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Inspection Summary


Overall summary & rating

Good

Updated 14 February 2018

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection at Honeypot Medical Centre on 17 October 2017 in response to concerns raised directly with CQC. This related to safety systems and processes, co-ordinating patient care, access to appointments, responding to complaints and governance of the practice. This report covers our findings in relation to the inspection on 17 October 2017. As a result of this inspection, the provider’s rating remains unchanged and stays Good overall.

Our key findings were as follows:

  • The practice had experienced a period of change in the last 12 months following a recent merger.
  • The practice had adequate infection control procedures in place and clearly defined and embedded systems to minimise risks to patient safety.
  • There were adequate recruitment arrangements in place which included the necessary checks for all staff.
  • There were arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs.
  • Clinical audits were carried out and patients’ needs were assessed; care was planned and delivered following best practice guidance.
  • Staff were aware of and provided patients’ care and treatment in line with current evidence based guidelines. They had also been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • The practice had a system in place to ensure that paper records were stored safely and securely.
  • Staff demonstrated an understanding of the importance of patient confidentiality. They treated patients with dignity and respect and took care to protect their privacy and personal information at the reception desk and in the treatment rooms.
  • Patients described staff as friendly, caring and helpful and specifically commented on how the practice had improved in the last six months since.
  • We found that the practice had taken positive steps to improve access to appointments and patients and staff told us access to appointments had improved.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.

However, there were areas of practice where the provider should make improvements.

The provider should:

  • Continue to monitor and improve patient access to the service.

  • Continue to review the national GP patient survey scores with the aim of improving patient satisfaction scores on GP and nurse consultations.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 February 2018

At our previous focused inspection on 23 December 2015, we rated the practice as Good for providing safe services. At this inspection, this rating remains unchanged.

  • Recruitment arrangements included all the necessary checks for all staff.

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.

Effective

Good

Updated 14 February 2018

At our previous focused inspection on 23 December 2015, we rated the practice as Good for providing effective services. At this inspection, this rating remains unchanged.

  • Staff were aware of current evidence based guidance and care was planned and delivered following best practice guidance.

  • Clinical audits were carried out and demonstrated quality improvement.

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

  • The information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way through the practice’s patient record system and their intranet system.

  • There was a system in place to ensure patient records were stored safely and securely.

Caring

Good

Updated 14 February 2018

At our previous focused inspection on 23 December 2015, we rated the practice as Good for providing caring services. At this inspection, this rating remains unchanged.

  • Although data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care, we saw evidence that the practice were in the process of recovering from recent challenges and were taking action to improve and this was consistent with patient feedback on the day.

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

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

Responsive

Good

Updated 14 February 2018

At our previous focused inspection on 23 December 2015, we rated the practice as Good for providing responsive services. At this inspection, this rating remains unchanged.

  • Although most of the patients we spoke with said they found it easy to make an appointment with a named GP, some highlighted issues with accessing appointments. We saw evidence that the practice had taken steps to improve access for patients.

  • There was continuity of care, with urgent appointments available the same day.

  • Information about how to complain was available and evidence from 31 examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 February 2018

At our previous focused inspection on 23 December 2015, we rated the practice as Good for providing well-led services. At this inspection, this rating remains unchanged.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on.

Checks on specific services

Older people

Good

Updated 8 June 2016

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

  • The practice was the pilot site for a new service that was introduced in 2015 a virtual ward. This service offered care for patients at risk of admission to hospital and in need of intensive monitoring. Patients at risk could be referred into the virtual ward; a multi-disciplinary team of specialist health and social care professionals visited, reviewed and supported patients and the GP to manage episodes of care until patients were more stable.

  • Advice or recommendations for treatment by another professional was always reconfirmed and re-explained to the patient before being instigated.

  • The practice worked and communicated well with local nursing homes. GPs provided regular visits and conducted ward rounds with the nursing home staff.

  • The practice used mobile technology, a system that allowed them to access up to date clinical information about patients during home visits. Patient’s clinical records were updated in real-time.

  • 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.

People with long term conditions

Good

Updated 8 June 2016

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

  • Nursing staff and the practice pharmacist 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 85.1%, being 1.6% below the CCG average and 4.1% below the national average.

  • 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 the 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 8 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.

  • 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 62%, which was comparable to the CCG average of 66% and below the national average of 74%.

  • 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. Monthly meetings were held with the health visitor.

Working age people (including those recently retired and students)

Good

Updated 8 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.

  • Telephone appointments were offered daily.

People whose circumstances may make them vulnerable

Good

Updated 8 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 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 used a ‘carer’s passport’ that ensured carers had access in a timely manner when they needed to be seen.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 June 2016

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

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    Performance for mental health related indicators was 94.1%, which is comparable to the national average.

  • 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.