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Inspection Summary


Overall summary & rating

Good

Updated 27 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southam Surgery on 16 February 2016. The overall rating for this service is good.

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

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff told us and records showed that training appropriate to their roles had been carried out. Staff training needs had been identified and planned for the following year.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning from incidents was shared with relevant staff at meetings relevant to their roles and responsibilities, although this was not always fully documented.
  • Information was provided to help patients understand the care available to them. Patients told us they were treated kindly and respectfully by staff at the practice. Their treatment options were explained to them so they were involved in their care and decisions about their treatment.
  • The practice was well equipped and had good facilities to treat patients and meet their needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • Information about how to complain was easy to understand and available in practice leaflets and on the practice website.
  • 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 are areas where improvements are needed.

The areas the provider should make improvements are:

  • Ensure that the infection control measures in place are followed and applied consistently by all staff.
  • Establish an agenda to ensure that significant events are routinely discussed or reviewed in meetings to provide an audit trail that demonstrates the learning and sharing of information.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 April 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Lessons were shared to make sure action was taken to improve safety in the practice although this was not always fully documented.
  • There were safeguarding measures in place to help protect children and vulnerable adults from the risk of abuse.

Effective

Good

Updated 27 April 2016

The practice is rated as good for providing effective services.

  • Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. NICE is the organisation responsible for promoting clinical excellence and cost-effectiveness. They produced and issued clinical guidelines to ensure that every NHS patient gets fair access to quality treatment.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits had been carried out in order to demonstrate quality improvement.
  • 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 27 April 2016

The practice is rated as good for providing caring services.

  • Results from the National GP Patient Survey published in January 2016 showed that the practice scored average or above for results in relation to patients’ experience and satisfaction scores on consultations with the GPs and the nurses.
  • 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.
  • Patients were very complimentary about the practice and commented that staff were very friendly, that they received excellent care from the GPs and the nurses, and could always get an appointment when they needed one.

Responsive

Good

Updated 27 April 2016

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.
  • Extended hours were available to benefit patients unable to attend during the main part of the working day.
  • 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 that the practice responded quickly to issues raised.
  • The practice had acted on suggestions for improvements and changed the way it delivered services in response to feedback from the Patient Participation Group (PPG) and patient surveys.

Well-led

Good

Updated 27 April 2016

The practice is rated as good for being well-led.

  • It had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff understood the values of the practice and worked to provide a service which was patient-centred.
  • 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 processes in place to monitor and improve quality and identify risk, although improvements were needed to evidence that learning was shared.
  • Staff had received inductions and attended staff meetings. Staff told us they were supported to develop their skills to improve services for patients.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active Patient Participation Group (PPG) which was positive about their role in working with the practice to respond to patients feedback and make improvements where needed.
Checks on specific services

People with long term conditions

Good

Updated 27 April 2016

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

  • GPs and the practice nurses 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 medicine needs were being met. For patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The quality monitoring data (QOF) for 2014/2015 showed that the percentage of patients with diabetes who had received a foot examination and risk classification for monitoring their conditions was 94% which was 3% above the CCG average and 7% above the national average.
  • Clinicians engaged in the Gold Standard Framework Palliative Care programme to improve palliative care services to patients. This involved auditing palliative care services in the practice, meeting with patients and discussing their needs regularly.

Families, children and young people

Good

Updated 27 April 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 patients who had a high number of accident and emergency (A&E) attendances.
  • Childhood immunisation rates for the vaccinations given were overall higher than the local Clinical Commissioning Group (CCG) averages.
  • Appointments were available outside of school hours and the premises were suitable for children with changing facilities for babies.
  • We saw good examples of joint working with midwives, health visitors and other local practices. The practice contacted parents when babies and children did not attend for their vaccinations and informed Child Health Services when appropriate.

Older people

Good

Updated 27 April 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • It was responsive to the needs of older patients, and offered home visits and urgent appointments for those patients unable to access the practice.
  • The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs.
  • There was a dedicated nurse who worked in conjunction with Age UK to provide holistic reviews of patients over the age of 75 years, and worked proactively with the practice to help patients maintain good health.
  • The practice provided services for 116 patients who lived in three care homes locally. Weekly visits were made to these homes by a designated GP. The practice worked collaboratively with care home staff to provide effective services for those patients. Care home staff were included in training events for practice staff to further develop collaborative working arrangements. A mobile number was given for care home staff to contact the GP at weekends and out of hours so that continuity of care could be maintained.

Working age people (including those recently retired and students)

Good

Updated 27 April 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 services that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.

  • The practice offered extended opening hours for appointments on Tuesday mornings and evenings and on Thursday evenings. Patients could also book appointments up to four weeks in advance or order repeat prescriptions online.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 April 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those patients with dementia. Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
  • The percentage of patients diagnosed with dementia whose care has been reviewed for 2014/2015 was 71% which was 15% lower than the CCG average and 13% lower than the national average. The practice had worked to improve on these rates for the 2015/2016 year and had achieved 87% of patients reviewed so far.
  • The GPs and the practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
  • The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations. Staff had received training on how to care for patients with mental health needs and dementia.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 27 April 2016

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

  • The practice held a register of patients living in vulnerable circumstances including patients with a learning disability. For example, the practice had carried out annual health checks for all 34 patients on their register for patients with a learning disability and offered longer appointments .
  • Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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 engaged in local initiatives to provide additional services such as the Identification and Referral to Improve Safety (IRIS) scheme (a domestic violence and abuse training support and referral programme). The project provided staff with training to help them with detecting any signs of abuse and patients were sign-posted to support agencies.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Information was provided for patients about how to access various support groups and voluntary organisations. For example, leaflets were available in the waiting area and on the practice’s website.
  • Vulnerable patients were supported to register with the practice, such as homeless people or travellers. The practice enabled patients who lived on boats with no formal postal address to register with the practice both for short term and longer term registrations.