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Inspection Summary


Overall summary & rating

Good

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berkeley Place Surgery on 8 September 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.
  • The patient participation group (PPG) were well engaged and represented across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services. For example, PPG members suggested rewording questions on the practice’s in-house patient survey, and information displayed on its waiting room screens, to make them easier to understand. The content of both areas has been changed as a result.
  • 90% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the Clinical Commissioning Group (CCG) average of 84% and the national average of 76%.
  • The practiced worked closely with local services including a homeless shelter and volunteer transport schemes.
  • The practice offered to the most appropriate patients the use of information and communication technologies in their homes, to support and self-manage long term conditions such as diabetes, epilepsy and Chronic Obstructive Pulmonary Disease, which causes long term breathing problems.
  • The practice is participating in a social prescribing scheme to support people who attend their GP surgery but do not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their wellbeing and meet their wider needs.
  • Staff had lead roles that improved outcomes for patients such as a care co-ordinator and a carers champion. Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.
  • 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.
  • 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 two areas where the provider should make improvement:

  • Continue to conduct clinical audits and embed these into its processes so that improvements made are implemented and monitored.
  • Review the process through which carers are identified to enable the practice to engage with and support a larger proportion of the patient practice list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 November 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 7 November 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 slightly 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 few examples of clinical audits that included improvements for patient care. It is important that the practice continue to conduct clinical audits and embed these into its processes so that improvements made are implemented and monitored.
  • 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.
  • The practice provides medical services for a local independent school, and its concussion protocol guidelines have been implemented and used as part of a national assessment tool.

Caring

Good

Updated 7 November 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 comparable with or better than other local practices 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 were 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. It is important that the practice review the process through which carers are identified to enable the practice to engage with and support a larger proportion of the patient practice list.

Responsive

Good

Updated 7 November 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 is participating in an online clinical support service which aims to relieve the pressure on hospital accident and emergency departments. Where relevant, the service signposts patients to other providers, such as walk in clinics, that might be more appropriate for their health issue.
  • 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.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
  • The practice was proactive in responding to patients’ needs and tailored services accordingly. For example:

    • The practice liaised with local voluntary organisations such as Age UK to provide support;
    • The practice worked with other health professionals to minimise unnecessary hospital admissions;
    • A specialist mental health nurse, from a mental health trust, ran a weekly clinic for patients in the practice who needed this service;
    • Patients were able to access the practice by telephone, emails and face to face.
    • The practice sent text reminders for appointments
    • The practice offered health advice and support for clinically obese patients followed by referral (after six weeks) to a reputable weight loss organisation.
    • Appropriate patients were offered the use of technology in their homes, to self-manage long term conditions such as diabetes, epilepsy and Chronic Obstructive Pulmonary Disease.

  • The practice recruited patients for a volunteer car service due to poor transport links, to enable more physically impaired patients to attend the surgery.

Well-led

Good

Updated 7 November 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 7 November 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 compared with national averages. For example, 75% 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 routinely offered longer appointments for patients with complex medical needs.
  • The practice offered patients the use of information and communication technologies in their homes, to self-manage long term health conditions.

Families, children and young people

Good

Updated 7 November 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 an accepted 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 77%, comparable to 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.
  • The practice provides medical services for a local independent school. A senior GP partner is the Chief Medical Officer for the school’s health centre and has produced concussion protocol guidelines for the Medical Officers Schools Association. These guidelines have been implemented and used as part of a national assessment tool, from June 2015. GPs answer calls from the school’s staff 24 hours a day, 7 days a week. The practice has also set up an email address for students who may find it difficult to access medical care for personal reasons, particularly relating to sexual and other health issues. We saw evidence that in a recent (2016) survey, 90% of pupils rated the health centre as excellent.
  • The practice set up an email address for students from a local school who may find it difficult to access medical care for personal reasons, particularly relating to sexual and mental health issues.

Older people

Good

Updated 7 November 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 patients 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 patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice care-co-ordinator worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
  • The practice referred patients to local community health improvement schemes.
  • Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.

Working age people (including those recently retired and students)

Good

Updated 7 November 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.
  • The practice offered text reminders for appointments.
  • Patients were able to book and attend appointments throughout the day.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 November 2016

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

  • 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with 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 who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 93%, which compared with the national average of 88%.
  • 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.
  • A specialist mental health nurse, from a mental health trust, ran a weekly clinic for patients in the practice who needed this service.

People whose circumstances may make them vulnerable

Good

Updated 7 November 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.