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Inspection Summary


Overall summary & rating

Good

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Farnham Road Surgery on 5 January 2017. Overall the practice is rated as good. Specifically it is rated good for the provision of safe, effective, caring and well led services and outstanding for delivery of responsive services.

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

  • Risks to patients were assessed and well managed.
  • 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. Learning and trends from complaints were shared with stakeholders. For example, with the patient participation group (PPG).
  • Patients said they found it easy to make an appointment, there was continuity of care. Urgent appointments were available the same day and appointments were offered on both Saturday and Sunday mornings.
  • The practice had 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 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.
  • A wide range of services were provided at the practice to facilitate easier access for patients and reduce time consuming and costly trips to hospitals and other clinics.

We saw areas of outstanding practice including:

  • Learning from significant events was central to improvement in practice performance. Detailed presentations of significant events were given to staff at team meetings to ensure consistent learning. Significant events were shared with the patient participation group and other external stakeholders to facilitate wider learning and improvement.

  • Patients individual needs and preferences were central to planning of services. The practice provided specialist clinics, led by the GPs, to increase attendance and reduce referrals. These included: dermatology and orthopaedics. Data showed this increased attendance and reduced referrals to hospitals and other clinics.

  • The practice took an active role in provision of services to the wider community and those in vulnerable circumstances. They provided a specialist drug and alcohol prescribing service to both registered patients and those from other practices in the area. This recognised that this group of patients frequently found contact with new services difficult.

The areas where the provider should make improvement are:

  • Ensure exception reporting for patients diagnosed with diabetes is reviewed.
  • Ensure a system is put in place to provide patients diagnosed with a learning disability to access annual health reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Learning from significant events was imparted consistently using presentations to staff. Actions required to reduce the risk of recurrence were detailed and shared with other stakeholders in the locality.

  • 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. Regular safety checks were undertaken and actions required to reduce risks were clearly documented and shared with staff.

Effective

Good

Updated 17 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. However, exception rates for diabetes indicators needed review.

    The practice was engaged with the CCG to access projects to improve engagement.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had an active programme of clinical audit that drove improvement. Outcomes of audits were well documented and shared with relevant staff within the practice.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others in the locality 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.

  • 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.

  • Information for carers was available and the practice was working towards accreditation as

    Investors in carers standards.

Responsive

Outstanding

Updated 17 March 2017

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example it offered a drug and alcohol prescribing service to both registered patients and those from other practices. The service ran with the support of the local drug and alcohol specialist service.
  • There are innovative approaches to providing integrated patient-centred care. For example by offering GP led outpatient clinics at the practice. Data showed this increased attendance and reduced referrals to hospitals and other clinics.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example the practice worked with their PPG in offering health promotion opportunities in the areas of healthy eating and health walks.
  • Patients had access to appointments on both Saturday and Sunday mornings. Evening and weekend women’s health clinics were offered.
  • 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 when issues were raised. Learning from complaints was documented clearly and shared with staff and other stakeholders. For example the PPG received a regular update on complaints and trends in complaints.

Well-led

Good

Updated 17 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 were positive about the support they received from partners and 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 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. Staff gave examples of their views being listened to and acted upon.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 17 March 2017

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.

  • Performance for diabetes related indicators was 97%

    which was higher than the clinical commissioning group average (CCG) of 90% and national average of 90%.

  • Performance for chronic obstructive pulmonary disease related indicators was 100%

    which was higher than the clinical commissioning group average (CCG) of 98% and national average of 96%.

  • 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 worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 17 March 2017

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

  • Performance for asthma related indicators was 100%

    which was higher than the clinical commissioning group average (CCG) of 99% and national average of 97%.

  • Childhood immunisation rates for the vaccinations given were comparable to national averages for those immunisations for five year olds but below national average for those aged 24 months.

  • Rates of attendance for cervical cancer screening were the same as the CCG average of 80%.

  • Same day appointments were available for children and there were appointments available outside of school hours.

Older people

Good

Updated 17 March 2017

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 patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Outcomes for long term conditions associated with older patients were above average. For example, the practice achieved 100% of the indicators relating to care of patients diagnosed with osteoporosis (a thinning of the bones). This was better than the CCG average of 92% and national average of 87%.

Working age people (including those recently retired and students)

Good

Updated 17 March 2017

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.

  • Appointments were available early morning and until 8pm every weekday. In addition the practice offered appointments on both Saturday and Sunday morning to assist those patients who found it difficult to attend an appointment during the working day.

  • Women’s health clinics were held in the evening and at weekends.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2017

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

  • The practice provided a specialist service for patients who were diagnosed with drug and alcohol misuse problems.

  • 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.

  • 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.

  • Performance for mental health related indicators was 100% which was above the CCG average of 98% and the national average of the national average of 93%.

People whose circumstances may make them vulnerable

Good

Updated 17 March 2017

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. However, the arrangements for providing annual health checks for patients with a learning disability were not operated effectively. Only 26% of these patients had received an annual health check in the last year. However, the practice had appointed a lead GP for learning disability patients. The practice were aware due to cultural difficulties that patients with learning difficulties did not often engage with health services. The lead GP had the knowledge to engage with this patient group and were starting to engage with local community leaders.

  • 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.