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Inspection Summary


Overall summary & rating

Good

Updated 10 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Dover Road 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 was an open and transparent approach to safety and an effective system for reporting and recording significant events.
  • Risks to patients were assessed and well managed. The practice had identified some areas of infection prevention and control that required improvement and at the time of inspection had begun to implement a range of improvements. However, the action plan for these improvements did not contain timescales.
  • 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.
  • The practice was committed to working collaboratively and participated in the Community Hub operating Centres (CHOC) aimed at improving communication between health and social care services.
  • 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.
  • The practice was a member of the Encompass Vanguard (an integrated multi specialty community provider consisting of 16 other GP practices, the CCG, three other NHS trusts, the local council and local social services, the local hospice and numerous voluntary groups), which aimed at providing services in the community and reducing the need for patients to travel to secondary care.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
  • There was a clear leadership structure and staff felt supported by management. The practice 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.

We saw one area of outstanding practice:

  • In response to staff suggestions the practice implemented a direct telephone line and issued business cards with contact details for the care co-ordinator to help ensure vulnerable patients, carers and other health and social care providers could obtain support and information to meet their needs in a timely manner.

The areas where the provider should make improvement are:

  • Review infection prevention and control action plans to include timescales for the completion of any actions and improvements. Ensure lead members of staff have received suitable training to support this role.
  • Review the process for managing childhood immunisations to help ensure immunisation data is accurate.
  • Continue to develop the carers register and review how the needs and requirements of this group of patients are being met.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system 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 help prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices to help keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. The practice had identified some areas of infection prevention and control that required improvements and at the time of inspection had begun to implement a range of improvements. However, the action plan for these improvements did not contain timescales.

Effective

Good

Updated 10 March 2017

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 and local averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. Records showed that results from audits and service reviews were shared at the regular Practice Development Meetings
  • 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.
  • The practice was committed to working collaboratively. Patients who had complex needs were supported to receive coordinated care and there were innovative and efficient ways to help deliver joined-up care to vulnerable patients. For example, the practice participated in the Community Hub operating Centres (CHOC) aimed at improving communication between health and social care services.

Caring

Good

Updated 10 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients consistently rated the practice higher than others for their 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 10 March 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. The practice was a member of the Encompass Vanguard (an integrated multi specialty community provider consisting of 16 other GP practices, the CCG, three other NHS trusts, the local council and local social services, the local hospice and numerous voluntary groups), which aimed at providing services in the community and reducing the need for patients to travel to secondary care.

  • 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.
  • The practice had a care coordinator to support elderly patients and to help ensure that their emotional and social needs were given as much importance as their physical needs.

Well-led

Good

Updated 10 March 2017

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.
  • 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 for notifiable safety incidents and ensured this information was shared with staff to help ensure appropriate action was taken.
  • The practice 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. The practice was a training practice for GPs and also provided training opportunities for physician’s associates.
Checks on specific services

People with long term conditions

Good

Updated 10 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.
  • Data from the Quality and Outcomes Framework (QOF) showed diabetes indicators were 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 10 March 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 A&E attendances.
  • There were four areas where childhood immunisations were measured; each had a target of 90%. The practice was above the target in two areas and below the target in the remaining two areas.
  • 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 86%, which was comparable to 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 school nurses.

Older people

Good

Updated 10 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. Through collaboration with local GPs patients had access to a paramedic practitioner.
  • The practice had a care coordinator to support elderly patients who, alongside one of the GPs, attended weekly multidisciplinary meetings.

Working age people (including those recently retired and students)

Good

Updated 10 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 help 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 March 2017

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

  • 77% of patients diagnosed with dementia had received a face to face care review meeting in the last 12 months, which was comparable to the local average of 81% and the national average of 84%.
  • Performance for mental health related indicators were comparable with local and national averages.
  • 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 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 10 March 2017

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

  • There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs. For example, the practice reviewed two homeless patients with the CHOC group to help ensure that their emotional, social and wellbeing needs were given equal consideration alongside their physical needs.
  • The practice held a register of patients living in vulnerable circumstances including homeless patients 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.
  • 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.