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Dr Solway & Dr Mallick Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 24 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Solway and Dr Whale Practice on 14 April 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 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.
  • Urgent appointments with a GP were available on the same day.
  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 practice was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are;

  • Ensure that all of the appropriate recruitment checks are carried out prior to staff employment.
  • Ensure the practice’s business continuity plan for major incidents includes emergency contact numbers for staff and utility companies.
  • Ensure the practice’s policies are reviewed regularly.
  • Record incidences of children who fail to attend hospital appointments on their clinical system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 June 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.
  • The practice did not record on their clinical system all children who fail to attend hospital appointments.
  • When there were unintended or unexpected safety incidents, patients received reasonable support and a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Bi-annual infection control audits had been undertaken regularly and we saw evidence of audits from August 2014 and September 2012 and action plans to address any improvements identified as a result. Mini audits to check cleanliness were undertaken monthly.
  • The practice had a Legionella policy and documented risk assessment in place.
  • The practice ensured all medicines needing cold storage were kept in an appropriate fridge and monitored.
  • Not all staff recruitment checks had been undertaken prior to their employment including, photographic proof of identification and qualifications. Registration with the appropriate professional body and the appropriate checks through the Disclosure and Barring Service (DBS) had been carried out on all appropriate staff. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). All members of staff who acted as chaperones had received a DBS check.
  • The practice had a business continuity plan in place for major incidents such as power failure or building damage however the plan did not include emergency contact numbers for staff or utility companies.

Effective

Good

Updated 24 June 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 for the locality and compared to the national average except depression related indicators which had a higher exception reporting rate than the CCG and England average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • Staff assessed patients’ 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 June 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice in line with others for several aspects of care.
  • The practice had identified 111 patients on the practice list (1.9%) as carers. Carers’ forms were available on the practice website and on the new patient registration form. Carers were referred to various support groups and charities.

  • 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 24 June 2016

The practice is rated as good for providing responsive services.

  • Patients said that urgent appointments with a GP were available on the same day.
  • Practice staff reviewed the needs of their local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • 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.
  • The practice translated some practice information into Romanian due to the high number of patients speaking this language registered at the practice.

Well-led

Good

Updated 24 June 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.
  • 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 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 knowing about 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 24 June 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. The practice encouraged patients to attend reviews by not running specific clinics and offering appointments at the patients convenience instead.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. QOF is a system intended to improve the quality of general practice and reward good practice. Data from 2014/2015 showed that performance for diabetes related indicators was 99%; which was better than the CCG average by 7% and the England average by 10% with a 7.9% exception reporting which was below the CCG average of 9.4% and the England average of 10.8%.
  • The practice had an annual recall system for patients who were pre-diabetic or had a history of gestational diabetes.
  • The nurse practitioners had completed a recognised certificate in diabetes care.
  • The practice offered pre-emptive antibiotics and steroids for the use of patients with chronic lung conditions over the winter period.
  • Longer appointments and home visits were available to patients 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 24 June 2016

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

  • Children and young people’s safeguarding meetings were held regularly with health visitors and safeguarding was a standing agenda for the weekly GPs’ meetings. GPs and nurses were safeguarding level three trained (safeguarding children and young people).
  • Immunisation rates were below the CCG average for the standard childhood immunisations. The practice worked closely with the health visitors to increase immunisation uptake.
  • 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice had a priority system for unwell children to be seen within 24 hours.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The practice had a private room available for mothers who were breast feeding and baby changing facilities.
  • The practice took part in the chlamydia screening programme.
  • The practice held a two weekly health visitor clinic for parents of under four year old children who had newly arrived in the UK.

Older people

Good

Updated 24 June 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice contacted housebound patients every three months if they had not been seen by a GP.
  • The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
  • The practice offered health checks for patients aged over 75.
  • GPs regularly visited patients in two care homes and liaised with the home managers. The practice had additional telephone access for the care homes for those patients at risk of hospital admission.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, end of life care. The practice had 15 patients on their palliative care register and they worked closely with hospice at home and their nursing teams and ensured proactive end of life planning (hospice at home is a charity which provides a 24 hour, seven days a week service). 

Working age people (including those recently retired and students)

Good

Updated 24 June 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. They offered telephone consultations during the day to patients that might not be able to access the surgery during normal hours. Appointments could be booked in advance and the telephone lines were open over the lunchtime period.
  • The practice offered lunchtime appointments for patients who might not be able to access the surgery any other time.
  • The practice offered online appointments and prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.
  • The practice’s uptake for the cervical screening programme was 92%, which was above the CCG and England average by 10%.
  • The practice offered minor surgery on site.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 June 2016

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

  • The practice carried out advance care planning for patients with dementia.
  • 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average by 10% and the England average by 11% with a 4.8% exception reporting which was below the CCG and England average by 3%.
  • Patients with mental health concerns were offered annual health checks.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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 might have been experiencing poor mental health including patients seen during out of hours.
  • 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 24 June 2016

The practice is rated as good for the care of people whose circumstances might make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. They had identified 29 patients with a learning disability and 17 had received an extensive health check in the previous 12 months. The practice referred patients to various support services and had regular liaisons with the local learning disability nurses to identify those patients not accessing the services and to facilitate attendance.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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 did not record on their clinical system children who fail to attend hospital appointments.