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Inspection Summary


Overall summary & rating

Good

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Argyle Surgery on 6 September 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 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 been trained to provide them with 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.
  • Patients said they could make an appointment within a reasonable time with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had adequate facilities and was equipped to treat patients and meet their needs. However, the premises were in need of a general upgrade.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice had been awarded the contract to provide a nursing home service to 18 out of the 21 care homes in the London Borough of Ealing. ‘The Argyle Care Home Service’ started its multi-disciplinary team approach to deliver innovative primary care to over 900 care home residents in July 2013. The clinicians work with the in-house pharmacy team to deliver the service. The service is accessible 8:00am to 8:00pm, seven days a week, 52 weeks a year. Key achievements of the multi-disciplinary team work from 2013 to date include a 66% reduction in the use of antipsychotic medicines in nursing home based dementia patients, a 20% reduction in accident and emergency admissions and a reduction of more than 40% in admission to hospital for end of life care. The practice had won the British Medical Journal Primary Care Team of the Year award in 2015 for its care home service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 November 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 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.
  • 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 8 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared 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.
  • The practice had improved outcomes for patients based in care homes in the London Borough of Ealing through providing a care home service.

    Key achievements included a 66% reduction in the use of antipsychotic medicines in nursing home based dementia patients, a 20% reduction in accident and emergency admissions and a reduction of more than 40% in admission to hospital for end of life care.

Caring

Good

Updated 8 November 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.
  • 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 November 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. For example, out of hospital services including anticoagulation and phlebotomy.
  • The practice had an in-house pharmacy team that worked collaboratively with the clinicians to respond to the prescribing needs of all patients registered at the practice including care home based patients.
  • The practice provided a nursing home service to 18 out of 21 care homes in the London Borough of Ealing. The clinicians worked with the in-house pharmacy team to deliver the service. Since 2013 the practice had responded to the older people's needs by reducing antipsychotic prescribing in care home based dementia patients, reducing accident and emergency admissions and reducing admissions to hospital for end of life care. The service was accessible 8:00am to 8:00pm, seven days a week, 52 weeks a year.
  • Patients said they could make an appointment within a reasonable time with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had adequate facilities and was equipped to treat patients and meet their needs. However, the premises was in need of a general upgrade.
  • 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.

      

Well-led

Good

Updated 8 November 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 it.
  • 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.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included 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 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.
Checks on specific services

People with long term conditions

Good

Updated 8 November 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.
  • Quality and Outcomes Framework performance for diabetes related indicators in 2014/15 was 100% with exception reporting of 19% (CCG average 12%). Unpublished data from 2015/16 provided by the practice showed they had reduced exception reporting.
  • 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 November 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 relatively high for all standard childhood immunisations.
  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 78% and the national average of 82%.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • 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, health visitors and school nurses.

Older people

Outstanding

Updated 8 November 2016

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

  • 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.
  • The practice provided a care home service to 18 care homes in the London Borough of Ealing. The clinicians worked with the in-house pharmacy team to deliver an innovative service. Key achievements of the service included a 66% reduction in the use of antipsychotic medicines in nursing home based dementia patients, a 20% reduction in accident and emergency admissions and a reduction of more than 40% in admission to hospital for end of life care. The practice had won the British Medical Journal Primary Care Team of the Year award in 2015 for its care home service.

Working age people (including those recently retired and students)

Good

Updated 8 November 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 November 2016

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

  • 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 88% and the national average of 84%.
  • 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 91% and the national average of 88%.
  • 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 November 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. The practice had 35 patients on the register including patients living in two specialist residential care homes. The practice pro-actively supported these patients through staff training, providing health checks at the homes for those who could not attend the practice and through working with local support groups.

  • 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 provided a substance misuse service with four GPs trained to prescribe methadone.
  • The practice worked with the local Mental Health Trust to reduce the number of smokers in patients experiencing poor mental health. A smoking cessation advisor worked at the practice once a week who contacted patients on the severe mental health register to provide smoking cessation advice.