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Inspection Summary


Overall summary & rating

Good

Updated 14 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sharnbrook Surgery on 26 January 2016. Overall the practice is rated as good.

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

  • The practice had a clear vision and had recognised the needs of patients in the community it served.
  • The partners had worked hard to install an open and transparent approach to safety and a system was in place for reporting and recording significant events.
  • Risks to patients were identified, assessed and appropriately managed. This included appropriate recruitment checks, clinical reviews and medicines management.
  • We saw that the 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.
  • Feedback from patients was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Results from the GP Patient Survey 2016 showed 93% patients would recommend the practice to someone new to the area.
  • Information about services and how to complain was available in the waiting area and published on the practice website. Where appropriate improvements were made to the quality of care as a result of complaints and concerns. Outcomes were shared and learning opportunities identified as appropriate.
  • Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP. 91% of patients described their experience of making an appointment as good.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice offered a full range of primary medical services and was able to provide pharmaceutical services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy premises.
  • There was a clear leadership structure and we noted there was good level of moral in the practice, staff said they felt supported by management.
  • 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 areas where the provider should make improvement are:

  • To introduce systems to monitor the allocation and use of prescription pads.

  • To ensure dispensary errors are routinely recorded, reviewed and investigated to avoid reoccurrence.

  • Continue to identify and support carers registered at the practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff understood their responsibilities to raise concerns and to report incidents or ‘near misses’.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected incidents patients received support, information and an apology as appropriate to the circumstances. The practice put steps in place to identify learning and changes to processes to avoid a possible repeat incident.
  • The practice had well established systems in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. For example, this included arrangements for infection prevention and control and security arrangements for prescriptions and medicines.

Effective

Good

Updated 14 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed the practice had performed well, obtaining 94% of the total points available to them, for providing recommended care and treatment to their patients. This outcome matched the practice average score across England.

  • Staff referred to guidance from the National Institute for Health and Care and Excellence (NICE) and used it as required to assess and deliver care in line with current evidence based guidance.

  • There was an ongoing programme of Clinical audits which demonstrated a commitment to quality improvement, professional development and patient care. Staff had the skills, knowledge and experience to deliver effective care and treatment. Personal and professional development was encouraged and supported.

  • There was clear 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. The practice staff participated in regular multidisciplinary meetings to meet the needs of patients and deliver appropriate care and support.

Caring

Good

Updated 14 July 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. For example, 77% of patients said they usually get to speak to their preferred GP, which compared very well to a CCG average of 60% and national average of 59%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Feedback from the CQC comment cards was consistently positive. A patient told us they were impressed by the attitude and approach of the staff.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Information for patients about the services available was easy to understand and accessible, with posters and leaflets available in the practice waiting area and on the website.

Responsive

Good

Updated 14 July 2016

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 the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • 94% of patients said the receptionist at the practice were helpful, which compared well against the CCG average of 88% and a national average of 87%.
  • Whilst 91% of patients described their experience of making an appointment as good, which again compared well with the CCG average of 75% and national average of 73%.
  • Urgent appointments were 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 as appropriate.

Well-led

Good

Updated 14 July 2016

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

  • The practice had a clear vision and strategy to deliver good 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 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.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners worked hard to encourage 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 continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 14 July 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.

  • 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held clears records of the number of patients with long term conditions. For example the practice had recorded 237 patients with diabetes, 589 with asthma and 75 with chronic obstructive pulmonary disease (COPD). These patients are seen at the surgery on a regular basis and invited to attend specialist, nurse-led clinics.

  • The practice offered longer appointments to these patients and home visits were available when needed.

  • Arrangements were in place to ensure patients with diabetes were invited for a review of their condition twice yearly. The practice had facilities to provide blood tests prior to an extended appointment with a nurse and GP.

  • 100% of the patients on the diabetes register had influenza immunization in the preceding year; August 2015 to March 2015.

  • The practice had a dedicated nurse to provide annual reviews and regular checks for patients with asthma and COPD. The practice had clear targets to reduce hospital admissions for respiratory conditions. All patients who are admitted to hospital were reviewed by the practice respiratory nurse after discharge.

Families, children and young people

Good

Updated 14 July 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.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. The practice had links with local schools and was able to respond to emergency situations in liaison with the school nursing staff.

  • 80% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was similar to the national average of 82%.

  • 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, health visitors and school nurses.

  • The practice supported a number of initiatives for families with children and young people. For example, the practice hosted a weekly clinic provided by the community midwife.

  • Immunisation rates for all standard childhood immunisations were broadly similar to local CCG performance averages. The practice provided weekly immunisation clinic staffed by a practice nurse and health care assistant.

Older people

Good

Updated 14 July 2016

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

  • The practice had accurate and clear information about the patients it cares for. With 1, 368 patients (25%) over 65 years of age and 363 (6%) over 80 years. Most live at their own homes, some with carers or other support and 49 in residential care.
  • 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. GPs undertook regular home visits to those patients who are unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
  • The practice has clear objectives to avoid hospital admissions where possible. For example, when GPs visited patients who lived in residential care homes it ensured that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.

Working age people (including those recently retired and students)

Good

Updated 14 July 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 provides a weekly surgery for NHS health checks with 178 completed for those patients aged under 65 years in 2015.
  • The practice provided a phlebotomy clinic two mornings each week.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 July 2016

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

  • 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia. For example, patients with memory problems were seen at the practice to undertake pre-referral checks completed before referral to the memory clinic at the local hospital.

  • 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.
  • The practice had 51 patients recorded on the dementia register and all these patients were invited for a medication review twice annually.

People whose circumstances may make them vulnerable

Good

Updated 14 July 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. GPs also made regular visits to patients with learning difficulties who lived at a local care home.

  • 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.