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Inspection Summary


Overall summary & rating

Good

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Newnham and Westbury Surgery on 5 May 2016. We found that the practice had breached a regulation relating to the safe delivery of services. Overall the practice was rated as good.

The practice required improvement for the provision of safe services to ensure that the risks associated with checking, maintaining and safely storing emergency equipment and medicines had been appropriately assessed. The practice also needed to implement a system to identify, assess and mitigate risks arising from cross infection this included the requirement to complete an infection control risk assessment required by the relevant code of practice.

Following the inspection the provider sent us an action plan detailing how they would improve the emergency equipment and infection control management systems ensuring they reflect national guidelines.

We carried out a desktop inspection of Newnham and Westbury Surgery on 7 September 2016 to ensure these changes had been implemented and the service was meeting the regulations previously breached. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report from 5 May 2016. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newnham and Westbury Surgery on our website at www.cqc.org.uk.

We found the practice had made improvements since our last inspection on 5 May 2016 and they were meeting the regulations that had previously been breached.

Specifically the practice was operating safe systems in relation to emergency equipment and infection control management systems. This included:

  • The practice had reviewed their systems for checking and storing emergency medicines and equipment and had implemented new processes. The practice had replaced the equipment previously noted to have been out of date.

  • The practice had improved infection control management by undertaking infection control audit training and completing infection control audits for both Newnham and Westbury practices.
  • Both of the improvements above were discussed at a practice meeting and minuted for all team members’ awareness.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 September 2016

The practice was rated as requires improvement for providing safe services in May 2016 and was re-rated as part of this inspection.

Our last inspection in May 2016 identified concerns relating to the management of emergency equipment and infection control management. During the inspection in September 2016 we saw the concerns had been addressed and now reflected national guidelines:

  • The practice had reviewed their systems for checking and storing emergency medicines and had implemented new processes. The practice had replaced the emergency equipment previously noted to have been out of date and new logs had been implemented to ensure all emergency equipment and medicines were regularly checked and replaced.

  • The practice completed infection control audit training and had completed infection control audits, detailing and undertaking any relevant actions as required.

  • Both of the improvements above were discussed at a practice meeting and minuted for all team members’ awareness.

Effective

Good

Updated 22 June 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.

  • 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.

Caring

Good

Updated 22 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with and slightly below others for several aspects of care.

  • 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 22 June 2016

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 (CCG) to secure improvements to services where these were identified. For example, the practice participated in a CCG led initiative called choice plus which allowed additional emergency slots to be available for patients to be seen at either Lydney hospital or the Dilke hospital. The appointments were triaged at the practice and available under strict criteria, this resulted in greater emergency appointment availability for patients of the practice.

  • The practice participated in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.

  • 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.

  • 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 22 June 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. We saw that the practice’s values were displayed in several staff areas to further embed this ethos.

  • 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. 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 22 June 2016

The practice is rated as good for the care of patients 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 overall diabetes related indicators was 93% which was below the clinical commissioning group average of 95% and above 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.

  • Multidisciplinary meetings were held every four to six weeks with community based staff.

Families, children and young people

Good

Updated 22 June 2016

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

  • 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 82% which was comparable to both the clinical commissioning group average of 84% 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, health visitors and rapid response nurses through minutes of monthly multi-disciplinary meetings.

Older people

Good

Updated 22 June 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in dementia, influenza and pneumococcal and shingles immunisations.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Older patients had access to a named GP to enable continuity of care.

  • The practice visits one nursing home and one residential home weekly and involved professionals to discuss the changing needs of patients.

  • Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients. The practice arranged support for the ‘homes’ through the local Rapid Response Nursing Service which has reduced inappropriate hospital admissions.

Working age people (including those recently retired and students)

Good

Updated 22 June 2016

The practice is rated as good for the care of working-age patients (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.

  • Extended hours evening appointments were available on Mondays for working age patients to attend outside of working hours. The nurses also held early morning appointments from 8.10am Mondays to Wednesdays.

  • Services available included in house spirometry, phlebotomy, vasectomy service, minor surgery, electrocardiogram, International Normalised Ratio monitoring for patients taking anticoagulants and NHS health checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 June 2016

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

  • 71% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.

  • Performance for mental health related indicators was 94% compared to the CCG average of 97% and national average of 82%.

  • 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. A patient participation group member runs a support group in the village for patients living with dementia and carers.

  • 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.

  • Annual dementia reviews were carried out on patients who had been diagnosed or are at risk of dementia and the practice maintains a register to monitor these patients.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and a mental health triage nurse visited the practice once a week.

People whose circumstances may make them vulnerable

Good

Updated 22 June 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability and assessed and reviewed their care at least every 12 months.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and held four to six weekly multi-disciplinary meetings to highlight any patients of concern or any safeguarding issues.

  • 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 took part in a local social prescribing initiative.