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Walton Surgery Good Also known as Walton Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Walton Surgery on 16 June 2015. The practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe, effective and well-led services and good for providing a caring and responsive service.

In particular, on 16 June 2015, we found the following areas of concern:

  • There was no audit trail that reflected that following incidents or concerns being raised improvement action had been taken.
  • Infection control audits were not being carried out in line with recommended timescales.
  • Risk relating to the management of medicines, medicines alerts, prescription reviews and stocks of emergency medicines were not being assessed.
  • A legionella risk assessment had not been carried out.
  • Reception staff acting as chaperones had not received a disclosure and barring service (DBS) check.
  • Staff were unclear which training they were expected to undertake and when it was due.
  • Annual appraisals had been undertaken for clinical staff but not for administration staff.
  • Data showed patient outcomes were average for the locality but where the Quality and Outcomes Framework was not being used there was no other performance measure in place.
  • The practice had not sought views from patients in the form of a survey or by other means.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 16 June 2015 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

We carried out a further comprehensive inspection at Walton Surgery on 23 November 2016 to check whether the practice had made the required improvements. We found that the majority of the improvements had been made across all areas of concern. Overall the practice is now rated as good.

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

  • Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
  • The practice assessed risks to patients and staff. There were systems in place to manage these risks.
  • Processes and systems around medicines management kept patients safe.
  • Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
  • All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
  • There was a clear and effective complaints system in place.
  • Patients had mixed views regarding access to appointments. Getting through on the telephone in the morning was identified as an issue by some patients. Others told us that access to same day appointments was good.
  • The practice had difficulty recruiting GPs to the practice and had reviewed the way it provided clinical services to meet the needs of its patient population.
  • There was a strong leadership structure in place and staff were supported to increase their knowledge and skills. Appraisals for non-clinical staff were not taking place, however we saw evidence that they still had access to training and career progression. 
  • There was an open and transparent approach evident throughout the practice. The practice management were aware of both their strengths and areas for improvement and had incorporated this into their planning for the future.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Provide non-clinical staff with regular performance appraisals.
  • Improve access to appointments via telephone.
  • Improve the monitoring of patients with poor mental health.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 February 2017

The practice is rated as good for providing safe services.

  • Staff were aware of and could explain their role and responsibilities in reporting and recording of significant events. They told us, and we found evidence to show, that following investigation of any incidents the outcome was shared with appropriate staff to ensure that lessons were learned and action was taken to improve safety in this area in the future.
  • When things when wrong involving patients, appropriate actions were taken and a full investigation completed, with the person affected, or their designated next of kin, given accurate and honest information.
  • There were processes and policies in place for the safe management of medicines.
  • There were clear safeguarding processes in place for adults and children. Staff were aware of their roles and responsibilities with regards to safeguarding and were aware of potential signs of abuse.
  • There were systems in place for the identification and assessment of potential risks to patients, staff and the premises, and plans in place to minimise these.

Effective

Good

Updated 27 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or below average compared to the CCG and national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits were limited but demonstrated 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 clinical staff.
  • Although non-clinical staff had not received a formal appraisal they had access to training to meet their needs, support from managers and were given opportunities for development.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 27 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 27 February 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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 27 February 2017

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

  • There was a clear leadership structure in place.
  • The governance systems in place had been strengthened since the last inspection.
  • Staff felt able to raise concerns and also provide suggestions for improvements to the running and development of the practice.
  • The practice had policies and procedures in place, which were relevant to the practice, regularly reviewed and updated as required.
  • ·There were systems in place for notifying about safety incidents and evidence showed that the practice complied with the duty of candour.
  • The practice sought feedback from staff and patients, which it acted on. The patient participation group provided feedback for the practice.
Checks on specific services

People with long term conditions

Good

Updated 27 February 2017

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

  • The practice adjusted their nurses’ appointments to meet the needs of patients with co-morbidities. For example, when a patient attended for another health condition a review of their long-term condition may be completed at the same time.
  • The practice performance for diabetes indicators was in line with or below the CCG and national average. For example, the percentage of patients with diabetes with a record of an annual foot examination and risk assessment was in line with the CCG and national averages.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP. 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 27 February 2017

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

  • There were systems and processes in place to enable staff to identify and take appropriate action to monitor and safeguard children and young people living in disadvantaged circumstances.
  • Immunisation rates were in line with CCG and national averages for standard childhood immunisations.
  • Patients told us that children and young people were treated appropriately.
  • Weekday appointments were available at the end of school hours.
  • There was a small table and chairs with books available for children to read whilst waiting.
  • The practice encouraged breast feeding and had signs to show mothers were welcome to breast feed their children.

Older people

Good

Updated 27 February 2017

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

  • Patients had a named GP.
  • The practice was accessible for those with limited mobility.
  • 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 in their practice population. They provided information about community facilities to these patients and worked with multi-disciplinary teams from health and social care to keep patients in their own homes where this was their preference.
  • The practice offered planned home visits for patients with enhanced needs, as well as urgent ones.

Working age people (including those recently retired and students)

Good

Updated 27 February 2017

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

  • The practice offered online services such as online booking and prescriptions
  • The practice offered a range of health promotion and screening that reflected the needs for this age group.
  • The practice offered in-house anti-coagulation and phlebotomy.
  • The practice offered coil fittings.
  • The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was higher than the CCG and national average.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 February 2017

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

  • The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was lower than the CCG and national average.
  • Performance data for the number of patients with a mental health diagnosis with an agreed care plan recorded in their record in the last 12 months was lower than CCG and national average.
  • 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 referred patients to a local dementia support service.

People whose circumstances may make them vulnerable

Good

Updated 27 February 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 such as those with a learning disability.
  • The practice offered longer appointments for those patients who needed them.
  • The practice worked with other health care professionals as needed in the case management of vulnerable patients.
  • The practice sign-posted vulnerable patients to various support groups and voluntary organisations.
  • Staff had received training in identifying and reporting possible signs of abuse.
  • The practice had identified 197 carers which was 2.25% of the patient list.
  • There was a local care advisor who the practice referred patients to for support.
  • The practice referred vulnerable patient to an external agency which provided a multi-agency approach to supporting vulnerable patients and aimed at avoid unplanned admissions into hospital.