You are here

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rangeways Surgery on 12 November 2015. Overall the practice is rated as good.

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

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.

  • Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans. The practice had supported staff members through a variety of training courses. We noticed how members of the practice team were mostly long term members of staff who had been supported and promoted to take on higher roles by the management team.

  • There were effective arrangements in place to identify, review and monitor patients with long term conditions. Patients’ needs were assessed and care was planned and delivered following best practice guidance

  • The practice was responsive to the needs of its patient population. There were services aimed at specific patient groups.

  • The practice had good facilities and was equipped to treat patients and meet their needs. While we observed the premises to be visibly clean and tidy, we found that the practice did not routinely keep records to evidence that the required cleaning of specific medical equipment had taken place.

The areas where the provider should make improvement are:

  • Ensure that the management of infection control is robust and reflects national guidance, including adequate record keeping to support the management of infection control.
  • Ensure fridge temperatures are recorded consistently, in line with national guidance, to ensure robust maintenance of the cold chain.
  •  Assess and manage risks associated with legionella.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 January 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 we spoke with confirmed that significant events and learning was regularly shared with them on an informal basis.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • While we observed the premises to be visibly clean and tidy, the practice did not keep records to evidence that cleaning of medical equipment such as the equipment used for ear irrigation had taken place.  Members of the nursing team confirmed that medical equipment was cleaned before and after use. Staff we spoke with assured us that cleaning records had been adapted as a priority and that these would include cleaning of medical equipment.

Effective

Good

Updated 7 January 2016

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance. Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.

  • 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 had supported staff members through a variety of training courses. We noticed how members of the practice team were mostly long term members of staff who had been supported and promoted to take on higher roles by the management team.

Caring

Good

Updated 7 January 2016

The practice is rated as good for providing caring services.

  • Patients said they were satisfied with the care provided by the practice and that their dignity and privacy was respected.

  • 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.

Responsive

Good

Updated 7 January 2016

The practice is rated as good for providing responsive services.

  • Results from the national GP patient survey published in July 2015 showed that patients responded positively regarding care and treatment.

  • However, results relating to waiting times were below local and national averages. While some patients commented that waiting times could be long, they all commented that this was because the GPs took the time to listen to patients and ensured thorough discussions took place.

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised.

  • There were disabled facilities, hearing loop and translation services available. Vulnerable patients, patients with hearing impairments and those who did not have English as a first language were flagged on the practices system so staff were aware of their needs.

  • The GPs frequently carried out home visits for older patients and patients who would benefit from these. The practice also offered a home visit phlebotomy service for patients who may have difficulties accessing the practice.
  • The practice worked with the local CCG and the Dudley Council for Voluntary Service (CVS) team to improve outcomes for patients in the area. For example,the practice was part of a scheme in the area to help to provide social support to their patients who were living in vulnerable or isolated circumstances.

Well-led

Good

Updated 7 January 2016

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

  • There was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The partners encouraged a culture of openness and honesty. The practice had systems in place for managing notifiable safety incidents.
  • The practice proactively sought feedback from staff and patients, which it acted on. Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans.
  • The patient participation group was active and involved in improvement projects across the practice.
Checks on specific services

People with long term conditions

Good

Updated 7 January 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 overall diabetes related indicators was 91% which was above the CCG average of 88% but below the national average of 96%. One the GPs specialised in diabetes care, this included teaching patients how to safely inject insulin and closely monitoring these patients with repeat visits and phone calls. The practice nurse also specialised in managing diabetes and often referred patients for insulin initiation. Staff we spoke with felt that these factors contributed towards their QOF performance for diabetes care.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 7 January 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. For example, childhood immunisation rates for under two year olds ranged from 90% to 100% compared to the CCG averages which ranged from 40% to 100%. Immunisation rates for five year olds ranged from 94% to 100% compared to the CCG average of 93% to 98%.

  • 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.

Older people

Good

Updated 7 January 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 people in its population.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice offered a home visit phlebotomy service for patients who were elderly and for patients with mobility difficulties.

  • The practice was part of a scheme in the area to help provide social support to their patients who were living in vulnerable or isolated circumstances. The practice was able to demonstrate the success of this scheme with examples of how members of the practice’s older population who been living in isolated circumstances were now living more active lifestyles through attending local centres and community clubs.
  • Flu vaccination rates for the over 65s was 78%, compared to the national average of 73%.

Working age people (including those recently retired and students)

Good

Updated 7 January 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 offered extended hours for working patients who could not attend during normal opening hours.

  • 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. The practice’s uptake for the cervical screening programme was 83%, compared to the national average of 81%.
  • We noticed a number of notice boards on display in the waiting area. Each board was populated with information to a specific population group. For example, there was a notice board for adults which contained carer information and dementia awareness resources. We also saw a notice board dedicated to young adults, this contained information on sexual health services.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 January 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health.

  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.

  • It 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 people with mental health needs and dementia. Performance for mental health related indicators was 88% compared to the CCG average of 87% and national average of 96%.

People whose circumstances may make them vulnerable

Good

Updated 7 January 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 homeless people, travellers and those with a learning disability.

  • It offered longer appointments at flexible times for people with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • It had told 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 worked with the local CCG and the Dudley Council for Voluntary Service (CVS) team to improve outcomes for patients in the area. For example,the practice was part of a scheme in the area to help to provide social support to their patients who were living in vulnerable or isolated circumstances.