You are here

Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greensand Surgery Ampthill on 17 November 2015. 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 a system in place for reporting and recording significant events. However, records were not always kept up to date and completed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Access to the service was monitored to ensure it met patients’ needs. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • 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.

However there were areas where the provider should make improvements.

  • Ensure that risk assessments of staff to determine their suitability for DBS checks are formalised and documented.
  • Risk assess stocks of emergency medicines kept to ensure they are suitable and that up to date protocols for their use are maintained to enable the practice to respond appropriately to a medical emergency.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services. There was a system in place for reporting and recording significant events. Systems were in place to identify and respond to concerns about the safeguarding of adults and children, although two members of staff were still due to complete update training. One member of staff did not have the required background checks needed to be carrying out chaperoning duties. Risks associated with non clinical staff carrying out chaperoning duties had been assessed and mitigated, although the risk assessment for one member of staff was informal. The practice adhered to infection control guidance to ensure people were protected from the risks of infection. The medical equipment at the practice was fit for purpose and maintained correctly. Medicines were stored correctly and emergency medicines were in date. The protocol for use in case of anaphylaxis was not kept with the emergency medicines and was out of date. However we received evidence from the practice that staff had recently had relevant training in this area and were already aware of the required updated dosages. The practice immediately updated their protocol but should ensure that these protocols are regularly reviewed. The practice did not have one recommended item in the emergency medicines kit and this was ordered immediately following our inspection.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff assessed needs and delivered care in line with current evidence based guidance. This included assessing capacity and promoting good health. Staff received training appropriate to their roles and records were kept. There was evidence of appraisals for all staff. Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 21 January 2016

The practice is rated as good for providing caring services. Patients were positive about the care they received from the practice. They commented that they were treated with dignity and respect and that staff were caring, helpful and supportive. Information for patients about the services available was easy to understand and accessible. Patients felt involved in planning and making decisions about their care and treatment. We saw that staff treated patients with kindness and maintained their privacy.

Responsive

Good

Updated 21 January 2016

The practice is rated as good for providing responsive services. It 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. For example providing an enhanced service for patients at risk of unplanned hospital admissions. The practice had closed its branch service and in response to the concerns raised by affected patients, was renting a room from a local pharmacy where it provided blood pressure checks and phlebotomy services from every week. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff at regular meetings.

Well-led

Good

Updated 21 January 2016

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. The practice had a number of policies and procedures to govern activity. Systems were in place to monitor and improve quality and identify and address risks. The practice was aware of future challenges and was proactive in discussing and preparing for these. The practice sought feedback from patients and staff which it acted upon. The patient participation group was active.

Checks on specific services

People with long term conditions

Good

Updated 21 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes and chronic obstructive pulmonary disease (COPD). This information was reflected in the services it provided, for example, reviews of conditions and treatment, vaccinations programmes and screening programmes. A diabetic retinal screening van was hosted by the practice once a year at the practice. These patients had a named GP and a structured annual review. Interim six monthly reviews were available to patients with enhanced needs. Patients who were housebound were visited at home. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. These patients were sent invitation letters offering them vaccinations they are entitled to such as flu and shingles vaccines.

Families, children and young people

Good

Updated 21 January 2016

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, the safeguarding lead GP liaised and met regularly with the health visitor to discuss any concerns about a child and how they could be supported. The practice computer system clearly identified and alerted staff to those children subject to a child protection plan, living in looked after conditions or who had been identified as at risk. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies, with a specific children’s area in the waiting room. There were no set immunisation clinics for babies and children. The practice had recognised the risk of errors occurring with the complexity of the current immunisation programme and a specific clinic will operate from January 2016. We saw evidence of joint working with midwives, health visitors and school nurses. Contraceptive and sexual health advice was provided.

Older people

Good

Updated 21 January 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number of older patients using the service and their health needs, offering them proactive and personalised care. Nationally reported data showed that outcomes for patients were good in conditions commonly found in older people. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and a Doppler service for patients who needed stockings for prevention and management of wound care. (A Doppler ultrasound is a non-invasive test used for estimating blood flow through blood vessels) .The practice worked with other agencies and providers to provide support and access to specialist help when needed. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 21 January 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 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. The practice was registered with the electronic prescribing service (EPS) and had plans to extend the online services available to patients via its website. There were no set times for clinics ensuring that patients could receive the reviews and treatment they needed at times that were suitable for them. Patients were able to book appointments with GPs and nurses online.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Of the 47 people on the dementia register 87% had had their care reviewed in a face to face meeting in the last 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice’s flexible appointment system benefitted these patients who could arrange appointments according to their individual needs. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice monitored prescriptions for patients with poor mental health, for example providing weekly prescriptions for patients at risk of an overdose.

People whose circumstances may make them vulnerable

Good

Updated 21 January 2016

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 those with a learning disability. Patients electronic records alerted staff to patients requiring additional assistance .The practice worked with local drug and alcohol services to provide tailored care for patients who were drug or alcohol dependent. One of the GPs made monthly visits to a local facility providing care for individuals with severe physical and learning disabilities, to enable them to receive continuity of care in an environment they recognised. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this.