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High Oak Surgery Good Also known as QOF Doc Limited

Inspection Summary


Overall summary & rating

Good

Updated 29 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Oak Surgery on 1 September 2015. Overall the practice is rated as good.

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

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed. However, we found that lessons learned were not always communicated widely enough to support improvement.
  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, we found some gaps in the management of infection control procedures, equipment checks and patient group directions (PGDs) were not in place for travel vaccinations administered by nurses.

  • Information about services and how to complain was available and easy to understand.
  • 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.

However there were areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are:

  • Ensure that the management of infection control is robust and reflects national guidance, including adequate record keeping to support the management of infection control.
  • Ensure fridge temperatures are recorded correctly, in line with national guidance, to ensure robust maintenance of the cold chain.
  • Ensure patient group directions (PGDs) are in place for nurses who administer travel vaccines.

The areas where the provider should make improvement are :

  • Improve the management of staff files and ensure all content reflects employee history such as reference checks for staff.
  • Raise aware among staff of lead roles to enable them to seek appropriate support, for example in safeguarding and infection control.
  • Consider the effectiveness of current failsafe systems for cervical screening tests, ensure that test results are received by the laboratory for every sample sent by the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 October 2016

The practice is rated as good for providing safe services.

  • Staff were aware of their responsibilities to raise and report concerns, incidents and near misses. Significant events, incidents and complaints were regularly discussed with staff and learning was shared widely to support improvement.

  • The practice had clearly defined systems, processes and practices in place to keep people safe and safeguarded from abuse. Staff were aware of lead roles such as safeguarding and infection control leads.

  • The practice had acted on the recommendations made during our comprehensive inspection. For example. The practice implemented an effective failsafe system; for ensuring that test results had been received by the laboratory for every cervical screening sample sent by the practice.

  • We observed the premises to be visibly clean and tidy. We found that the practice had made many improvements with regards to infection control practices and record keeping.

  • The practice followed guidance by Public Health England and kept adequate records to ensure effective management of the cold chain (for the safe storage and handling of vaccinations). Additionally, we saw that patient group directions (PGDs) well organised, current and signed by relevant staff members.
  • Improvements had been made across a number of processes and systems. These included the process for monitoring prescription stationary and the practices staff filing system. 

Effective

Good

Updated 29 October 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence 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. The practice supported staff through training and personal development. Clinical and non-clinical staff were up to date with their yearly appraisals and personal development plans were in place. Staff worked with multidisciplinary teams.

Caring

Good

Updated 29 October 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 described the staff as caring, helpful, kind and polite. Patients commented that they were happy with the service overall and described the practice as clean and welcoming.

The practice worked with a number of support organisations to support their carer population. The practice had achieved a carer aware award which was awarded by The Carers Trust. 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 29 October 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 Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice had good facilities and was equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised.

Well-led

Good

Updated 29 October 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. 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 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 said they felt respected, valued and supported by all members of the practice team. All staff were involved in discussions about how to run and develop the practice, and the partners encouraged all members of staff to identify opportunities to improve the service delivered by the practice. Staff had received inductions, regular performance reviews and attended staff meetings and events. The practice had initiated a number of innovative projects and made use of the resources available to them and was awarded with an innovation award from their CCG.

Checks on specific services

People with long term conditions

Good

Updated 29 October 2015

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. 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. Practice nurses who specialised in the management of long term conditions visited patients at home to explain care plans, give medication advice and facilitate rescue packs for patients with respiratory conditions such as COPD. 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 29 October 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 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 PPG was also involved in a practice project where a drop in centre was implemented at a local school where the practice offered counselling support, smoking cessation and sexual health advice to young people and teenagers. The practice also involved victim support services and drug support services at the drop in centre by liaising with other organisations.The practice was a provider of the C-Card scheme which was an initiative run throughout the area where patients aged between 13 and 19 could access free sexual health advice, condoms, chlamydia testing and pregnancy testing.

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. Urgent access appointments were available for children and those with serious medical conditions.

Older people

Good

Updated 29 October 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 dementia and 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.

Working age people (including those recently retired and students)

Good

Updated 29 October 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, 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.The practice also offered early and evening appointments as well as Saturday morning clinics to help their working age population to access appointments outside of core hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 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 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 (A&E) 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. The practice offered longer appointments at quieter times for people experiencing poor mental health and also for patients who benefitted from them.

The practices patient participation group (PPG) was given the opportunity to be involved in specific areas to help improve patient care. For example, external speakers were invited to a number of PPG meetings to educate the practice on how to offer appropriate advice to patients, relatives and carers of those who were newly diagnosed with dementia. The practice also worked with the Alzheimers Society and the PPG in developing an information pack for patients who were diagnosed with dementia.  

People whose circumstances may make them vulnerable

Good

Updated 29 October 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 homeless people, travellers and those with a learning disability. The practice offered longer appointments at quieter times for patients with learning disabilities. The practice also carried out annual health checks for patients with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. 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 achieved a carer aware award which was awarded by The Carers Trust. The practice worked with a number of support organisations to support their carer population. For example, the practice regularly liaised with a local support group to provide respite to those with caring responsibilities. The practice was awarded with an innovation award from their CCG. The practice had initiated a number of innovative projects and made use of the resources available to them. Examples included how the practice identified patients who required literacy and reading support and regularly referred patients to the adult literacy service. The practice also encouraged their patients to attend weekly sessions with the librarian who attended the practice as part of the local in-house library service.