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Inspection Summary


Overall summary & rating

Good

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The London Road Surgery on 25 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. We found that it was good for providing services to all of the population groups we looked at.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Generally risks to patients were assessed and well managed however a health and safety risk assessment had not been undertaken.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by the partners and practice manager. The practice proactively sought feedback from staff and patients, which it acted on.
  • Clinical governance was robustly monitored with an ethos of continuous improvement and learning.
  • Effective systems were in place to monitor and assess the quality service provision. High levels of performance and quality of care were evident across the processes and procedures at the practice.

We saw one area of outstanding practice:

  • Cohesive leadership was in place that included staff at all levels. The leadership and culture had a positive impact on the delivery of care. All staff shared the practice objectives and worked towards them. Staff satisfaction levels were high.

However there was an area of practice where the provider needs to make improvements.

Importantly the provider should;

  • Undertake health and safety and legionella risk assessments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 May 2015

The practice is rated as good for providing safe services. The partners at the practice were focused on safety and adopted a pro-active approach to learning from incidents. Staff understood their responsibilities to raise concerns and to report incidents and near misses. Team meetings were used to cascade learning from incidents. Information about safety was recorded, monitored, appropriately reviewed and addressed. Staff had been trained in safeguarding procedures and knew the different types of abuse. Children at risk and vulnerable adults were monitored and reviewed. Staffing levels were maintained and recruitment processes robust. Medicines were managed safely and securely stored. Infection control procedures were being followed. Health and safety and legionella risk assessments had not been completed. Staff had received chaperone training and followed procedures. Equipment in use was in sufficient quantities. Staff had been trained to manage medical emergencies.

Effective

Good

Updated 28 May 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality and performance was regularly monitored. Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely. Staff had received appropriate training and it met the needs of patients. Staff were suitably qualified and received annual appraisals and personal development plans. Staff worked with multidisciplinary teams and other specialists. Information was shared appropriately with healthcare professionals. Staff had an understanding of consent and the Mental Capacity Act 2005.

Caring

Good

Updated 28 May 2015

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 to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality. People with caring responsibilities were identified and offered appropriate support.

Responsive

Good

Updated 28 May 2015

The practice is rated as good for providing responsive services. It 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. Patients generally commented that the appointment system met their needs. Reception staff supported patients to obtain appointments at times that suited their circumstances such as the elderly or young children. The practice sought feedback from patients through surveys, complaints and through the patient participation group, responding to ideas for improvement. Patients could obtain appointments with a GP of their choice on most occasions. Patients received continuity of care, with urgent appointments available the same day. The practice had satisfactory facilities and was equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints took place with staff to prevent reoccurrences.

Well-led

Good

Updated 28 May 2015

The practice is rated as good for being well-led. The practice had a clear vision with quality and safety as its top priority. The four partners took responsibility overall and had oversight of all issues. Where responsibilities had been delegated to others they were monitored. There was evidence of regular structured meetings and staff received updates and feedback on the objectives and performance. The strategy to deliver this vision was regularly reviewed and discussed with staff. All staff spoken with felt involved in the future of the practice and were very complimentary about the leadership in place. Patients had been invited to comment on the future of the practice through surveys. High standards were promoted and owned by all practice staff and teams worked together across all roles. Managers dealt with underperformance in a fair and robust way. Staff appraisals had been completed for all staff. GPs sought patient views about their performance for their annual appraisals. Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. Partners had oversight of complaints and took decisions to resolve them to the satisfaction of patients. An annual review of complaints took place to identify themes and trends. There was a high level of constructive engagement with staff and a high level of staff satisfaction. There was evidence of clinical and non-clinical audit taking place at the practice.There was a willingness to learn at all levels within the practice. External CCG locality meetings were attended by the GPs and practice managers to share learning and good practice.

Checks on specific services

Older people

Good

Updated 28 May 2015

The practice is rated as good for the care of older people. They maintained a register of those patients at risk of an avoidable hospital admission and put a care plan in place to reduce the risk of their health deteriorating. Each patient over 75 had a named GP and could see a GP of their choice whenever available. Home visits were available if needed. Multidisciplinary team meetings took place regularly where individualised care was discussed with other healthcare professionals. The practice had started a virtual ward to help support the elderly and enable them to receive care in their own homes. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services including for patients with dementia and for those requiring end of life care. The practice was pro-active in identifying and involving relatives and carers to support patients. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Vaccination programmes were readily available to help keep patients healthy.

People with long term conditions

Good

Updated 28 May 2015

The practice is rated as good for the care of people with long-term conditions. A register of patients was maintained and their care and treatment discussed at multidisciplinary team meetings with other healthcare professionals to deliver a package of care. Care plans were in place to provide the most appropriate care and treatment and to avoid the risk of unnecessary hospital admissions. GPs and nursing staff had lead roles in chronic disease management and regularly monitored patients through annual health reviews. 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 medication needs were being met. Advice and guidance was readily available to help patients to manage their conditions and they were signposted to external organisations that could offer support. Patients with palliative care needs were regularly monitored and relatives and carers involved in the planning of their treatment.

Families, children and young people

Good

Updated 28 May 2015

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. Immunisation rates were high for all standard childhood immunisations and performance was regularly monitored. Appointments were made available out of school hours to provide flexibility and the premises were suitable for children and young babies. Contraception and family planning advice was readily available. Ante and post natal services were available and patients had access to the community midwife who ran a clinic each Wednesday morning. Children under the age of 16 were able to access appointments with a GP without their parent/guardian being present, in appropriate circumstances.

Working age people (including those recently retired and students)

Good

Updated 28 May 2015

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. Students were able to register temporarily at the practice and could receive health checks and lifestyle advice. The practice was proactive in offering online services as well as a full range of health promotion and health checks that reflected the needs for this age group. Late night opening was available one evening each week until 9pm.

People whose circumstances may make them vulnerable

Good

Updated 28 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients with learning disabilities and monitored their care and treatment. Annual reviews took place and these often involved relatives and/or their carers where relevant. Longer appointments were available for these reviews and for appointments. Patients were signposted to various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children and had received training relevant to their role. The practice did not have any patients living in vulnerable circumstances including homeless people and/or travellers but they were welcome at the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). A register was being maintained for patients with dementia and those experiencing poor mental health. Referrals were made to specialised memory clinics to support patients with dementia. Care plans had been put in place to monitor and review their condition to help ensure that their health did not deteriorate. Multidisciplinary meetings took place to discuss each patients individual care and treatment requirements. Regular liaison took place with the local pharmacy to ensure medicines were being taken in line with the prescription to identify either under or over use of medicines. Mental health counselling took place on one day each week at the practice by a qualified counsellor. Health reviews took place annually or more frequently as required by the GP and/or nurse. The practice had ready access to the local mental health crisis team for children and adults and could refer patients requiring urgent support. The practice signposted patients experiencing poor mental health to various support groups and voluntary organisations including MIND.