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Inspection Summary


Overall summary & rating

Good

Updated 15 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 18 March 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive/focused inspection at Laurel House Surgery on 4 January 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • The Quality Outcome Framework (QOF) results for 2016/17 showed that clinical exception reporting for patients with long term conditions, such as asthma, COPD, diabetes and patients experiencing poor mental health were significantly higher than local and national averages. We foundthat patients had had their records reviewed by a GP before exception reporting was agreed including patients who had not attended for an appointment on three occasions. The documentation seen was robust.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Staff employment references including verbal references should be appropriately documented.

  • Continue to update policies and procedures including the implementation documentation to support the one to one sessions held with the Advanced Nurse Practitioners/nurse prescribers.

  • Consider Mental Capacity Act training for all clinical staff.

  • Consider improvement in telephone access for patients and survey patient opinion on access to the practice.

  • Review complaints procedures to include recording informal complaints received. Ensure that all complainants have the parliamentary health ombudsman details documented in the practices response letter.

  • Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including appointment access and ease of access to the practice by telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 February 2018

Effective

Good

Updated 15 February 2018

Caring

Good

Updated 15 February 2018

Responsive

Requires improvement

Updated 15 February 2018

Well-led

Good

Updated 15 February 2018

Checks on specific services

People with long term conditions

Good

Updated 8 May 2015

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. Longer appointments and home visits were available when needed. Patients had a named GP to provide continuity of care. The practice was below the regional average in managing long term conditions such as diabetes however there was an action plan in place to address this. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 8 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. For example, children and young people who had a child protection plan in place. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Older people

Good

Updated 8 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. 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, preventing avoidable hospital admissions and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 8 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. 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 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Quality Outcomes Framework (QOF) data from April 2013 to April 2014 showed that 100% of people experiencing poor mental health had an agreed care plan in place. QOF is a voluntary incentive scheme for GP practices in the UK. The scheme financially rewards practices for managing some of the most common long-term conditions and for the implementation of preventative measures. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 8 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 living in vulnerable circumstances including vulnerable adults and patients with a learning disability. The practice worked with district and palliative care nurses to carry out annual health checks for their most vulnerable patients. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.