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Inspection Summary


Overall summary & rating

Good

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spa Practice on 14 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for all the population groups. It required improvement for providing safe services.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff told us they had received training appropriate to their roles and any further training needs had been identified and planned.
  • 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.
  • Patients said there was continuity of care, with urgent appointments available the same day.
  • There was a clear leadership structure and staff felt supported by the partnership. The practice proactively sought feedback from staff and patients, which it acted on.
  • Some risks to patients were assessed and managed, with the exception of those relating to recruitment checks and legionella testing

However, there were areas of practice where the provider should make improvements.

  • Ensure recruitment arrangements include all necessary pre-employment checks.
  • Ensure a legionella test is completed and action plan implemented in accordance with the findings.
  • Ensure risk assessments are appropriately documented and recorded and updated as necessary.
  • Keep a record of all training and updates staff attend.
  • Comply with fire safety regulations by performing fire evacuation drills as required.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 March 2017

This inspection was conducted to review issues that were found at the comprehensive inspection carried out on 14 July 2015. The issues at the previous inspection included:

  • Staff files we looked at contained some evidence of appropriate recruitment checks having been undertaken prior to employment. However; not all files contained references or evidence of professional registration.

  • We noted that not all staff undertaking chaperone duties had received Disclosure and Barring Service (DBS) checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

  • We noted only some of the actions recorded in the legionnella risk assessment were documented as completed.

  • The practice had not performed a fire evacuation drill in the last year.

The practice manager told us they completed a weekly walk around of the building to identify anything which was amiss and to agree action to rectify it. However; this was not documented and we saw no record of risks identified and how these would be mitigated.

At this inspection on 1 February 2017 we found:

  • The practice had recruited to a number of posts since the previous inspection. We looked at two recently recruited staff files, one clinical and one non-clinical. We found both files contained evidence of appropriate recruitment checks having been carried out, including references and professional registration.

  • We saw that all clinical staff and those acting in the role of a chaperone had received a DBS check. Risk assessments were in place for all non-clinical staff to outline why a DBS check had not been conducted.
  • The practice had a legionella log book outlining roles and responsibilities. Water temperature readings were taken on a monthly basis and a documented record kept. We saw evidence that a legionella risk assessment had been carried out on 31 January 2017.
  • We saw evidence that a fire risk assessment had been carried out and all actions had been completed. For example; the evacuation chair had been re-sited to the first floor in the practice and a fire drill had been carried out in July 2016.

  • We saw a full practice health and safety risk assessment had been carried out and documented. This included manual handling and slips, trips and falls.

Effective

Good

Updated 10 September 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were comparable to the locality. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 10 September 2015

The practice is rated as good for providing caring services. Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 10 September 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Local Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients told us there was continuity of care, with urgent appointments available the same day. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 September 2015

The practice is rated as good for being well-led. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by the partners. The practice had a number of policies and procedures to govern activity and held business partner meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients which it acted on. The patient participation group (PPG) was active. Staff had received inductions, regular performance reviews and attended staff training events.

Checks on specific services

People with long term conditions

Good

Updated 10 September 2015

The practice is rated as good for the care of people with long-term conditions. Practice nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people 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 September 2015

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 accident and emergency attendances. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 10 September 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. In partnership with other practices in the area the practice co-funded a community nurse team to care for patients

in their own homes.

Working age people (including those recently retired and students)

Good

Updated 10 September 2015

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 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 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of those people experiencing poor mental health, 94% had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It 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 received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 10 September 2015

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 those with a learning disability. It had carried out annual health checks for people with a learning disability and all had received a follow-up for the current year. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of people whose circumstances may make them vulnerable. Patients were supported to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in patients. 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.