You are here

Southgates and The Woottons Surgeries Good

Inspection Summary


Overall summary & rating

Good

Updated 14 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Lazarus and Partners on 3 January 2017. The overall rating for the practice was good but with breaches identified in regulation 12. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Lazarus and Partners on our website at www.cqc.org.uk.

This inspection was carried out 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 on 3 January 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

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

  • The practice had recently taken over responsibility for another practice within the area; this second practice, The Woottons is now a branch site of Dr Lazarus and Partners.

  • To ensure that patient’s records and care was integrated, in February 2017, the main practice changed its computer operating system to the same one used at the branch site.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The systems and processes in place to ensure and record that all staff were safely employed had been improved.

  • Systems and processes had been implemented to record the immunisation status of staff appropriate to their role.

  • The practice had implemented systems and processes to identify and mitigate risks relating to fire safety and legionella.

  • The practice training log had been significantly improved; accurate records were kept and there was effective oversight to ensure staff received the training appropriate to their role and responsibilities.

  • The practice system to ensure all prescription stationary was safely monitored needed to be improved.

  • Practice staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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.
  • The practice had ensured that information about how to complain was easily available.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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.

We saw an area of outstanding practice;

  • The practice had over 5000 patients who did not speak English as a first language. The practice had identified that Russian and Lithuanian were the two most common languages spoken, and in addition to the translation services available they had employed three staff members who were able to translate these languages for patients ensuring they had easy access to healthcare.

There was one area where the provider should make improvements:

Review and improve the process to ensure blank prescriptions are tracked and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 September 2017

The practice is rated as good for providing safe services.

  • The practice had implemented comprehensive systems and processes to identify and mitigate risk.

  • The practice system to ensure that prescription stationary was safely monitored needed to be improved.

  • There was an effective system in place for reporting and recording significant events. Comprehensive minutes of meetings where learning was shared were available for all practice staff.

  • Where learning was identified, this was shared with staff and action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support and a detailed written apology. They were told about any actions to improve processes to prevent the same thing from happening again.

  • The practice had clearly defined and embedded systems, processes, and practices in place to keep patients safe and safeguarded from abuse.

Effective

Good

Updated 14 September 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes for 2015-2016 for both sites were in line with the local and national averages. The practice exception reporting rate was 11%; this was in line with the CCG and national average.

  • Practice staff assessed patient’s needs and delivered care in line with current evidence based guidance.

  • Clinical audits were routinely used to encourage quality improvement.

  • Practice 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.

  • Practice staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 September 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with, or above, other practices both locally and nationally for all aspects of care.

  • Patients said they were treated with compassion, dignity, and respect, were listened to, and were involved in decisions about their care and treatment.

  • Information for patients about the services available was generally easy to understand and accessible. The practice had a population of over 5000 patients that had not listed English as their first language; additional measures had been put in place to improve care for these patients.

  • We saw staff treat patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice had identified 251 patients as carers at the main site (approximately 1.5% of the practice list).

Responsive

Good

Updated 14 September 2017

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 to secure improvements to services where these were identified. The practice offered to host clinics to bring services closer to the patient, for example a continence nurse, specialist team for drug and alcohol dependency and a midwife attended the practice.

  • The practice had over 5000 patients who did not speak English as a first language. The practice employed staff who could speak the highest identified languages of Russian and Lithuanian. The practice had letters, leaflets and useful templates translated to ensure these patients were managed safely. For example the practice had translated versions of a screening tool used to help identify patients who may be of low mood.

  • Travel advice was given to patients ensuring they had access to immunisations that were covered under the NHS and those that the patient paid privately for.

  • Patients said they found it more difficult to make an appointment with a named GP, however, they were always able to see a GP if needed.

  • Information about how to complain was available. When complaints were received evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice employed two specialist nurses (matrons) to ensure the vulnerable housebound patients were well managed.

Well-led

Good

Updated 14 September 2017

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. They held regular governance meetings with comprehensive minutes taken to ensure that all actions were managed and reviewed.

  • An overarching governance framework 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 partners encouraged a culture of openness and honesty.

    The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken. Regular reports were produced and shared with all the practice staff.

  • The practice proactively sought feedback from staff and patients, which it acted on.

  • There was a strong focus on continuous improvement.

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.