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Sunbury Health Centre Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunbury Health Centre Group Practice on 8 December 2015. The practice had been rated as good for caring and well-led, however, required improvement in safe, effective and responsive domains and therefore had an overall rating of Requires Improvement. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

  • Improve processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
  • Ensure systems are in place for disseminating information received from Medicines and Healthcare products Regulatory Agency to all appropriate staff members.
  • Ensure Disclosure and Barring service (DBS) checks are in place for those staff members that acted as chaperones.
  • Ensure that blank prescription forms are tracked and stored securely within the practice.
  • Ensure that all staff have completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and ensure evidence of this is recorded.
  • Ensure that systems and processes are reviewed to complete referrals in a timely manner.
  • Carry out regular fire drills.
  • Ensure staff have regular appraisals.
  • Ensure the complaints policy contains information regarding advocacy or the Ombudsman for patients to refer to.

We undertook this announced focused inspection on 14 July 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and are rated as Good under the safe, effective and responsive domains.

This report only covers our findings in relation to those requirements.

  • There were robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses. Non-clinical staff also raised significant events and learning from all events was discussed with all team members.
  • Information received from Medicines and Healthcare products Regulatory Agency was disseminated to all appropriate staff members and stored on the practices computer system.
  • Disclosure and Barring Service (DBS) checks and training was in place for those staff members who acted as chaperones.
  • There was a robust system in place for the tracking and secure storage of blank prescription forms within the practice.
  • Staff had completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and we saw training certificates to evidence this.
  • A new referral system was in place which ensured that all referrals made by the GP were completed within four days. We checked the process and found that the practice no longer had a backlog and was working on referrals for the previous day and the day of the inspection only.
  • The practice had carried out a fire drill, which had been discussed and evaluated with action points recorded. Six monthly fire drills were planned.
  • A new appraisal form and system was in place for appraisals. Staff had received an appraisal, which recorded training requests, objectives and career development.
  • The complaints information had been updated. It included information for patients in relation to advocacy and the ombudsman. Posters in the waiting area, leaflets and the website had also been updated with this information.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 August 2016

The practice is rated as good for providing safe services.

At our last inspection, undertaken on 8 December 2015, the practice was rated as requires improvement for providing safe services, as there were areas where it needed to make improvements. Previously we found:-

  • Significant events were not effectively reviewed and investigations were not thorough enough. Lessons learned were not communicated widely enough to support improvement.
  • The practice had failed to disseminate information received from Medicines and Healthcare products Regulatory Agency to all appropriate staff members
  • Staff had not received training in safeguarding vulnerable adults.
  • Although risks to patients who used services were assessed, some systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, the tracking of blank prescription pads, not conducting regular fire drills and staff training was not up to date.
  • Not all staff who acted as chaperones had received a criminal record check from the Disclosure and Barring Service (DBS).

At this inspection, we found:-

  • Significant events were reviewed and investigated by the practice. These were then discussed at fortnightly partner meetings and then further discussed at quarterly significant event meetings. Quarterly meetings were attended by the GP’s, the lead nurse, the assistant practice manager, the business manager and the reception manager. The learning was then disseminated to all team members. We saw evidence that non-clinical staff were aware of how to raise significant events which were discussed and learning shared.
  • Information received from Medicines and Healthcare products Regulatory Agency was sent to the medicines lead GP and the business manager. This was then disseminated to all relevant staff via e-mail and saved within a shared folder on the practices computer system. All staff were aware of the process.
  • Risks to patients were assessed and well managed. We saw there was a list of staff members on display who were trained as chaperones. All of these staff members had an up to date Disclosure and Barring Service check (DBS).
  • Staff training was up to date and we saw certificates to evidence this, including safeguarding vulnerable adults.
  • There was a robust system in place for the tracking and secure storage of blank prescription forms within the practice.
  • The practice had carried out a fire drill, which had been discussed and evaluated with action points recorded. Six monthly fire drills were planned.

Effective

Good

Updated 12 August 2016

The practice is rated as good for providing effective services.

At our last inspection, the practice was rated as requires improvement for providing effective services, as there were areas where it needed to make improvements. Previously we found:-

  • We found staff appraisals were not fully completed and staff training was not up to date for fire safety, infection control, information governance and safeguarding vulnerable adults.
  • The administrative systems in place which dealt with patient referrals did not ensure correspondence was dealt with in a timely and effective manner. However, we saw evidence that the practice had reviewed the system and was in the process of outsourcing this service in order to speed up the process.

At this inspection, we found:-

  • Staff had completed relevant training as required by the practice for basic life support, fire safety, infection control, information governance and safeguarding vulnerable adults and we saw training certificates to evidence this.
  • A new appraisal system and appraisal form were in place. Staff had received an appraisal, which recorded training requests, objectives and carer development.
  • A new referral system was in place, which ensured that all referrals were completed within four days. We checked the process and found that the practice no longer had a backlog and was working on referrals for the previous day and the day of the inspection only.

Caring

Good

Updated 12 August 2016

Responsive

Good

Updated 12 August 2016

The practice is rated as good for providing responsive services.

At our last inspection, the practice was rated as requires improvement for providing responsive services, as there were areas where it needed to make improvements. Previously we found:-

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. However, the complaints policy did not contain information regarding advocacy or the ombudsman and still made reference to the Primary Care Trust, which has been replaced with Clinical Commissioning Group. Learning from complaints was not shared with all staff.

At this inspection, we found:-

  • The complaints information had been updated. The update included information for patients in relation to advocacy and the Ombudsman. Posters in the waiting area, leaflets and the website had also been updated with this information.

Well-led

Good

Updated 12 August 2016

Checks on specific services

People with long term conditions

Good

Updated 12 August 2016

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

At our previous inspection on 8 December 2015 the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nurses had received the appropriate training in order to take ownership and review the needs of all diabetic patients. Systems were in place to maintain continuity of care to patients with diabetes which avoided fragmentation of care.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and were offered a structured annual review to check that 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 healthcare assistant screened patients for pre-diabetes and was able to monitor patients identified and give information in how to make lifestyle changes.

Families, children and young people

Good

Updated 12 August 2016

The practice is rated as good for the care of families, children and young people.

At our previous inspection on 8 December 2015 the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • 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 patients who had a high number of A&E attendances.
  • The practice had a child protection lead GP who was also the Clinical Commissioning Group lead for maternity, children and young patients and ensured that practice polices held relevant information.
  • Immunisation rates were high for all standard childhood immunisations.
  • 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 and health and school nurses who shared the health centre building.
  • The practice ensured that children needing emergency appointments would be seen on the day or were offered a same day telephone appointment to discuss any concerns.

Older people

Good

Updated 12 August 2016

The practice is rated as good for the care of older people.

At our previous inspection on 8 December 2015 the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice offered continuity of care with a named GP.
  • Patients were discussed at bi-weekly clinical meetings with other healthcare professionals to discuss any patient concerns.
  • It was responsive to the needs of older patients, and could offer same day telephone appointments with a GP or a home visit when required.
  • The practice had a register of older patients with complex medical needs or who were at high risk of hospital admission.
  • The health care assistant maintained a register of housebound patients to ensure that flu vaccinations and chronic disease management was up to date.
  • Important information was recorded as alerts on patients’ notes.
  • Patients were encouraged to have their flu vaccination to prevent severe flu related illnesses.
  • The practice looked after a large nursing home and conducted weekly ward rounds with a dedicated GP who also attended throughout the week as required.

Working age people (including those recently retired and students)

Good

Updated 12 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

At our previous inspection on 8 December 2015 the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • 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 flexible.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • The practice offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
  • The practice offered early morning appointments from 7:20am Monday to Friday.
  • Electronic Prescribing was available which enabled patients to order their medicine online and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 August 2016

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

At our previous inspection on 8 December 2015, the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • 84% of patients diagnosed with dementia, had their care reviewed in a face to face meeting in the last 12 months. The national average score was also 84%.
  • 98% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the preceding 12 months. The national average score was 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 12 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

At our previous inspection on 8 December 2015 the practice had been rated as requires improvement for providing safe, effective and responsive services. The issues identified as requiring improvement overall affected all patients including this population group and so it had previously been rated as requires improvement.

At this inspection, we found the practice had improved and was now rated as good in providing safe, effective and responsive services and this is reflected in the population group ratings.

  • The practice could offer longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations
  • Translation services were available for patients who did not use English as a first language. We also saw advertised a sign language service for those patients who had a hearing impairment and the practice provided an auditory loop in the practice.
  • The practice could accommodate those patients with limited mobility or who used wheelchairs.
  • Carers and those patients who had carers were flagged on the practice computer system and were signposted to the local carers support team.
  • 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.
  • Information was routinely shared with out of hours and ambulance services to help improve patient care and safety for those most at risk.