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Larksfield Surgery Medical Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 13 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Larksfield Surgery Medical Partnership on 20 September 2016. The overall rating for the practice was good with requires improvement for safe.

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

This inspection was an announced focused follow up inspection carried out on 4 July 2017 to confirm that the practice had carried out their plan to meet the recomendations for improvement that we identified in our previous inspection on 20 September 2016.

The areas identified as requiring improvement during our inspection in September 2016 were as follows:

The practice were told they should:

  • Establish a system that will ensure all Medicines and Healthcare products Regulatory Agency (MHRA) alerts are appropriately reviewed and acted on.
  • Review arrangements in place to monitor the updating of medical records.

Overall the practice is now rated as good in all areas.

Our focused inspection on 4 July 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

  • There was an open and transparent approach to safety. The practice had improved the system to manage, review and action patient safety alerts. For example, those received from the Medicines & Healthcare products Regulatory Agency (MHRA).
  • Risks to patients were assessed and well managed. The practice had implemented a system to review and monitor the changes made to patients’ records after they had been updated by clerical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 July 2017

At our comprehensive inspection on 20 September 2016, we identified areas where improvements were recommended to processes and procedures to ensure the practice provided safe services.

During our focused follow up inspection on 4 July 2017, we found the practice had taken action to improve and the practice is now rated as good for providing safe services.

  • The practice had implemented systems to manage, review and ensure action was taken in relation to patient safety alerts. For example, alerts received from the Medicines & Healthcare products Regulatory Agency (MHRA).

  • The practice had implemented a system to review and monitor the changes made to patients’ records after they had been updated by clerical staff.

Effective

Good

Updated 31 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar to the local and national averages. For example, the most recent published results showed the practice achieved 95% of the total number of points. This was comparable with the CCG average of 96% and the national average of 95%.
  • Staff assessed needs and delivered care in line with current evidence based guidance. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met patients’ needs.
  • Clinical audits demonstrated quality improvement. There had been three clinical audits undertaken in the last year, all of these were completed audits where the improvements made were implemented and monitored.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 31 March 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 others for most aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Members of the patient participation group (PPG) we spoke with were positive about the practice and the care provided.
  • 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.
  • The practice had identified 324 patients as carers, which was approximately 2.4% of the practice list. There was a carers lead who was proactive in identifying patients with caring responsibilities.

Responsive

Good

Updated 31 March 2017

The practice is rated as good for providing responsive services.

The identification of the needs for individual patients was at the centre of planning and delivery of services at the practice. Practice staff reviewed the needs of its local population and engaged with NHS England and Bedfordshire Clinical Commissioning Group to secure improvements to services where these were identified.

Patients we spoke with on the day said they could get appointments when they needed them, with urgent appointments available the same day. However, results from the GP Patient Survey indicated that the practice were below average for patient satisfaction relating to ease of access, for example;

  • 67% of patients were satisfied with the practice’s opening hours compared to the CCG average of 77% and the national average of 76%.
  • 54% of patients said they could get through easily to the practice by phone compared to the CCG average of 76% and the national average of 73%.

In response to the low outcomes the practice had plans to replace the complete telephone handling and management system and had recruited two additional reception staff to improve the volume of telephone call that could be dealt with at peak times. The practice also offered extended opening hours

Located in a modern, purpose built health centre the practice had good facilities and was well equipped to treat patients and meet their needs. They had facilities that were suitable for patients with disabilities that included access enabled toilets, wide doors and corridors and consultation rooms on the ground floor. A phlebotomy service was provided at the practice so that patients did not have to attend the local hospital.

The practice worked closely with other organisations and with the local community in planning services that met patients’ needs. Links with children’s centre and the health visitors meant that information of concern could be shared appropriately.

The practice hosted staff from a drug and alcohol rehabilitation and support service in their building and facilitated referrals for patients as required.

Information about how to complain was available and easy to understand. Evidence demonstrated the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders as appropriate. The practice also encouraged positive feedback and celebrated success appropriately.

Well-led

Good

Updated 31 March 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 policies and procedures in place to govern activity. The practice had a clear schedule of meetings that incorporated staff and governance matters.
  • There was a governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. However, we found that some systems for managing risk would benefit from review and strengthening.
  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.

Families, children and young people

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.

Older people

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.

Working age people (including those recently retired and students)

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.

People whose circumstances may make them vulnerable

Good

Updated 13 July 2017

Following our comprehensive inspection on 20 September 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our focused inspection to alter this rating.