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Rothschild House Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rothschild House Surgery on 11 January 2017. Overall the practice is rated as good.

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

  • There were effective systems to monitor and maintain patient safety in the practice.
  • Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were regarded as opportunities for learning across the practice team and for improving patient care.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment in line with current evidence based guidance.
  • Patients said they were treated with kindness, dignity and courtesy and that 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.
  • All patients had a nominated GP, which provided continuity of care.
  • Patients said that it was easy to make an appointment with a named GP and that they appreciated the continuity of care. Patients could get urgent appointments the same day.
  • There was an active Patient Participation Group.
  • The practice had 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 is:

  • Consider introducing a regular programme of dispensary audits as part of the quality improvement programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 February 2017

The practice is rated as good for providing safe services.

  • The system for reporting and recording significant events was effective. Incidents were investigated and logged on a spreadsheet. Staff understood their responsibilities with regard to raising concerns and reporting incidents and near misses.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, information, and a written apology. They were told about any actions to improve processes to prevent a recurrence.
  • The practice had clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse. All staff had received safeguarding training appropriate to their role.
  • The practice assessed risks to patients and had systems for managing specific risks such as fire safety, infection control and medical emergencies.
  • We noted that the driver for the medicines delivery service had not had a Disclosure and Barring Service (DBS) check. A risk assessment carried out in July 2014 was provided subsequently which showed that the practice decided that a Criminal Records Bureau check was not required. The practice has since reversed this decision and applied for a DBS check.
  • The practice had a comprehensive business continuity plan for major incidents such as power failure, loss of medical records and incapacity of GPs.
  • There were sufficient staff on duty to keep patients safe and the practice was visibly clean and tidy.
  • Recruitment procedures were followed to ensure that appropriately qualified staff were employed at the practice.

Effective

Good

Updated 27 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that 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 were carried out and the findings used to improve the quality of care.
  • Staff had the skills, knowledge and experience appropriate to their roles to enable them to deliver effective care and treatment.
  • We saw that appraisals were carried out on an annual basis, which included personal development plans. Staff worked with other health care teams to understand and meet the range and complexity of patients’ needs. 

Caring

Good

Updated 27 February 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice as average or higher than others for several aspects of care.
  • Patients said that they were treated with kindness, dignity and respect and that they were involved in decisions about their care and treatment options. Opinions expressed on the comment cards aligned with these views. We spoke with a manager of a local care home, who said that the level of care was very good and that the weekly ward round by the nominated GP provided continuity of care.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality. Staff were very polite and helpful to patients both at the reception desk and on the telephone.

Responsive

Good

Updated 27 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 could access appointments and services in a way and at a time that was convenient for them by subscribing to the online facility.
  • Extended hours were available which provided flexibility for patients who could not attend during core opening hours.
  • Patients said that 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 implemented suggestions for improvements and made changes to the way in which services were delivered in response to feedback from patients and from the Patient Participation Group. For example, registration procedures for patients aged 16-18 years were modified in acknowledgement that young people did not always have utility bills (normally required as proof of address).
  • A community navigator, employed by the Cinical Commissioning Group (CCG), came to the practice once a month to provide advice and signpost patients to appropriate community services.
  • The practice was due to start hosting a weekly Citizen’s Advice Bureau service shortly after our inspection, which evidenced the practice’s recognition of the link between social and healthcare needs. This service has now started.
  • 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 at meetings. 

Well-led

Good

Updated 27 February 2017

The practice is rated as good for being well-led.

  • The practice had developed a mission statement in consultation with staff. Staff were clear about the mission statement and their responsibilities with regard to achieving 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 business 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 that this information was shared with staff to ensure appropriate action was taken.
  • There was a schedule of regular practice meetings, including business meetings and protected learning time meetings. Staff told us that they were encouraged to develop their skills. This encouragement extended to the trainee GPs, one of whom had become a salaried GP, because of the support and high level of job satisfaction.
  • The practice proactively sought feedback from staff and patients, which it acted on. There was an active Patient Participation Group, which met regularly and contributed to practice development.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 27 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.
  • Longer appointments and home visits were available when needed.
  • The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 89%, which was 12% above the CCG average and 11% above the national average.
  • 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.
  • The nursing team provided healthy lifestyle advice and NHS health checks.
  • A consultant rheumatologist visited once a month.

Families, children and young people

Good

Updated 27 February 2017

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 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 82.2% which was in line with the to the CCG average of 82.4%and slightly above the national average of 81%.
  • The practice hosted a children’s speech and language therapy service and a children’s physiotherapy service.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. There was a separate children’s area in the main reception area and facilities for children in the first floor reception area.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. 

Older people

Good

Updated 27 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
  • The practice provided care for patients in a local care home which was visited weekly by the nominated GP.
  • The practice hosted a weekly podiatry service.

Working age people (including those recently retired and students)

Good

Updated 27 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.
  • Patients could book routine GP appointments online as well as request repeat prescriptions at a time that was convenient for them.
  • Patients could sign up to a text messaging service, which sent appointment reminders and enabled patients to cancel appointments by text, which was convenient for working people.
  • Extended hours appointments were provided which provided flexibility for those patients who could not attend during core opening hours.
  • General contraceptive advice was available at the practice as well as coil fittings.
  • Health promotion information was available in the reception areas and on the practice website.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 February 2017

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

  • 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 9% above the CCG average and 10% above the national average.
  • 95% of patients with poor mental health had a comprehensive care plan documented in the last 12 months, which was 3% above the CCG average and 6% above 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.
  • Staff had undertaken online dementia friendly training to increase their awareness.
  • The practice hosted a Cognitive Behavioural Therapy clinic once a week, which meant that patients could attend the clinic in familiar surroundings.
  • 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. For example, reception staff telephoned patients with dementia on the day before their appointment as a reminder.

People whose circumstances may make them vulnerable

Good

Updated 27 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 including homeless people, travellers and those with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • There were 74 patients on the learning disability register and 17 had a review since April 2016.
  • The practice had appointed a member of the reception team to be a Learning Disabilities Champion. The practice was working towards attaining the Purple Star accreditation, which was sponsored by Hertfordshire County Council. This award would be recognition of the staff’s achievements in making the practice more accessible for patients with learning disabilities. The assessment visit was scheduled during the week after the inspection, and we were subsequently informed that formal accreditation had been awarded.
  • The practice offered longer appointments for patients with a learning disability.
  • Letters were sent to patients with learning disabilities in large font, so that they were easier to read.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • There was a flexible shared care substance misuse clinic to accommodate the needs of patients with chaotic lifestyles.
  • Staff had attended a female genital mutilation learning event to increase their awareness.
  • 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. There was a GP lead for safeguarding adults and a GP for safeguarding children.