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St Giles Surgery Dr A Patel Good Also known as Dr Patel practice at St gilesSsurgery

Inspection Summary


Overall summary & rating

Good

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Giles Surgery (Dr J Rosemen) on 18 August 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 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.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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 areas where the provider should make improvement are:

  • Ensure the practice is registered for the regulated activity maternity and midwifery services to cover the post-natal care provided by the practice.
  • Ensure the guidelines for the correct segregation and disposal of sharps waste is followed to ensure compliance with legislation.
  • Ensure blank prescriptions are tracked through the practice in line with national guidance.
  • Ensure all staff know how to access clinical protocols relevant to their role.
  • Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Formulate a written strategy to deliver the practice’s vision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 4 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with 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 4 November 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey was above CCG and national averages for several aspects of care. For example, 90% said the last GP they saw or spoke to was good at treating them with care and concern (CCG average 81%; national average 85%).
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. This was echoed in the National GP Patient Surgery which showed 91% of patients said the last GP they saw or spoke to was good at involving them in decisions about their care (CCG average 77%; national average 82%).
  • 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 4 November 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 to secure improvements to services where these were identified.
  • 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 National GP Patient Survey showed 61% of patients were able to see or speak to their preferred GP (CCG average 50%; national average 59%).
  • 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 4 November 2016

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

  • The practice told us they had a vision to deliver high quality care and promote good outcomes for patients. However, there was no formal written strategy or supporting business plan to achieve 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 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 4 November 2016

The practice is rated as good for the care of people with long-term conditions.

  • The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice hosted ‘virtual diabetes clinics’ provided by the local diabetes community team which involved diabetes consultants and specialists visiting the practice to undertake case review of complex patients.
  • The practice utilised the Coordinate My Care (CMC) personalised urgent care plan developed to give people an opportunity to express their wishes and preferences on how and there they are treated and cared for.
  • Performance for diabetes related indicators was below the local and national average for some indictors and comparable for others. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 66% (CCG average 73%; national average 78%) and the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% (CCG average 85%; national average 88%).
  • 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 4 November 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, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the three RCP questions was 83% (CCG average 75%; national average 75%).
  • The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 80% and the national average of 82%.
  • The practice promoted and offered chlamydia screening for the under 25s.
  • 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 school nurses.

Older people

Good

Updated 4 November 2016

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.
  • All patients over 75 had a named GP.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. There was an alert system on the clinical system for elderly patients at risk and patients on a case management register receive same day telephone consultations.
  • The practice referred its patients into the local Age UK’s Safe and Independent Living (SAIL) project aimed to support older people stay healthy and independent in their home for as long as possible by helping them navigate and access the full range of services available, including leisure and social services.

Working age people (including those recently retired and students)

Good

Updated 4 November 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 and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website. The practice operated an automated text reminder system for appointments.
  • The practice offered a ‘Commuter’s Clinic’ on Wednesday from 6.40am to 8am and from 6.30pm to 8pm for working patients who could not attend during normal opening hours. Both GP and healthcare assistant appointments were available at these clinics.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 November 2016

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

  • Performance for mental health related indicators was comparable to the local and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 76% (CCG average 85%; national average 88%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 84% (CCG average 86%; national average 90%).
  • The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 73% (CCG average 80%; national average 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 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.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 4 November 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 including homeless people and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients and signposted vulnerable patients to 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 GPs and practice nurse had undertaken Female Genital Mutilation (FGM) training.