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Inspection Summary


Overall summary & rating

Good

Updated 5 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elborough Street Surgery on 17 November 2016. The overall rating for the practice was good; however the safe domain was rated as requires improvement as:

  • The practice did not have an automatic external defibrillator (AED) available on the premises for use in medical emergencies and no formal risk assessment in place to mitigate the risk to patients of not having one.

We also asked the practice to:

  • Review how patients with caring responsibilities were identified and recorded on the clinical system to ensure information, advice and support was made available to them.
  • Review the requirements for, and stocks of, emergency medicines in the practice to ensure these were in line with guidance and meeting the needs of patients.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Elborough Street Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 23 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 November 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice had installed an AED in the practice and all staff had been trained to use it.
  • The practice had reviewed and had put in place systems to improve how carers were identified. For example, the practice spoke to patient opportunistically, including those on the practice register of patients at risk of admission to hospital, to ask them if they had caring responsibilities. The practice also reviewed their computer system to make sure that patients were correctly ‘coded’ after being identified as having caring responsibilities (coding allows the computer system to be searched to find groups of patients with common interests or conditions or patients with specific needs such as carers). Carers are now included in the practice quarterly care planning process, where patient needs are reviewed and staff updated on information and support available. However the practice were unable to demonstrate the impact of the work or the increase in the numbers of carers identified.
  • The practice had reviewed their emergency medicines and had updated stocks to include recommended medicines that were not present at our last inspection; Aspirin (used in the treatment of suspected myocardial infarction, a heart attack) and Diazepam (used in the treatment of epileptic seizures).

The areas where the provider should make improvement are:

  • Review how patients with caring responsibilities were identified and recorded on the clinical system to ensure information, advice and support was made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 July 2017

At our previous inspection on 17 November 2016, we rated the practice as requires improvement for providing safe services as;

  • The practice did not have an automatic external defibrillator (AED) available on the premises for use in medical emergencies and no formal risk assessment in place to mitigate the risk to patients of not having one.

When we undertook a follow up inspection on 23 May 2017 we found these arrangements had improved. The practice is now rated as good for providing safe services.

Effective

Good

Updated 17 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages.

  • 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 17 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice above others locally and nationally for several aspects of 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 17 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 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.

Well-led

Good

Updated 17 February 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 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 17 February 2017

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

  • Nursing staff had lead roles in management of long term conditions and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was above the local and national average.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and were offered 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 17 February 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, children and young people who had a high number of A&E 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 79%, which was comparable to the CCG average of 79% and the national average of 81%.

  • 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 and health visitors.

Older people

Good

Updated 17 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.

  • All older people had a named GP responsible for their care.

Working age people (including those recently retired and students)

Good

Updated 17 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.

  • The practice was proactive in offering online services, telephone appointment booking, and telephone consultations 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 17 February 2017

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 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 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 17 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 offered longer appointments for vulnerable patients.

  • 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.