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Belmont Hill Surgery Good Also known as The Surgery

Inspection Summary


Overall summary & rating

Good

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 14 April 2016 at Belmont Hill Surgery. At that inspection the practice was rated good overall, but as requires improvement for some aspects of providing safe services. The full comprehensive report on the 14 April 2016 inspection can be found by selecting the ‘all reports’ link for Belmont Hill Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 18 May 2017 to check that the practice had followed their plan to address the findings we had identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. Following the desk-top review we found the practice to be good for providing safe services.

Our key findings were as follows:

  • Cleaning arrangements for the practice had been reviewed which included the implementation of a comprehensive cleaning schedule and audit process.
  • Findings from the infection prevention and control audit had been addressed and improvements identified and actioned.
  • Processes had been put in place to check emergency medical equipment was fit for use.
  • Systems had been implemented to ensure blank printer prescription security and to track their use through the practice in line with national guidance.
  • Improvement grant funding had been approved in principle to make adaptations in the practice relating to auditory privacy and accessible toilet facilities.
  • An event had been arranged in the practice with Carers Lewisham to promote the identification of carers in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 July 2017

The practice is rated as good for providing safe services as improvements had been made in relation to cleaning, infection prevention and control and the management of emergency medical equipment.

Effective

Good

Updated 8 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national average.
  • 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.
  • 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 8 August 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, 94% of patients said the GP was good at listening to them (CCG average 86%; national average of 89%) and 90% of patients said the GP gave them enough time (CCG average 83%; national average 87%).

  • 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.

Responsive

Good

Updated 8 August 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 to secure improvements to services where these were identified.
  • The national GP patient survey showed 61% usually get to see or speak to their preferred GP (CCG average 51%; national average 59%) and 81% of patients were able to get an appointment to see or speak to someone the last time they tried (CCG average 81%; national average 85%). However, CQC comment cards and some patients we spoke with on the day of the inspection told us it was sometimes difficult to get an appointment.
  • 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 and other stakeholders.

Well-led

Good

Updated 8 August 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.
  • 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.
  • The arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not in all instances effective specifically in relation to infection control, cleaning arrangements and the checking of emergency medical equipment.
  • 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.
  • There was a strong focus on continuous learning and improvement at all levels. The practice supported staff to undertake training and had supported a receptionist to train as a phlebotomist.
Checks on specific services

People with long term conditions

Good

Updated 8 August 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.
  • Performance for diabetes related indicators was similar to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c is 64 mmol/mol or less in the preceding 12 months was 75% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 99% (national average 94%).
  • 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 8 August 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 good for all standard childhood immunisations.
  • The practice’s uptake for the cervical screening programme was 76%, which was comparable with the national average of 82%. 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 positive examples of joint working with midwives, school nurses and health visitors.

Older people

Good

Updated 8 August 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.
  • All patients 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.
  • Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main line.

Working age people (including those recently retired and students)

Good

Updated 8 August 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 a ‘Commuter’s Clinic’ on Wednesday from 6.30pm to 7.30pm and Thursday and Friday from 7am to 8am for working patients who could not attend during normal opening hours.
  • The practice was proactive in offering online services and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website. The practice operated an automated text reminder system for appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 August 2016

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

  • 73% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which was lower than the national average (84%). However, the practice provided evidence that they had increased their dementia prevalence and diagnosis rate since the 2014/15 QOF results.
  • 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 lower than the national average (practice 74%; national average 88%). Evidence provided by the practice showed they had increased the care plans undertaken in 2015/16 and had identified 59 patients and undertaken 55 care plans (93%).
  • 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 8 August 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 and those with a learning disability. The practice had a policy to register homeless patients at the surgery address.
  • 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 and 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.
  • All doctors and nurses had undertaken radicalisation awareness training.
  • The practice ran a twice-weekly substance misuse clinic for its patients and those within the local practices.