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Inspection Summary


Overall summary & rating

Good

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Street Surgery on 7 September 2016. This was to check that improvements had been made following the breaches of legal requirements we identified from our comprehensive inspection carried out on 21 May 2015. During our inspection we found that the practice had made improvements since our previous inspection and was now meeting regulations that had previously been breached. 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 and recording significant events.
  • Risks to patients were assessed and well managed.
  • 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.
  • 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.
  • Some patients said it was difficult to book appointments in advance. However, they were positive about access to same day and urgent appointments at the practice.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • The provider complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Continue to review systems and processes for the effective management of patients receiving medicines which require monitoring.
  • Continue to monitor and take steps to make improvements to the National GP Patient Survey results; including access to the practice by telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 October 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 learnt were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received support and a verbal and written apology. They were 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 patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 28 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average. Staff assessed needs and delivered care in line with current evidence based guidance.
  • The practice had GPs with a special interest (GPwSI) in orthopaedics and dermatology which enabled the practice to meet patient needs in a number or areas including joint injections and minor surgery.
  • Nurses held minor illness clinics on a daily basis.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 28 October 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey results published in July 2016 showed patients rated the practice in line with others for several aspects of care.
  • The practice offered flexible appointment times based on individual needs.
  • 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.
  • The practice held a register of carers with 357 carers identified which was approximately 2% of the practice list. The practice had completed 142 health checks for carers since April 2015.
  • There were two nominated Carers’ champions who provided information about local support groups and services.

Responsive

Good

Updated 28 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 East and North Hertfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice was in the process of developing a system to review their vulnerable patient list in order to provide more specific and targeted care and treatment for vulnerable patients at risk.
  • The practice had created a working group in partnership with their Patient Participation Group and had made improvements to their appointment booking and telephone system.
  • 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 28 October 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.
  • The practice 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 identifying 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 Liaison Group was active.
  • There was a strong focus on continuous learning and improvement and the practice worked closely with other practices, a local GP Federation and the local East and North Hertfordshire CCG.
Checks on specific services

People with long term conditions

Good

Updated 28 October 2016

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

  • Nurses 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 comparable with the local CCG and national average. The practice had achieved 92% of the total number of points available (with 8% exception reporting), compared to local average of 89% (9% exception reporting) and national average of 89% (11% exception reporting). The diabetic lead GP and nurses held an annual meeting with the local community diabetic consultant and diabetic specialist nurse to review patients.
  • 78% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable with the local and national average of 75%.
  • Longer appointments and home visits were available when needed.
  • All patients with a long-term condition had a named GP. 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.
  • The practice had changed their clinical system in April 2016. During our inspection we found that the practice did not have a robust medication review system in place for patients on levothyroxine. The practice told us that they had held a clinical meeting shortly after our inspection and had updated their repeat prescribing protocol to ensure their systems and processes were improved for the review of patients receiving medicines that require monitoring.

Families, children and young people

Good

Updated 28 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 identified as being at possible risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.
  • The practice held monthly meetings with health visitors to support and manage vulnerable children and families
  • 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 78% which was comparable with the local average of 83% and national average of 82%.
  • Appointments were available on the same day and outside of school hours. The premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 28 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, this included taking part in local initiatives to avoid unplanned admissions to hospital and end of life care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
  • Regular visits to two care homes were carried out by named GPs for continuity of care and emergency visits were also provided when needed. We spoke with a senior staff member at one of the homes who told us that the practice offered excellent care and treatment. They described the practice as very caring, responsive and accessible.
  • The practice worked closely with a multidisciplinary team to support older people and patients considered to be in the last 12 months of their lives.
  • The practice provided health checks for patients aged over 75 years and had completed 604 health checks in the last months, which was 51% of this population group.

Working age people (including those recently retired and students)

Good

Updated 28 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
  • The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.
  • The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
  • Extended opening times were available one evening each week and on Saturday mornings.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 October 2016

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

  • 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/2015, which was comparable with the local average of 86% and national average of 84%.
  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
  • Patients were referred to a Cognitive Behavioural Therapy (CBT) Counsellor who was part of the local wellbeing service and held a weekly clinic at the practice.
  • 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented, in the preceding 12 months compared to 92% locally and 88% nationally.
  • 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 A&E where they may have been experiencing poor mental health.
  • There was a lead GP for mental health and 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 28 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 those with a learning disability.
  • The practice offered longer appointments and annual health checks for people with a learning disability. The practice had completed 78 out of 98 health checks between 2015/2016.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Vulnerable patients had been told how to access various support groups and voluntary organisations.
  • Staff had accessed safeguarding training and knew how to recognise signs of abuse in vulnerable adults and children. Staff members 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.