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Southgates and The Woottons Surgeries Good

Inspection Summary


Overall summary & rating

Good

Updated 29 June 2018

We carried out an announced comprehensive inspection at the surgical unit at Southgates and The Woottons Surgeries, previously known as Dr H I Lazarus and partners, on 03 and 10 August 2017. This inspection was unrated. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Southgates and The Woottons Surgeries on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 June 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. The surgical unit remains unrated. Our key findings were as follows:

  • The service applied inclusion and exclusion criteria to help staff assess patients’ suitability for the service. Following an incident relating to an inappropriate referral we saw that the provider had reviewed and amended their surgery inclusion criteria.

  • All training the practice deemed mandatory was up to date with the exception of basic life support for one surgeon, which had already been arranged prior to our inspection to be undertaken in the week following our inspection.

  • Systems were in place, including appraisals for clinical staff, to support senior staff to be assured of the ongoing competency and clinical skills of the surgeons working in the service.

  • Bank nursing staff had received appraisals since our last inspection. As a result of the appraisals staff had been provided with further learning and development opportunities.

  • Regular surgery team meetings including all staff had been introduced to provide better oversight of the service. The surgery manager described the meetings as a good forum to discuss any issues which may have arisen from the team, referral rates, waiting list times, maintenance, audits and budget matters.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 June 2018

We do not currently have a legal duty to rate minor surgery services where these services are provided as an independent healthcare single speciality service.

  • The service applied inclusion and exclusion criteria to help staff assess patients’ suitability for the service. Following an incident relating to an inappropriate referral, resulting in a procedure being abandoned, we saw that the provider had taken appropriate action.
  • All mandatory training was up to date with the exception of basic life support for one surgeon, which had already been arranged prior to our inspection to be undertaken in the week following our inspection.

Effective

Good

Updated 29 June 2018

We

do not currently have a legal duty to rate minor surgery services where these services are provided as an independent healthcare single speciality service.

  • Systems were in place, including appraisals for clinical staff, to support senior staff to be assured of the ongoing competency and clinical skills of the surgeons working in the service.

  • Bank nursing staff had received appraisals since our last inspection. As a result of appraisals staff had been provided with further learning and development opportunities.

Caring

Good

Updated 29 June 2018

Responsive

Good

Updated 29 June 2018

Well-led

Good

Updated 29 June 2018

Checks on specific services

People with long term conditions

Good

Updated 14 September 2017

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. The practice worked closely with the diabetic specialist nurse, ensuring that patients were treated and supported without the need to travel to the hospital.

  • Longer appointments and home visits were available when needed this included for patients with a learning disability.

  • 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 14 September 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 in line with the national average for the 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.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice offered six week postnatal and baby checks with a GP.

  • A full range of contraceptive care was offered, including long acting contraceptives. These services were available at both sites.

  • We saw positive examples of joint working with midwives, health visitors, and school nurses.

Older people

Good

Updated 14 September 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 that needed them.

  • The practice employed two specialist nurses (matrons) who predominantly worked with older patients ensuring holistic assessment in the patients preferred place of care.

  • The practice looked after patients who lived in eight different care homes, including an end of life care unit. They offered proactive care for these patients and undertook regular visits to the homes.

The practice referred to voluntary and third sector agencies, for example West Norfolk Befrienders and West Norfolk Carers. This ensured that patients who may be marginalised or isolated had access to support and advice.

Working age people (including those recently retired and students)

Good

Updated 14 September 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. For example, the practice provided appointments on a Wednesday evening and on one Saturday morning each month.

  • Telephone appointments were available for those patients who wished to access advice this way.

  • 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.

  • Smoking cessation and NHS health checks were encouraged.

  • The practice was flexible with appointments; patients were able to make appointments at times that were convenient to them for routine and annual follow ups.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 September 2017

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

  • The practice had 114 patients diagnosed with dementia on the register. 70% of these patients had received an annual review. The reviews included advance care planning. Most of the remaining 30% lived in the care homes and received reviews on a regular basis rather than annually.

  • One GP partner had additional experience in mental health care and had held a section 12 approved (some decisions under the Mental Health Act, such as deciding on your medication or giving you permission to leave the ward or hospital, can only be taken by approved clinicians). The practice told us that this enabled them to manage patients who may be experiencing poor mental health within the practice setting, in particular the patients who did not speak English as a first language. The GP shared this additional knowledge with the practice team.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.

  • Appointments were available with GPs on the day to ensure that any urgent conditions or deterioration of situations were managed in a timely manner.

People whose circumstances may make them vulnerable

Good

Updated 14 September 2017

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

  • The practice told us they were aware of the patients who were vulnerable, and worked cohesively as a team to ensure their needs were met.

  • The practice offered longer appointments for patients with a learning disability. The practice undertook regular reviews of these patients.

  • 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 were aware of their responsibilities regarding information sharing, and the documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

  • The practice held drug dependency clinics in shared care arrangements with the Norfolk Recovery Partnership on a regular basis. This ensured that this group of patients who may be marginalised had access to specialist care and general healthcare closer to home.

Surgery

Updated 12 September 2017

Surgery was the main activity of the service. We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the service was in breach of two regulations of the Health and Social Care Act (2014). These were regulation 12, Safe care and treatment and regulation 18, Staffing.

As a result of this we issued two requirement notices.