of patients were satisfied with the practice’s opening hours compared to the CCG average of 80% and the national average of 79%.
  • 99% of patients said they could get through easily to the practice by phone compared to the CCG average of 76% and the national average of 73%.
  • The practice offered bookable extended hours appointments and telephone consultations if required.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. There were disabled facilities and the practice had installed a stair lift to enable patients with restricted mobility to access treatment rooms on the first floor. Any patient unable to use the stair lift or stairs were given appointments on the ground floor. The practice had a hearing loop and translation services were available

  • Information about how to complain was available and easy to understand there was a poster in the waiting area and a leaflet explaining the process. Evidence showed the practice responded quickly to issues raised. Lessons were learnt from individual concerns and complaints and action was taken as a result to improve the quality of care.

Well-led

Good

Updated 10 February 2017

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 in place 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 and had a virtual patient participation group (PPG). They communicated practice news, gathered information and received feedback from patients through a variety of routes including the practice newsletter and social media.
  • There was a comprehensive schedule of meetings held in the practice including those for reviewing unplanned admissions, significant events and safeguarding.
Checks on specific services

People with long term conditions

Good

Updated 10 February 2017

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.
  • The percentage of patients with diabetes, on the register, with a record of a foot examination in the preceding 12 months was 99% compared to the CCG average of 90% and the national average of 89%.
  • 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.
  • Through the use of the clinical system, templates were used to ensure that the appropriate information was correctly recorded.
  • Patients who are nearing the end of their life were treated by GPs who were in regular contact with the community teams. Visits and contact was made by GPs on a regular basis, and this was offered to all patients who were known to be nearing the end of their life.

Families, children and young people

Good

Updated 10 February 2017

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 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 percentage of women aged 25-64 years whose notes recorded that a cervical screening test had been performed in the preceding five years was 83% compared to the CCG average of 82% and the national average of 81%.
  • 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. The community midwife and health visitors held weekly clinics at the practice. Safeguarding information regarding children was shared with health visitors andthe local authority for children who may be at risk.

  • The practice child immunisation clinic was held when a GP was on the premises. If a parent/guardian did not bring the child in for immunisations the practice nurse would telephone or write to the parent/guardian to discuss any concerns. The practice had a policy to follow up non-attendance (DNA) at any service, for example, immunisation clincs or check up appointments. The practice would follow up on DNAs and all children who were identified as potentially at risk were reviewed by the GP.

Older people

Good

Updated 10 February 2017

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 worked with other health and social care professionals to understand and meet the range and complexity of older patients’ needs and to assess and plan ongoing care and treatment. This included when patients moved between services, including when they were referred, or after they were discharged from hospital.
  • Meetings took place with other health care professionals on a monthly basis when care plans were routinely reviewed and updated for patients in this group.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Information on organisations and community groups was available in the waiting area and on the practice website for example bereavement services and Age UK.
  • All patients over 75 years had a named GP and were offered a full comprehensive health assessment. On the day of inspection 8% of the practice population was aged 75 years or over.

Working age people (including those recently retired and students)

Good

Updated 10 February 2017

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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • For example, 52% of patients aged 60-69 years had been screened for bowel cancer in the preceding 30 months, where the CCG average was 59% and the national average was 58%. 62% of female patients aged 50 to 70 years had been screened for breast cancer in the preceding 3 years, where the CCG average was 74% and the national average was 72%.
  • The practice also offered the meningitis C vaccination to patients aged 14 to 25 years and advertised this in the practice newsletter and through social media to encourage this group of patients to attend. There were a number of access routes to the practice, for example, the use of the online booking process for appointments including those outside of surgery hours. Patients were also able to book a telephone appointment, or email any queries they may have.
  • Repeat medications could be requested via the online clinical system, by email, fax, letter or telephone.
  • The information pack, supplied when a patient registered, took a proactive approach in advising patients of their options for help and advice and tips on how to deal with minor illness. There was also a wide range of information and videos on the practice website to pmote health living.
  • The practice offered a bookable extended hours appointments on Wednesday evenings for those patients that otherwise were not able to attend regular clinics due to work commitments.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 February 2017

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

  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 93% which was above the CCG and national averages of 89%.
  • Patients with mental ill health were routinely monitored and an annual health review was offered.
  • Patients who had more complex psychological or mental health illnesses were offered an extended appointment.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information was available in the waiting area in the form of leaflets and posters along with links to videos and national groups on the practice website.
  • 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.
  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, above the CCG average of 86% and the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had developed specific screening tests for patients who may be at risk of developing or who were suffering from dementia.
  • The practice carried out advance care planning for patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 10 February 2017

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 which could include, homeless people, travellers and those with a learning disability.
  • The practice had a register of patients with learining disabilities and at the time of inspection there were 23 patients registered.
  • Patients with learning disabilities were offered annual reviews which included a health assessment, medication review and an up to date health plan. Also the practice offered longer appointments for patients in this group.
  • Vulnerable patients were highlighted on the clinical system. GPs monitored the status of the patient and any further risk factors they may encounter and if high risk, their details were passed on to the local safeguarding team. The reception staff were also made aware of any potential vulnerable adults to help ensure the patients saw a GP regularly.
  • 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.