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Inspection Summary


Overall summary & rating

Good

Updated 22 November 2017

Letter from the Chief Inspector of General Practice

We previously undertook a comprehensive inspection of High Street Surgery on 26 January 2016. The overall rating for the practice was Good with the Safe domain being rated as Requires Improvement. We found two breaches of legal requirements and as a result we issued requirement notices in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
  • Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed

The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

High Street Surgery and Landywood Lane Surgery merged on 1 July 2017. We previously undertook a comprehensive inspection of Landywood Lane Surgery on 22 September 2016. The practice was rated as Inadequate overall and placed into special measures. We found three breaches of a legal requirements and as a result we issued requirement notices in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance
  • Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed

The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Landywood Lane Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 5 October 2017. Overall the combined practice is now rated as good.

Our key findings were as follows:

  • The management team had undertaken a review of both services following the merger. This included working practices, policies and procedures and the overall governance framework. The management team recognised and identified the challenges and had developed an action plan to address these.
  • The practice had an overarching governance framework which supported the delivery of the strategy and good quality care. The management recognised that the framework needed to implemented and become embedded across both sites. Staff at the branch site were being supported through the implementation and cross site working was also being introduced.
  • There was a clear leadership structure and staff felt supported by management. The leadership and management provided to staff who previously worked at Landywood Lane Surgery had been strengthened following the merger.
  • Staff from the merged practice spoke positively about the changes that had taken place since the merger. They told us they felt supported by the management team from High Street Surgery, and efforts had been made to bring both teams together as one new team.
  • Improvements had been made to how the practice provided safe services. There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The same policy and procedure had been adopted across both sites. Recruitment procedures had been strengthened and appropriate recruitment checks were undertaken. All staff had received Disclosure and Barring Service (DBS) checks.
  • Staff were aware of current evidence based guidance. NICE guidance was a standing agenda item at monthly clinical meetings which all clinical staff were expected to attend. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. There were plans to review the results for both practices to identify any areas were improvements could be made.
  • Improvements had been made to the availability of information for patients on how to complain at the branch site. Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised
  • Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • Patient feedback on comment cards was generally positive about the merger and the increased availability of appointments. Comments included being able to see a GP on a Friday afternoon, and being able to book a diabetic review any day rather than just one.
  • The provider was aware of the requirements of the duty of candour. The example we reviewed showed the practice complied with these requirements.

There were also areas of practice where the provider should make improvements.

The provider should:

  • Continue to review and update the policies and procedures and share these with staff.
  • Continue to monitor and encourage the uptake of the
  • Ensure that all uncollected prescriptions are reviewed by the GPs before being destroyed.
  • Provide additional fire marshals at the branch site.
  • Assure themselves that the legionella risk assessment, water temperatures and running of water outlets is carried out at the branch site.
  • Formalise the system for recording verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 November 2017

The practice is rated as good for providing safe services.

  • We saw that improvements had been made to the recording of significant incidents. The same policy and procedure had been adopted across both sites. We found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety at the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined systems, processes and practices in place to minimise risks to patient safety. The same policies and procedures had been adopted across both sites and the practice management recognised that it would take time for these to become embedded.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • All staff who acted as chaperones were trained for the role and had received Disclosure and Barring Service (DBS) checks.
  • We observed both sites to be clean and tidy. Appropriate bins for the disposal of sharps contaminated with
  • We saw that improvements had been made to the arrangements for managing medicines, including emergency medicines and vaccines. Blank prescription forms and pads were securely stored and there were systems to monitor their use. The management of the cold chain and storage of vaccines had improved and appropriate action taken when the cold chain was broken. A full range of emergency medicines were available to staff.
  • Recruitment procedures had been improved. Appropriate recruitment checks were undertaken for both permanent and locum staff. A locum pack with relevant information for different types of staff was available.
  • The practice had adequate arrangements to respond to emergencies and major incidents

Effective

Good

Updated 22 November 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the national average.
  • Staff were aware of current evidence based guidance. NICE guidance was standing agenda item at monthly clinical meetings which all clinical staff were expected to attend.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff. Training expectations had been standardised across both sites and all staff had completed their role specific mandatory training.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved. The clinical staff at the practice met every three months with the community nurses and palliative care team to discuss patients identified with palliative care needs.

Caring

Good

Updated 22 November 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. For example: 85% of patients said the GP gave them enough time compared to the CCG average of 83% and the national average of 86%.
  • Information for patients about the services available was accessible.
  • The practice had developed separate adult and child carers packs. A member of staff acted as a carers’ champion to help ensure that the various services supporting carers were coordinated and effective.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 22 November 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. The practice offered extended hours on Tuesday and Wednesday evenings for working patients who could not attend during normal opening hours.
  • Annual review visits were organised at home for those patients who were unable to attend the practice.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • Patient feedback on comment cards was positive about the merger and the increased availability of appointments. Comments included being able to see a GP on a Friday afternoon, and being able to book a diabetic review any day rather than just one.
  • Results from the national GP patient survey published in July 2017 showed that patients’ satisfaction with how they could access care and treatment was comparable to or above the local and national averages. For example: 83% of patients said that the last time they wanted to speak to a GP or nurse they were able to get an appointment compared with the CCG and the national average of 84%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Improvements had been made to the availability of information for patients on how to complain at the branch site. Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 22 November 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. The practice had a mission statement which supported the practice vision. Both the practice vision and mission statement were included in the business plan.
  • There was a clear leadership structure and staff felt supported by management. The leadership and management support provided to staff who previously worked at Landywood Lane Surgery had been strengthened following the merger.
  • Staff from the merged practice spoke positively about the changes that had taken place since the merger. They told us they felt supported by the management team from High Street Surgery, and efforts had been made to bring both teams together as one new team.
  • Lead roles within the practice were divided between the two partners and practice manager from High Street Surgery and the practice nurses.
  • The practice had an overarching governance framework which supported the delivery of the strategy and good quality care. The management recognised that the framework needed to be implemented and become embedded across both sites. Staff at the branch site were being supported through the implementation and cross site working had been introduced.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. In the example we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • The patients and the PPGs from both practices had been given the opportunity to discuss the proposed merger at meetings held during June 2017. Information had also been made available on the website.
  • There was a focus on continuous learning and improvement at all levels. The practice nurses and the health care assistant told us they were supported to attend training courses and extend their skills.
Checks on specific services

People with long term conditions

Good

Updated 22 November 2017

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

  • Nursing staff had lead roles in long-term disease management with support from the GP partners.
  • Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 92% compared with the CCG average of 82% and the national average of 78%.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.
  • Annual reviews visits were organised at home for those patients who were unable to attend the practice.
  • 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 22 November 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Appointments were available outside of school hours and the premises were suitable for children and babies
  • The practice worked with midwives, health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. Six week baby checks and post-natal checks were carried out by the GPs at the same time.
  • Three out of the four indicators for uptake rates for the vaccines given to under two year olds were all above the national expected coverage of 90%, ranging from 91% to 94%. However, the percentage of children aged two who received the measles, mumps and rubella (MMR) vaccine was 88%. The uptake rates for vaccines given to five year olds were comparable to the national average and ranged from 92% to 96%.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable with the CCG average of 82% and the national average of 81%.
  • The practice offered in-house contraceptive services.

Older people

Good

Updated 22 November 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
  • The practice worked closely with social services and community nursing services to support older patients.

Working age people (including those recently retired and students)

Good

Updated 22 November 2017

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

  • The needs of these populations 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, extended 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.
  • Telephone consultations were available for all patients, but especially for those working age patients or students.
  • The practice enabled students at university to either re-register or be seen as temporary patients during out of term times.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 November 2017

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

  • The practice was a dementia friendly practice and a member of reception staff had been recruited as a dementia champion.
  • The practice carried out advance care planning for patients living with dementia.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The practice had 49 patients on the dementia register. Eighty two percent of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the England average.
  • The practice had 34 patients on the severe mental health register and these patients were offered an annual review.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients experiencing specific mental health conditions with an agreed care plan documented in the preceding 12 months was 86% which was comparable to the local CCG average of 90% and national average of 89%.
  • Patients at risk of dementia were identified and offered an assessment. The practice recognised it had a lower than average prevalence of patients diagnosed with dementia and was actively reviewing patients to ensure they were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 22 November 2017

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 those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice had 30 patients on their learning disability register. These patients were invited for an annual review with the GP and offered longer appointments. The specialist learning disability nurse supported patients at appointments if required.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.