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Inspection Summary


Overall summary & rating

Good

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gables Surgery on 27 October 2016. The overall rating for the practice was good but specifically requiring improvement in the provision of effective services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Gables Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 30 August 2017 to check that improvements had been made since our previous inspection on 27 October 2016. This report covers our findings in relation to those improvements made since our last inspection.

Overall the practice is rated as good and the provision of effective services is now also rated as good.

Our key findings were as follows:

  • Clinical audits were examined and proof of second cycle audits were seen.

As part of the inspection on 27 October the practice was advised that they should make available proof of identity including a recent photograph for recruitment files and formalise the identification and recording of patients who are carers so that all carers are offered support. During our inspection on 30 August 2017 we saw evidence that the recruitment process for all staff had been reviewed and that proof of identity checks are being carried out with photographic identification now being held on file. The practice was also able to demonstrate that it was more proactive in the identification of carers and that it had now increased the number of identified carers from 12 to 44. This represented 1.2% of the practice list and, whilst still fairly low, the practice was able to demonstrate plans to increase that figure still further.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 October 2017

Effective

Good

Updated 12 October 2017

The practice is rated as good for providing effective services.

  • The practice was able to provide evidence of completed two-cycle clinical audits which were seen to show improvement in the quality of care.

Caring

Good

Updated 12 October 2017

Responsive

Good

Updated 12 October 2017

Well-led

Good

Updated 12 October 2017

Checks on specific services

People with long term conditions

Good

Updated 23 March 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.

  • Performance against clinical targets for patients with diabetes was comparable to local and national averages.

  • 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.

Families, children and young people

Good

Updated 23 March 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 those that had missed a hospital appointment. 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 eligible women having the cervical screening test was comparable to the local and national averages.

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

Older people

Good

Updated 23 March 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.

  • Housebound patients discharged from hospital received a home visit from the healthcare assistant for a check up to ensure their needs were being met.

  • Where a patient might benefit, and with their consent, the practice put them in touch with the patient participation group who organised social visits and events such as Christmas dinner and coffee mornings.

Working age people (including those recently retired and students)

Good

Updated 23 March 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 and a smartphone app, as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 March 2017

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

  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. The practice had 11 patients with dementia.

  • Performance against mental health indicators was comparable to local and national averages.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • Staff had a good understanding of how to support patients with mental health needs.

People whose circumstances may make them vulnerable

Good

Updated 23 March 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 and those with a learning disability.

  • The practice offered longer appointments for patients whose circumstances may make them vulnerable.

  • 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.

  • Housebound patients discharged from hospital received a home visit from the healthcare assistant for a check up to ensure their needs were being met.

  • Where a patient might benefit, and with their consent, the practice put them in touch with the patient participation group who organised visits and social events.

  • The practice followed up patients who had not attended their hospital appointments