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Archived: Dockham Road Surgery Good

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Inspection Summary


Overall summary & rating

Good

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dockham Road Surgery on 28 July 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 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 98% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which exceeds both the clinical commissioning group (CCG) average of 86% and the national average of 84%.
  • 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.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We found one area where the provider should make improvement:

  • The provider should seek support to recruit members to its patient participation group, to better reflect the patient population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 September 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 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 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.

Effective

Good

Updated 16 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework for April 2015 to March 2016 showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • We saw a programme of clinical audits that included improvements for patient care, with schedules identified for a second cycle of audits.
  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (January 2016) showed patients rated the practice as either above or comparable with 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.
  • The practice had identified patients who acted as carers and alerted them whenever a local carers group met. This provided an opportunity for carers to gain support and raised awareness of carers services locally.

Responsive

Good

Updated 16 September 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 (CCG) to secure improvements to services where these were identified. For example, the practice was working with the CCG to look at maintaining or reducing non elective admissions of elderly patients to hospital, by having extended appointments in which clinicians or the care co-ordinator could book an older person in for a review of all health care problems, or to identify potential problems.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with regular appointments available the same day.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of patient feedback.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice increased the length of individual appointment times for patients with complex medical conditions.
  • The practice offered telephone appointments where appropriate, as an alternative to face to face consultations, and at the time of inspection was considering video consultations.
  • Patients could access art therapy sessions at a nearby location to improve their mental health, general wellbeing and social interaction.
  • The practice hosted a diabetic clinic followed by referral (after six weeks) to a reputable weight loss organisation.
  • The practice referred patients to local community health improvement schemes such as Walking For Health and Forest Health Trainers.
  • The practice GPs made at least four visits per day to patients’ homes between morning and afternoon surgeries. This service was mainly available for elderly and terminally ill patients who were unable to attend the surgery and could not make alternative arrangements.
  • The practice offered home visits by the practice nurse for vulnerable patients who did not attend their scheduled appointments. Patients were assessed and if necessary, booked for a same day appointment at the practice.
  • The practice referred patients to the Exercise On Prescription scheme. The scheme, run by South Gloucestershire Council in partnership with local GP practices, helps people with medical conditions such as diabetes and coronary heart disease, who are not normally active, to access a supported 12-week exercise programme.

Well-led

Good

Updated 16 September 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 provider 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.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 16 September 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 patients with long-term conditions was better than national averages. For example, 83% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
  • 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.
  • The practice increased the length of individual appointment times for patients with complex medical conditions.

Families, children and young people

Good

Updated 16 September 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 assessed the capability of young patients using Gillick competencies. These competencies are a means to determine whether a child is mature enough to make decisions for themselves.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 80%, consistent with 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 16 September 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.
  • Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice GPs made at least four visits per day to patients’ homes between morning and afternoon surgeries. This service was mainly available for elderly and poorly/terminally ill patients who were unable to attend the surgery and could not make alternative arrangements.

Working age people (including those recently retired and students)

Good

Updated 16 September 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.
  • Patients were able to order repeat prescriptions on-line.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 September 2016

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

  • 98% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose level of alcohol consumption had been recorded over the course of a year was 93%, which was comparable with the national average of 90%.
  • 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.
  • Patients could access art therapy sessions at a nearby location to improve their mental health, general wellbeing and social interaction.

People whose circumstances may make them vulnerable

Good

Updated 16 September 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 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 was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.