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Inspection Summary


Overall summary & rating

Good

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oliver St Surgery on 12 April 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.
  • Any child under the age of five years was offered an appointment two days after their original consultation to reassure their parent or guardian.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had introduced an observation sheet for completion during a medical emergency.
  • 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:

Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 August 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 learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, an explanation 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.
  • The practice maintained effective working relationships with other safeguarding partners such as health visitors and social workers.
  • There were appropriate systems in place to protect patients from the risks associated with medicines management and infection control.
  • Emergency medicines and equipment were available and in date and the practice had developed an observation chart for completion during an emergency.

Effective

Good

Updated 15 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to 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 records were in order with good evidence of all checks carried out.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice was proactive in encouraging patients to attend national screening programmes for cervical, breast and bowel cancer.

Caring

Good

Updated 15 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in January 2016 showed patients rated the practice higher than others 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.
  • Staff felt well supported by the practice management team and the practice had an ‘open door’ policy, this was supported by a specific ‘Well Being’ policy for staff which included a ‘changes to mood’ template for staff to complete if they felt the need.
  • The practice held a register of patients identified as carers.

Responsive

Good

Updated 15 August 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 practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice offered a weekly physiotherapy service.
  • 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.
  • Any A&E attendances or hospital admissions/discharges were followed up within 3 days by the practice if required.
  • A prescription delivery service was available for patients unable to collect their own medication.
  • A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.

Well-led

Good

Updated 15 August 2016

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 15 August 2016

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

  • Nursing staff had lead roles and received regular training in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was comparable to the Bedfordshire Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 68%, where the CCG average was 76% and the national average was 78%.
  • 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 multi-disciplinary package of care.

  • The practice arranged home visits for patients in this group to monitor their long term conditions.
  • Personalised care plans for this group were completed and there was a recall system in place to ensure patients were reviewed regularly and appropriately.

  • There were GP leads for individual long term conditions.
  • The practice utilised external specialist clinicians who attend the practice and assisted in supporting non-compliant patients.

Families, children and young people

Good

Updated 15 August 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.
  • 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 83% and 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 and health visitors.
  • The practice referred new mums and children with eating problems to a weight management programme specifically for this group.
  • The practice offered a sexual health awareness clinic for patients aged 14 to 19 years.
  • Family planning and contraceptive advice was available.
  • Any child under the age of five years was offered an appointment two days after their original consultation to reassure their parent or guardian.

Older people

Good

Updated 15 August 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. 
  • Annual health checks were available for patients in this group.

  • Medication control boxes were available for repeat medication.
  • The practice offered flu immunisation at home for those patients unable to attend the practice.
  • Any unplanned attendance at accident and emergency, hospital admission or discharge, on review, were followed up by the practice within three days of receipt of discharge information.

Working age people (including those recently retired and students)

Good

Updated 15 August 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, including ‘Well man’ and ‘Well woman’ checks.
  • The practice had enrolled in the Electronic Prescribing Service (EPS) in 2015. This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
  • The practice offered catch-up and ongoing vaccination both proactive and opportunistic for students returning home.
  • On line services were available for booking appointments and prescription ordering.
  • The practice offered extended hours appointments until 8pm on Mondays and telephone triage for patients unable to attend during normal surgery hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 August 2016

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

  • The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% where the CCG average was 84% and the national average was 84%.
  • Performance for mental health related indicators were otherwise comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 82% where the CCG average was 87% and the national average was 88%.
  • 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 A & E 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.
  • The practice was part of a mental health triage hub, providing patients access to counselling and wellbeing psychologists.
  • The GPs carried out weekly ward rounds in the local dementia care home.

People whose circumstances may make them vulnerable

Good

Updated 15 August 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, travellers 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.
  • The practice held a register of patients who were also carers and same day appointments were available to this group as a priority.
  • Vulnerable patients who were unable to attend the practice were contacted by telephone, or offered home visits.
  • The practice worked with local pharmacies to deliver patient’s medication to their home addresses when needed.