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Inspection Summary


Overall summary & rating

Good

Updated 12 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Corinthian Surgery on 7 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and most staff felt supported by management. The practice proactively sought feedback from staff and patients, which it mostly acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Review the infection control audit to highlight improvements made and include review dates.

  • Ensure training records are reviewed and kept up to date and that mandatory training is repeated as needed in a timely way for example fire safety.

  • Continue to improve the support and care of patients with long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 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 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.

However,

  • Improvements made from the infection control audit were not clearly documented and there was no review date identified on the audit.

  • Staff training records showed there were gaps in training such as safeguarding adults and children which has since been amended and fire training.

Effective

Good

Updated 12 October 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.

  • One of the GPs had a special interest in ear, nose and throat clinical issues and carried out clinics at the practice at least once per week. This service was not limited to the practice’s patient list and patients from other local practices could also be referred to be seen by this GP. This enabled patients to access this service locally instead of attending secondary care services.

Caring

Good

Updated 12 October 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 12 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 clinical commissioning group to secure improvements to services where these were identified. For example, the practice took part in a local social prescribing initiative whereby patients with non-medical issues, such as financial debt or loneliness could be referred to a single hub for assessment as to which alternative service might be of most benefit.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice participated in a Gloucestershire scheme called ‘Choice Plus’, which provides additional GP appointments for patients with acute on the day problems at various locations in the county.

  • 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 12 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 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 focus on continuous learning and improvement at all levels

  • However the practice did not always ensure that training records were updated and mandatory training such as for fire safety update was not delivered in a timely way.

Checks on specific services

People with long term conditions

Good

Updated 12 October 2016

The practice is rated as good for the care of patients 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.

  • The practice achieved 98% of the targets for care of patients with diabetes in 2014/15 which was above both the clinical commissioning group average of 95% and national average of 89%.

  • 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.

  • The nurses visited housebound patients with long term conditions to complete annual reviews.

  • The practice used self-management plans, particularly for asthma and chronic obstructive pulmonary disease (a chronic lung disease) and supported a small number of patients who had home monitoring through Telehealth (a system where information about the patient’s condition is monitored remotely and the information sent to a clinician at the practice without the need for the patient to attend the practice).

  • The practice participated in the winter resilience program. They provided additional appointments between January and March primarily for patients diagnosed with chronic obstructive pulmonary disease to avoid unnecessary hospital admissions. All the practice patients could access the additional appointments.

Families, children and young people

Good

Updated 12 October 2016

The practice is rated as good for the care of families, children and young patients.

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young patients 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 80% which was comparable to the clinical commissioning group average of 84% and national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The safeguarding lead GP held regular child safeguarding meetings with health visitors, school nurses and community midwives.

Older people

Good

Updated 12 October 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Nurses visited patients in care homes and those who were housebound to offer and administer flu vaccines.

  • The practice supported two care homes and provided fortnightly “ward rounds” to patients living in those homes.

  • The practice held weekly meetings which the district nurses and health visitors were invited to attend.

Working age people (including those recently retired and students)

Good

Updated 12 October 2016

The practice is rated as good for the care of working-age patients (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.

  • The practice offered extended hours every Mondays from 7.30am and Wednesdays from 7am.

  • The practice participated in a Gloucestershire scheme called ‘Choice Plus’, which provides additional GP appointments for patients with acute on the day problems at various locations in the county.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 October 2016

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

  • 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above the clinical commissioning group (CCG) average of 86% and the national average of 84%.

  • The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 95% compared to the CCG average of 93% and national average of 88%.

  • The practice had a nominated nurse who was responsible for inviting patients who had mental health problems in for annual review. This involved a physical health check, lifestyle advice and completing a mental health care plan. The lead nurse for mental health gave us positive examples of how they encouraged patients to attend reviews.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • A primary mental health care nurse held clinics at the practice once a week and the practice had links to a community dementia nurse.

  • The practice carried out advance care planning for patients living 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 12 October 2016

The practice is rated as good for the care of patients 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 supported a local residential home for patients with learning disabilities. Patients living in the home had a named GP who visited annually to offer health checks.

  • 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 through social prescribing.

  • 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 also supported a local alcohol and drug rehabilitation unit. There was an alcohol support worker attached to the practice who offered weekly appointments for patients who needed to be seen.