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Archived: Dr RM Rowland's Practice Good Also known as The Jenner Practice

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr RM Rowland’s Practice on 16June 2015.

We found the practice to be good for providing safe, effective, caring, responsive and well led services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people including those recently retired and students, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • There were comprehensive systems in place to ensure that the practice provided safe care. The practice reviewed policies regularly to ensure that they remained fit for purpose. The practice also had an appropriate system in place to review untoward incidents which were used to inform how services might be developed to improve patient care.

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents.

  • The practice did not own the building from which it operated. Those areas of care provision (such as some aspects of infection control) which required working with the owner of the building were less effective. The practice had written to the owner of the building in order to address this. The practice had specifically asked for cleaning orders, improved toilet facilities on site and further cleaning to these facilities.

  • Outcomes for patients at the practice were in line with or better than national averages, and a developed system of audit was in place at the practice, with evidence that this had led to improvements in patient care.

  • Multidisciplinary meetings were carried out and information was shared with a range of different services to ensure continuity of care for patients.

  • Patients reported that they were pleased with the level of service provided by the practice, and an active patient participation group was in place at the practice, with whom the practice had worked to improve services to patients.

  • The practice had actively reviewed its patient population so that services could be targeted to meet the needs of everyone.

  • Information about services and how to complain was available and easy to understand. This included the practice’s website which was thorough, clear and informative. Appointments could be made and prescriptions requested online.

  • There was a clear practice strategy, which included delivering improved governance over the next two years.

  • Staff felt well-supported by the practice team and felt able to raise any concerns

We saw several areas of outstanding practice including:

  • Care plans were in place for many patients in the practice. For example the practice had recently allocated each of its housebound patients over the age of 75 to one of the duty doctors, and when they had been the “on call” doctor at the practice they had proactively contacted and visited each of these patients over a two month period. New care plans had been implemented for those patients that needed them. A further example was that the practice worked closely with a homeless hostel in the area, and had again proactively seen patients to determine whether or not a formalised care plan would be of benefit.

  • Two staff at the practice had taken a course in basic sign language such that a better service could be provided to patients with hearing difficulties. This was appropriate given the needs of the practice population.

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

In addition the provider should:

  • Ensure with the owner of the practice that they are provided with infection control information including environmental audits, and that the patient toilets in the practice are appropriately cleaned and fit for purpose. Further ensure that any areas not cleaned by the building’s owner (for example computer equipment) are kept clean.

  • Ensure that all checks that have been completed and safety measures taken are clearly recorded (this includes checks on emergency equipment, records of drug expiry dates and staff immunisations against hepatitis).
  • Ensure that where vaccine refrigeration temperatures are outside of safe ranges that any actions are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 July 2015

The practice is rated as good for providing safe services. The practice ensured that it learned from significant events and could demonstrate where systems had been improved following review There were clinical leads in place to support the delivery of services to specific patient groups, and the provision of safe clinical care was supported by policies which were appropriate and reviewed regularly.

There was a lead GP for safeguarding, and staff at the practice understood their roles and responsibilities in this regard. Chaperones in the practice were all clinically trained, and all had been trained.

The practice did not own the building in which they were based. Cleaning and infection control were the responsibility of the landlord. Although in the main the practice was clean, some computer equipment in the practice was dusty, and one of the toilets required redecorating. The practice also did not have access to the landlord’s policies, protocols and audits relating to infection control, although they reported that they had repeatedly asked for them, and provided evidence of this.

Appropriate medicines management systems were in place at the practice. Storage of medicines and vaccines was appropriate, although vaccine refrigerator temperatures on three occasions were noted to have been slightly outside of the safe range and no action in relation to this had been recorded. Clinical equipment was well maintained and serviced regularly. Safety checks in the place were noted to be undertaken, although these were not always recorded.

Staffing levels in the practice were adequate. There were thorough risk management processes in the practice and a business continuity plan was in place. The practice was well equipped to deal with emergencies on site.

Effective

Good

Updated 30 July 2015

The practice is rated as good for providing effective care. Quality and Outcomes Framework (QOF) information for the practice demonstrated good outcomes for patients and a review of patient records showed that reviews of patients were taking place at appropriate times and that patients were on correct medications.

The practice had a developed process of audit, and a number of examples were provided which had been through two full audit cycles. Audits in the practice were proactive, as well as being reactive to any clinical incidents that might occur. Clinical staff in the practice were open when discussing areas that required improvement and the practice was part way through implementing a new governance framework which looked to improve outcomes for patients further. All staff were involved in designing this.

A number of regular meetings took place in the practice where information was shared. At clinical meetings new guidance was discussed as were significant events and individual patient care. Representatives from the practice also met regularly with other local healthcare providers and the Clinical Commissioning Group (CCG)

All staff were supported in professional development and a training matrix was kept to ensure that mandatory training was completed. The practice also demonstrated how it supported members of staff where performance improvement was required.

The practice had effective health promotion and preventative care systems in place.

Caring

Good

Updated 30 July 2015

The practice is rated as good for providing caring services.

The patients and carers we spoke to said that the service being delivered was of a good quality. They stated that they were involved in decisions that related to their care and they were treated with respect and dignity. Patients said that they were happy with the standard of service provided by the practice. The practice had an active patient participation group (PPG) who reported that the practice had implemented a number of changes suggested by them

Patient comments left by patients in the weeks before the inspection were mostly positive, particularly relating to the friendliness of staff. This was also noted by the team during the inspection visit. Relevant information was available to patients both in the waiting area and on the website.

Patient feedback from the last national patient survey was also positive. The practice scored over average for the CCG area in all but one domain

Responsive

Good

Updated 30 July 2015

The practice was rated as good at being responsive to patients’ needs.

The practice had taken measures to better understand its practice population, and had taken steps to improve services, particularly in relation to improving patient access. The practice had dedicated telephone receptionists situated away from the main reception desk to ensure best service to patients calling by telephone and those attending in person. The practice utilised an on call doctor who took calls for patients who needed an appointment urgently, and the same practitioner could arrange emergency appointments and home visits as necessary.

The practice had actively looked at delivering better care to each of its population groups, and named GPs, care plans, and double length appointments were all available for patients who required them. They had taken appropriate steps to improve the level of service for all service users.

The practice offered a combination of same day and pre-bookable appointments, up to two weeks in advance. All clinical areas of the practice were accessible to patients. However, only the main entrance to the practice was wheelchair accessible.

The practice had an active patient participation group (PPG) who had been involved in implementing a number of changes in the practice.

Well-led

Good

Updated 30 July 2015

The practice is rated as good for being well led.

The practice had clear vision and values, which staff were aware of. A practice development plan was in place which looked at improving governance systems in place in the practice by 2017. Governance arrangements already in place in the practice were appropriate and a range of suitable policies and procedures were in place. Relevant information was shared with the practice staff by a number of means.

Clinical and management leads were in place for specific areas of clinical practice, as well as for the development of policies and systems. Member of staff at the practice were aware of who they needed to contact in specific situations. Management line reporting in the practice was clear and most staff in the practice had already received their appraisal for last year

The practice involved both staff in the practice and patients in how they were looking at developing the practice in the future. Staff stated that they felt that there was an open and honest atmosphere within the practice and that they were engaged with managers. Members of the patient participation group (PPG) also reported that they were actively involved with the practice, and they reported that managers had been receptive to ideas about the improvement of services.

Checks on specific services

People with long term conditions

Good

Updated 30 July 2015

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

The nurses in the practice took the lead in the management of long term conditions (including asthma, diabetes and hypertension). There was a GP practice lead for medicine’s management and protocols were in place which were used by the practice nurses. Where patients had multiple conditions, the practice made provision by allowing extended appointments so that all issues could be addressed in one appointment so the patient did not have to re-attend.

All patients who had asthma or chronic obstructive pulmonary disease (COPD) had individualised care plans which allowed them to manage their conditions. This optimised patients’ independence and reduced unfavourable outcomes. The practice also ran a neighbourhood community pulmonary rehabilitation service on site.

The practice lead for diabetes ran a joint clinic with a diabetic specialist nurse from the local diabetes service. This allowed for more intensive care for patients with more complex management issues. The practice initiated insulin therapy in these clinics to reduce the need for onward secondary care referral.

Blood tests were available at the practice which provided greater convenience for patients. Where patients were newly diagnosed with a long term condition, further information to advise patients how to manage their condition was proactively provided by clinical staff.

Families, children and young people

Good

Updated 30 July 2015

The practice is rated as good for providing services to families and young people.

The practice provided a range of services for young people including contraception clinics, cervical screening (with an uptake level of 83%, compared to 82% nationally) and chlamydia screening (uptake information was unavailable).

In supporting pregnant women the practice had an antenatal clinic run by a midwife from the local hospital and there were regular meetings with midwives to discuss vulnerable women. The practice also offered a one appointment service for postnatal checks, child development checks and first immunisations at eight weeks. Uptake of child immunisations was higher than the average for all immunisations at age 12 months, 24 months and five years. There was a breast feeding café at the practice every Friday morning, which provided advice and support to breastfeeding parents. This was run by the health visitors and all new mothers were invited.

In supporting children the practice had a dedicated play area in the waiting room. The named GP lead for child safeguarding held monthly meetings with clinicians and the link health visitor who was based in the same building. All staff in the practice had a minimum of Level 1 child protection training and all clinicians had Level 3 training which was updated annually. The GP lead attended bimonthly Lewisham-wide child safeguarding meetings. Computer records were tagged if there were child protection concerns. The practice also had a system in place to follow up children who did not attend hospital visits

Appointments with GPs and nurses were available in the practice both pre-bookable and on the day and access for families, children and young people was adequate.

Older people

Good

Updated 30 July 2015

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

All patients in the practice over the age of 75 had a named GP in order to improve patient care, and this was clearly flagged within the patient record. The practice had made full assessments of patients within this group and those in the most vulnerable group had individualised care plans.

Consultations for this patient group were available face to face, and for those who were not able to attend the surgery in person, telephone consultations and home visits were available through a duty doctor who was available throughout the day. Specific appointment slots were available to older patients, and reception staff were aware of this. A primary care assistant practitioner was also available to visit patients at home.

The practice held regular monthly multi-disciplinary team meetings with healthcare providers in the community. This included meetings with both district nurses and palliative care teams. Within the previous six months, the practice had pro-actively carried out home visits for patients over the age of 75 who were housebound.

Working age people (including those recently retired and students)

Good

Updated 30 July 2015

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

The practice offered appointments from 8:00am to 6:30 pm five days a week with early opening at 7:30 am twice a week and late closing at 7:00pm once a week. Appointments could be booked both on the telephone and online. In addition the practice had created special telephone workflow slots to follow up and action pathology results and hospital letters which could reduce the need for patients to have to come in to the surgery.

In the waiting area in the practice there were two “pods” where people could measure their blood pressure, height and weight. These could be accessed at any time when the practice was open without appointment. Instructions on how to use the pods was provided in several languages.

The practice had an in house dietician who accepted both GP and self-referrals. The practice showed the inspection team awards won by the nurses in the delivery of smoking cessation services in the past three years, but exact figures for the last year were not available.

The practice offered a walk in phlebotomy service every morning including pre bookable appointments before 8am for those that were working. The practice also offered a joint injection clinic late on Friday afternoon.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 July 2015

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

The practice area covered a number of homes and hostels for people with enduring poor mental health. The practice reported that they had a good working relationship with community mental health and community psychiatric teams, and meetings were held regularly with them both at and away from the practice.

The practice had several patients with chronic psychosis for whom they ran regular clinics. The practice undertook physical health checks annually for all patients with serious mental illness. This included routine blood tests, electro cardiogram (ECG) and health promotion advice.

The practice reported that they were proactively asking patients about memory problems. Those patients who were identified as being at risk were referred onwards to the community memory clinic. Patients with established dementia had annual reviews which included medication reviews, blood tests, support offered for carers and safeguarding.

People whose circumstances may make them vulnerable

Good

Updated 30 July 2015

The practice is rated as good at providing services for people whose circumstances might make them vulnerable.

The practice recognised that people who were homeless and those with learning disabilities had particular requirements and might face problems accessing the care that they needed, and systems were in place to allow them to access care at the practice.

The practice carried out annual health checks for patients with learning difficulties. Within the area that the practice covered there was a homeless hostel for which the practice ran outreach clinics in order to be responsive to the needs of these patients. This addressed some difficulties that they might otherwise have in accessing care. A number of patients in this group had drug and alcohol problems and chronic mental health issues which were reflected in their individualised care plans.

All practice staff had completed training on detection of domestic violence and local resources were available, including multi-agency risk assessment conferences (MARAC).

The practice had a large group of non-English speaking patients including refugees who had access to interpreting services. Some of the staff in the practice spoke languages other than English.

The practice had a thorough set of risk assessments in place. Policies for the safeguarding of both children and vulnerable adults were in place, and members of staff were aware of the procedures for managing any issues arising. Chaperoning services were available at the practice, and this service was prominent in notices in the waiting room, but not in the consulting rooms.