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Inspection Summary


Overall summary & rating

Good

Updated 19 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashville Surgery on 14 January 2016. The overall rating for the practice was good, with a requires improvement rating for the key question of safe and we issued a requirement notice for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment). The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Ashville Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 26 November  2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches identified in the requirement notice.

Overall the practice is now rated as good, with the previous rating of requires improvement for the key question of safe updated to a rating of good.

Our key findings were as follows:

  • The practice was able to demonstrate that they had considered risks and identified mitigating actions in a number of areas.

  • Systems were in place to monitor the use of prescription paper

However, there was an area of practice where the provider should make improvements.

The provider should:

  • Consider current guidance from the Resuscitation Council (UK) as part of their risk assessment and rationale for no defibrillator on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 January 2018

At our previous inspection on 14 January 2016, we rated the practice as requires improvement for providing safe services as the practice had not ensured risks were assessed and mitigating actions implemented in a number of areas and there was no system to monitor the use of prescription paper.

These arrangements had improved when we undertook a desk top review in November 2017. The practice is now rated as good for providing safe services.

  • The practice was able to demonstrate that they had considered the risks relating to the health and safety of staff and patients. An outside business support service was now used by the practice to review and develop further the practice’s health and safety policies and risk assessments. We saw examples that the risks of lone working and transporting blood samples had been documented and mitigating actions were implemented. The practice had considered the risk of no defibrillator on the premises in April 2017. They had ensured staff had been trained to provide basic life support and they informed us they were looking into funding for a defibrillator.

Measures had been introduced to allow the safe storage and monitoring of blank prescriptions.

Effective

Good

Updated 18 February 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • The majority of staff had the skills, knowledge and experience to deliver effective care and treatment. However, not all staff had yearly appraisals.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 February 2016

The practice is rated as good for providing caring services.

  • 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 18 February 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of the 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 difficult to make some appointments, especially for on the day urgent appointments. However, the practice had put actions in place to rectify this issue. A duty doctor with no pre-booked appointments was available to meet on the day demand of urgent appointments.

  • 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 18 February 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 this.
  • 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 practice 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 knowing about 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 18 February 2016

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.
  • Performance for diabetes related indicators was better than the national average for all five indicators (2014/15). The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 87.2%, above the England average at 77.54%. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 81.15% which was above the England average of 78.03%. The percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015), was 97.72% with the England average at 94.45%. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2014 to 31/03/2015) was 84.29% with the England average at 80.53%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 91.47% with the England average at 88.3%.
  • 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 18 February 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.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages (01/04/2014 to 31/03/2015). For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 51.5% to 93.4% and five year olds from 36.7% to 95.4%.
  • 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 (01/04/2014 to 31/03/2015) was above the England average of 70.81% at 77.84%.
  • 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 72.2% (March 2015), which was higher than the CCG average of 65.4% and comparable to the national average of 74.3%. The staff told us this was due to 50% of the local population being from black and minority ethnic (BME) communities who had difficulty in understanding some concepts in relation to cervical and cancer screening.
  • 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 18 February 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.

Working age people (including those recently retired and students)

Good

Updated 18 February 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 February 2016

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

  • 91.8% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (01/04/2014 to 31/03/2015), which was above to the national average (84.01%).
  • 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 (01/04/2014 to 31/03/2015) was 90.6%, which was above the England average of 88.47%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 93.65%, which was above the England average of 89.55%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 18 February 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 multi-disciplinary teams in the case management of vulnerable people.
  • 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.