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Inspection Summary


Overall summary & rating

Good

Updated 6 April 2016

We carried out an announced comprehensive inspection at Beckett House Practice on 7 January 2016. Overall the practice is rated as Outstanding.

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

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

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Feedback from patients about their care was positive.

  • 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.

  • 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.
  • The practice was well equipped to treat patients and meet their needs. Information about how to complain was available in a variety of languages and was easy to understand.
  • 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.

We saw several areas of outstanding practice including:

  • The practice had translators who would attend the practice on set days each week to accommodate Portuguese and other foreign languages speakers. Twenty percent of the practice’s population were Portuguese speaking and 11% were Spanish speaking. Fifty percent of the Portuguese speaking population and 58 % of Spanish speakers required the use of a translator. The practice had developed its translation policy on the basis of feedback they had received from patients and had a range of information translated into other languages; including their complaint policy and chaperoning policy. The practice’s out of hours answer phone message had also been translated into three different languages.

  • The practice had completed business cases in conjunction with two colleagues from other federations which resulted in funding being obtained for two initiatives which were introduced to other practices in the locality. Firstly the practice had helped to introduce Primary Care Navigators (non clinical staff trained to provide information and make referrals to support agencies that could help patients manage their long term conditions more effectively) within the locality. The practice’s Primary Care Navigator had referred 25 patients since July 2015 compared with no referrals between April and June 2015; prior to the introduction of the care navigator. The Primary Care Navigators within the practice are both Spanish and Portuguese speakers to ensure that people who speak these languages are able to access this service. The practice had also worked to obtain funding from the CCG to make the holistic health assessment programme viable for GPs in the locality and participated in a subsequent audit which showed a significant increase in the numbers of the assessments being conducted and ensured that funding was continued.

  • The practice manager costed and setup a weekend winter hub at a neighbouring GP practice over the winter of 2014/15. This was staffed by receptionists from the practice who worked outside of their contracted hours. The hub enabled other providers in the locality, out of hours services and A &E services to divert patients where appropriate over the busy winter period. Work undertaken at the winter hub formed the basis of a successful bid to fund local extended hours access hubs under the Prime Minister’s challenge fund as those practices involved were able to demonstrate, through joint working, their ability to operationalise a service at short notice with limited resources.

The areas where the provider should make improvement are:

  • The practice should ensure that all staff complete annual basic life support training.

  • The practice should review the systems to ensure mediciens are fit for use.

  • The practice should review their fire safety policy and consider fire safety training for all staff.

  • The practice should consider instituting a programme of clinical audits.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 April 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 there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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 people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 6 April 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

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

  • We saw a clinical audit which demonstrated quality improvement.

  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 6 April 2016

The practice is rated as good for providing caring services.

  • Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 6 April 2016

The practice is rated as good 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 people’s needs.

  • There are innovative approaches to providing integrated person-centred care.

  • 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.
  • People can access appointments and services in a way and at a time that suits them; though wait to see a GP when patients attended the surgery was an issue for some.
  • 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 shared with staff and other stakeholders where appropriate.
  • The practice had worked to obtain funding from the CCG to make the holistic health assessment programme within the CCG, making this financially viable for GPs in the locality, and participated in a subsequent audit which showed a significant increase in the numbers of the assessments being conducted.
  • The practice had worked to introduce primary care navigators within the locality. These are non-clinical staff trained to provide information and support and referrals to educational programmes with long term conditions. The practice primary care navigator was fluent in other languages spoken by a proportion of the practice population.
  • The practice had assisted in the development of a local Portuguese community project. Although the programme was initiated by another surgery the practice had brought this within the locality and worked with the CCG to obtain additional funding which has resulted in quicker development of the initiative.

Well-led

Good

Updated 6 April 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 this.

  • 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 encouraged a culture of openness and honesty. The practice had systems in place for knowing about 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 6 April 2016

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

  • Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 83.17% compared to 77.54% nationally. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 88.24% compared to 78.03% nationally. The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March was 98.46% compared to 94.45% nationally. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 85.51% compared to 80.53% nationally. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 98.66% compared with 88.3% nationally.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice reviewed patients who had frequent A & E admissions. They assessed the needs of these patients and provided education and information on different services in the area in order to reduce the number of unnecessary admissions.

  • The practice had trained non clinical members of staff to act as primary care navigators for patients with diabetes; providing patients with information on sources of support to help patients manage their condition. Staff at the practice had been instrumental in getting this initiative introduced in the locality. The primary care navigator was fluent in Spanish and Portuguese to ensure that patients who only spoke these languages were able to access this service. The introduction of the service had resulted in increased referrals to a locally run diabetic educational programme.

Families, children and young people

Good

Updated 6 April 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, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 77.19% which was comparable to the CCG average of 79.7% and the national average of 81.83%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw good examples of joint working with midwives, health visitors and school nurses. The practice also ran a virtual clinic with a consultant from a local hospital.

Older people

Good

Updated 6 April 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.

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

  • The practice had been active in securing locality wide funding for Holistic Health Assessments (HHA) for patients over 80, over 65 and housebound or those over 65 who had not seen there GP in 15 months. These assessments reviewed both health and social needs and put measures in place to address any needs not being met. An audit of the assessments found that one in three patients had two onward referrals to other health care agencies as a result of the findings in the assessment. The practice helped to compile a business case to secure funding for 5500 HHAs to be completed in the locality in 2015/16.

  • The practice attended North Lambeth Community Multi-Disciplinary Team (CMDT) meetings where patients who had received an HHA were reviewed and discussed. The meetings were attended by various health and social care organisation and case studies were used to generate ideas and take actions in respect of how to best coordinate care and services in the local community. This has resulted in increased awareness in both the practice and wider locality of the services available to support older people in their care. One of the practice partners was the co-chair of the CMDT and had increased attendance among general practices in the area by offering educational sessions after each meeting.

Working age people (including those recently retired and students)

Good

Updated 6 April 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 April 2016

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

  • One hundred percent of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 91.67% compared with 88.47% nationally. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 91.67% compared to 89.55% nationally. The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months was 94.01% compared to 94.1% nationally.

  • It 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.

  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 6 April 2016

The practice is rated as good for the care of people who circumstances may make them vulnerable.

  • One of the practice GPs was the lead for learning disability and undertook annual reviews of learning disabled patients to ensure that health and social needs were being met, provide additional support where required and update care plans.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • It offered longer appointments for people with a learning disability.

  • The practice regularly hosted a worker from Citizen’s Advice Bureau who provided patients with information on a range of social issues.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • It had told 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.