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Thorkhill Surgery Good Also known as Dr Roberts, Mitchell & Taki

Inspection Summary


Overall summary & rating

Good

Updated 8 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorkhill Surgery on 4 May 2016. During this inspections we found a breach of legal requirements and the provider was rated as Good overall but with requires improvement under the effective domain. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

  • To ensure administrative staff undertake the practice’s mandatory training.

We undertook this announced focused inspection on 20 December 2016 to check the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the effective domain.

Our key findings across the area we inspected were as follows:

  • Administrative staff had completed the practice’s mandatory training. This included Safeguarding children and vulnerable adults, fire awareness, infection control, health and safety and information security.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection published on 27 June 2016, by selecting the 'all reports' link for Thorkhill Surgery on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 June 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, 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 and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • The practice was clean and tidy and there were arrangements in place to ensure appropriate hygiene standards were maintained.
  • The practice had policies and procedures in place to help with continued running of the service in the event of an emergency

Effective

Good

Updated 8 February 2017

At our previous inspection in May 2016 the practice had been rated as requires improvement for providing effective services. We found the provider had failed to ensure that administration staff had completed mandatory training as required by the practice.

At this inspection, in December 2016, we found administration staff had undertaken on line training for topics the practice had considered as mandatory. This included Safeguarding children and vulnerable adults, fire awareness, infection control, health and safety and information security.

Caring

Good

Updated 27 June 2016

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 June 2016

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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 27 June 2016

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.
  • The leadership structure within the practice was changing and staff were aware of the new responsibilities being taken on by different staff members. Staff told us they felt supported by management.
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching 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, not all staff had  completed mandatory training.
  • 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 had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • 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 improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 27 June 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP and practice nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Performance for diabetes related indicators were either slightly higher or similar to the clinical commissioning group (CCG) and national average. For example, 86% of patients on the diabetes register, had a record of a foot examination and risk classification within the preceding 12 with the national average being 88%.
  • The practice hosted dermatology, paediatric and neurology clinics which patients could be referred to.

Families, children and young people

Good

Updated 27 June 2016

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

  • There were systems in place 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 A&E attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the national average of 82%.71% of female patients aged 50-70, had been screened for breast cancer in last 36 months which was comparable to the CCG average of 72%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.
  • Safeguarding policies and procedures were readily available to staff.
  • The practice ensured that children needing emergency appointments would be seen on the day.

Older people

Good

Updated 27 June 2016

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

  • 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, and offered home visits and urgent appointments for those with enhanced needs.
  • Older patients with complex care needs and those at risk of all had personalised care plans that were shared with local organisations to facilitate the continuity of care.
  • The practice was working to the Gold Standards Framework for those patients with end of life care needs.
  • The practice nurse telephoned patients on discharge from hospital to offer support, and enquire whether a visit or other assistance was required.

Working age people (including those recently retired and students)

Good

Updated 27 June 2016

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • 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.
  • The practice offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
  • Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.
  • The practice offered NHS health-checks and advice for diet and weight reduction.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 June 2016

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

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%
  • 90% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 which was comparable to the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice carried out advance care planning for patients living with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 27 June 2016

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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.
  • The practice could accommodate those patients with limited mobility or who used wheelchairs.
  • Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team