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Inspection Summary


Overall summary & rating

Good

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Robin Hood Surgery on 5 July 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events. Lessons were shared to make sure action was taken to improve safety in the practice.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • There was evidence to show that most staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Although staff had a good understanding of their responsibilities there was no evidence of training that was appropriate to staff roles, such as safeguarding, infection control, information governance and fire safety training for some staff members.
  • 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.
  • 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.
  • 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 practice held regular clinical meetings. Meetings with non-clinical staff were informal and were not documented.

The areas where the provider should make improvement are:

  • Ensure all staff know how to use the defibrillator.

  • Ensure appropriate recruitment checks are conducted for all new staff prior to employment and there is a robust system for documenting processes such as meetings and training received.

  • Ensure translation services and the facility to discuss sensitive information in private is advertised in a format patients can understand, and review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Strengthen efforts to establish a patient participation group and improve patient satisfaction, particularly with regard to waiting times, and review opportunities to make the practice more accessible to wheelchair users.

  • Continuously monitor and improve outcomes for patients with poor mental health, in relation to the Quality and Outcomes Framework.  

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 October 2016

The practice is rated as good for providing safe services.

  • The practice had systems in place to keep patients safe and safeguarded from abuse. Most staff had received safeguarding training but we were not provided with evidence to back this up for some staff, when requested. All staff demonstrated they understood their responsibilities in relation to safeguarding.

  • We were informed that all staff had received training for basic life support, infection control, fire safety, safeguarding and information governance. Although staff demonstrated a good understanding of their responsibilities, we were not provided with evidence of this training for some staff members, when requested.

  • Risks to patients were assessed and well managed. At the time of our inspection the practice did not have a defibrillator available for use in medical emergencies, nor had the risk of not having one been formally assessed; however, the practice ensured that a defibrillator was in place after our inspection.

  • There was an effective system in place for reporting, recording and investigating 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.

Effective

Good

Updated 3 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes were comparable, for the majority of indicators, to the national average. Outcomes for  recording care plans for patients with poor mental health were below average in 2014/2015; the practice provided evidence (which had not been made public or independently verified) that performance in these areas had improved in 2016.

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

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The majority of staff had received training relevant to their roles; however, there was no evidence of safeguarding, information governance, fire safety and infection control training for some staff.

  • 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 3 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in January 2016 showed that patients rated the practice in line with 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 that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 3 October 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 (CCG) to secure improvements to services where these were identified. For example, they participated in the local CCG’s Enhanced Diabetes Care scheme with an aim to improve outcomes for patients with diabetes.

  • Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

  • Three out of four patients we spoke with told us they often faced long waiting times after arriving for appointments. This was reflected in the results of the GP patient survey published in January 2016, where 62% of patients felt they normally had to wait too long to be seen (CCG average 37%, national average 35%).

  • The practice had good facilities and was well equipped to treat patients and meet their needs, with the exception of the absence of a defibrillator for use in medical emergencies.

  • 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 and other stakeholders.

  • The practice read coded patients who were known or suspected to be in gangs, and females who had undergone, or were at risk of undergoing, female genital mutilation (FGM), so that they could be monitored and appropriately supported. A nurse had previously attended a local mosque to give a talk about the dangers and legal implications of FGM.

  • Staff had received a variety of training to improve patients’ experience of the service, such as customer care, conflict resolution and equality and diversity.

Well-led

Good

Updated 3 October 2016

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

  • The practice had a clear vision and strategy to deliver personalised care, and to promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • The practice had a number of policies and procedures to govern activity and held regular clinical meetings. They also held regular discussions with non-clinical staff but these were informal and were not documented.

  • There was a clear leadership structure and staff felt supported by management. Although staff felt valued by the GP partners and manager, they felt hesitant to approach the GPs with ‘minor’ issues and felt that establishing regular formalised governance meetings would facilitate communication.

  • There were 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 sought feedback from staff via a staff survey; at the time of our inspection it was in the process of implementing improvements identified from the survey. It also sought feedback from patients through its monthly friends and family test. There was no active or virtual patient participation group in place at the time of our inspection.

Checks on specific services

People with long term conditions

Good

Updated 3 October 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.

  • Nationally reported data showed that performance for diabetes related outcomes in 2014/2015 was average. For example, 78% of patients with diabetes had well-controlled blood sugar in (national average 78%).

  • Longer appointments and home visits were available when needed.

  • The patients with a long-term condition had a named GP and the majority had received a structured annual review to check their health and medicines needs were being met.

  • In 2014/2015, 74% of patients with asthma had a review of their condition. This was in line with the national average of 75%.

  • In 2014/2015, 91% of patients with chronic obstructive pulmonary disease had a review of their condition. This was in line with the national average of 90%.

  • 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 3 October 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 attendances to Accident & Emergency.

  • Immunisation rates were comparable to the local Clinical Commissioning Group average for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way.

  • Nationally reported data showed that performance for cervical screening in 2014/2015 was average. For example, 79% of females aged 25 to 64 years had a cervical screening test (national average 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 and health visitors.

Older people

Good

Updated 3 October 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.

  • Older patients aged over 75 had a named GP.

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

  • Nationally reported data showed that performance for conditions commonly found in older people in 2014/2015 was average. For example, 84% of patients with hypertension had well-controlled blood pressure (national average 84%).

Working age people (including those recently retired and students)

Good

Updated 3 October 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 offered extended hours opening on a Thursday evening until 8.00 pm for working patients who were unable to attend during normal opening hours.

  • The practice was proactive in offering online services such as appointment booking and repeat prescription ordering, as well as a 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 3 October 2016

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

  • Nationally reported data showed that performance for dementia related outcomes in 2014/2015 was average. For example, 70% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the previous 12 months (national average 84%). The practice provided evidence that performance had improved in 2016, although this had not been made public or independently verified at the time of our inspection.

  • Nationally reported data showed that performance for mental health related outcomes in 2014/2015 was below average. For example, 60% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their records (national average 88%). The practice provided evidence that performance had improved in 2016, although this had not been made public or independently verified at the time of our inspection.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 3 October 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, and they 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. Most staff had received safeguarding training, but there was no evidence of this training for other staff members.

  • A GP had received training on domestic violence awareness.

  • Patients who were known or suspected gang members were read coded on the computer system in order that they could be provided with the appropriate support in avoiding violence related activities.

  • Female patients who had undergone female genital mutilation, or were at risk of undergoing the procedure, were also read coded in order that they could be provided with the appropriate support.