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Review carried out on 12 July 2019

During an annual regulatory review

We reviewed the information available to us about Littledown Surgery on 12 July 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 15 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Littledown Surgery, Bournemouth on Wednesday 15 June 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • The practice were committed to working collaboratively with patients who had complex needs to ensure they received coordinated care. For example, one of the GPs provided a project to improve care for patients over the age of 75, in order to reduce hospital admissions and improve recognition of cognitive impairment. The project had reduced hospital admissions and had reduced the length of hospital stay.
  • 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.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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 a proactive carers lead who had identified 3% of the practice population as carers. The ongoing support included carers coffee mornings, facilitation of outside speakers, carers health checks, links to local services for carers, and an annual newsletter of useful information.
  • The practice had actively sought feedback from patients and dementia specialists about the building which had resulted in changes in signage, flooring and seating. There were 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 was organised and had effective governance structures in place.
  • 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.
  • The practice demonstrated a strong, visible, person-centred culture and staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. For example, the practice had been proactive in the care of patients with dementia.
  • Patients were truly respected and valued as individuals and were empowered as partners in their care. For example, the practice worked closely with a voluntary coordinator which had resulted in patients accessing befriending and transport services which increased social activity, reduced isolation and reduced the number of times the patient attended the practice for emotional support.

We saw an area of outstanding practice:

There was evidence of quality improvement which was used by the practice to improve services. For example, one of the GPs provided a project for patients over the age of 75 to improve care, reduce hospital admissions and improve recognition of cognitive impairment. The GP had performed two cycles of an audit which demonstrated avoidable hospital admissions dropped from 33% in 2014 to 22% in 2015. The audit also showed an increase in dementia diagnosis. For example, seven patients had been diagnosed in 2014 and this had increased to 16 patients in 2015. The audit also saw a 50% reduction in the duration of hospital stay.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 4 June 2014

During a routine inspection

Littledown Surgery is a primary medical services GP surgery based in the Bournemouth suburb of Littledown. It carries out the following regulated activities; diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. The service operates between 0830 hrs and 1830 hrs from Monday to Friday, with late opening on a Monday until 2030 hrs. The practice has four GP’s and two nurses. The service is commissioned by NHS Dorset Clinical Commissioning Group (CCG).

CCGs are clinically led groups that commission (or buy) a range of healthcare services including hospital care, rehabilitation care, urgent and emergency care, community health services, mental health and learning disability services. CCGs include all the GP groups in their geographical area. All GP practices must belong to a CCG.

During our site visit we spoke with seven patients on a one to one basis. We also attended a Patient Participation Group (PPG) meeting and spoke with twelve more patients in a group discussion. We spoke with the practice manager and two other members of the administrative staff. We also spoke with three GP’s including the senior partner at the practice.

Each of the seven patients we spoke with on an individual basis were extremely satisfied with the care they received and with the staff at the practice. The overall sentiment from the 12 patients we spoke with at a PPG meeting was very positive about the service.

We found that the practice had strong leadership and robust internal management systems. Effective communication took place within the organisation, with regular staff meetings providing open forums to discuss learning points and updated information. Patients told us that they felt well informed about the services available at the practice.

The service had systems in place to learn from feedback. We saw evidence that incidents, accidents and complaints were handled effectively at the practice. We saw the practice had an effective clinical governance process in place. This process identified where care had not been fully effective, understanding why, learning lessons and making improvements to reduce the risk of future reoccurrence.

The practice undertook minor surgical procedures such as mole removals. This enabled patients prompt access to a service with a doctor they knew. All of the patients we spoke with told us that the practice was always clean, tidy and well organised. We saw that patients were cared for in a clean and hygienic environment. The practice had up to date policies relating to recruitment and retention of staff, which included recruitment of sessional doctors, confirmation of eligibility to work in the UK, criminal record checks and an induction process. However, we found that the practice had not carried out a criminal record check with the Disclosure Barring Service (DBS) on one member of administrative staff.

We found the practice was effective in meeting the needs of the local population in the catchment area of Littledown. Regular and timely audits had been carried out to identify areas for improvement and ensure the quality and safety of care delivered.

Patients told us that they were involved in discussions about the health care they received and asked for their consent before it was provided. We observed there was a friendly and professional atmosphere at the practice, with patients being treated with respect by staff. However, we found that as the reception point was next to the waiting area, privacy was not always protected.

The practice was responsive to the needs of patients with an active PPG which was also attended by senior staff. We saw that there were opportunities for patients to provide feedback about the care they had received, from regular patient meetings in a group forum, on a one to one basis with staff or via regular surveys.

We found that the practice contained essential emergency first aid equipment such as an Automated External Defibrillator (AED). Staff had been trained in its use and in delivering first aid. The practice had level access with consultation and treatment rooms situated on the ground floor. There was a toilet with appropriate facilities for patients with mobility difficulties; however there was no emergency alarm cord in place.

Appropriate information was provided for staff via an internal computer based intranet system. This contained up to date policies, procedures and useful information. All staff we spoke with described the service as well-led and said they felt well supported. Information was shared with staff via email, telephone and at regular meetings.

We found evidence that the quality and safety of care and treatment was monitored effectively using a wide range of clinical and non-clinical audits using set criteria. This provided the practice with the required information to ensure a high quality of care and to make improvements where required.