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Inspection Summary


Overall summary & rating

Good

Updated 16 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Surgery on 13 December 2016. Overall the practice is rated as good.

  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear ethos which had quality and safety as its top priority. The ethos was to provide the highest standard of individualised healthcare in a safe, friendly and welcoming environment.
  • The practice had an active Patient Participation Group (PPG) which met twice a year and had an active online forum through the year. The PPG provided us with positive feedback about the practice.
  • 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.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 January 2017

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.

  • The practice had an efficient system of maintaining a running log of safeguarding concerns for both children and vulnerable adults. This was updated and actioned on a regular basis.

  • Risks to patients were assessed and well managed.

  • Recruitment procedures and checks were completed as required to ensure staff were suitable and competent.

  • There were appropriate arrangements for the efficient management of medicines.

  • Health and safety risk assessments had been performed and were up to date. For example, recent fire risk assessments.

  • The practice was clean, tidy and hygienic. We found suitable arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.

Effective

Good

Updated 16 January 2017

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. The practice had achieved 99% of its QOF target 2015-16 which was higher than the clinical commissioning group (CCG) average of 98%.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Audits demonstrated performance was being monitored and continuously improved.

  • 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 16 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey 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.

  • The practice had a carer’s lead  who provided signposting to support services relevant to carers.

  • The practice had recently introduced systems in place to identify military veterans and ensured they received appropriate support to cope emotionally with their experience in the service of their country in line with the national Armed Forces Covenant 2014. The practice had identified one military veteran so far.

Responsive

Good

Updated 16 January 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.

  • In response to patient feedback regarding their appointment system, the practice had invested in an online appointment system. The practice also offered an electronic prescribing service.

  • 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 16 January 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 16 January 2017

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice maintained disease registers for all patients with a diagnosed chronic disease. There was a lead clinician for each area of chronic disease. These patients were invited regularly to attend for structured disease specific reviews with GPs or practice nurses.

  • The percentage of patients with diabetes, on the register, whose blood sugar tests were within average ranges in the last 12 months, was 88% which was better than the national average of 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 multidisciplinary package of care.

Families, children and young people

Good

Updated 16 January 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.

  • GPs met monthly at a multi-disciplinary (MDT) meeting with the health visiting team and other health professionals to discuss any safeguarding or domestic violence issues, including looked after children, children ‘at risk’ or on child protection plans.

  • The practice’s uptake for the cervical screening programme was 90%, which was higher than the CCG average of 84% 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, health visitors and school nurses.

Older people

Good

Updated 16 January 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.

  • The Practice participated in the Bournemouth North Locality’s ‘Over 75 Nurse’ project which referred eligible patients to a specialist nurse assessment which provided health checks, care plans, admission avoidance, long term conditions, mental health, dementia, general well-being and social care needs.The nurse also looked at safety in the home, falls risks, problems with isolation and lack of support from family or carers.The nurse could make referrals to other agencies, signpost patients to services like the voluntary sector and feedback to GPs on any clinical concerns.This scheme had only recently been established with a single nurse. 17 patients had been referred to date.

  • Recent locality data from the clinical commissioning group (CCG) showed the practice had reduced the number of patients aged over 75 attending hospital as an unplanned emergency admission by 7.1% over the last 12 months.

  • The practice hosted an Abdominal Aortic Aneurysm Service which screened male patients aged over 65 for abdominal aneurysms.

Working age people (including those recently retired and students)

Good

Updated 16 January 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 about to start having a lunchtime GP surgery so patients who worked could attend appointments at a more convenient time. The practice held early morning and evening surgeries and tried to keep these appointments for working people. This included an evening practice nurse surgery which had proved very popular.

  • On-line access was available for medical appointments, repeat prescriptions and medical records for all of its patients. Text reminder messages were sent to all patients on the booking of an appointment, further reminder sent nearer the time. The practice had started using the MJOG text messaging service in order to text patients with reminders. Patients could respond back with a text message and this could be automatically added to the patient’s clinical record and read coded for audit purposes.

  • 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.

  • Health promotion material was available through the practice and on the website.

  • The practice had a high student population (3,500 of its 9,503 patients which was 36%) from the neighbouring Arts University Bournemouth. The practice had established good links with the University and held a weekly GP and Nurse Practitioner clinic at the Student Services Centre. Students were sent a practice “Welcome Pack” together with information informing them how to access medical services when in Bournemouth. The practice also promoted meningitis booster vaccinations relevant to student populations.

  • The practice was looking at easier ways to engage with students such as creating a Village Surgery app for smartphones and having the practice booklet put into a computerised format so it could be scanned by smartphones.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 January 2017

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

  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the clinical commissioning group (CCG) average of 85% and the national average of 84%.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 96% which was higher than the CCG average of 92% and the national average of 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 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.

  • The practice was working with national dementia support charities to achieve official “dementia friendly” status. Two members of staff at the practice were dementia champions and were actively working towards changes to help their dementia patients, such as introducing dementia friendly signage throughout the practice. All staff had attended training on recognising the signs of dementia and how to support patients.

People whose circumstances may make them vulnerable

Good

Updated 16 January 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 patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • Monthly multi-disciplinary team meetings were held with all relevant health professionals to discuss all patients on the Practices ‘at risk’ or ‘End of Life Care’ register. This included liaison with health and social care co-ordinators.

  • 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 had a carer’s lead who liaised with and offered advice to people who were caring for vulnerable patients.