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Greystone House Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greystone House Surgery on 19 October 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.
  • The practice had comprehensive business continuity plans in place in case of major incidents occurring.
  • 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 or their ‘buddy’ 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 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:

An annual summary of complaints and significant events was posted on the website and noticeboards emphasising the practice’s commitment to a transparent, learning culture which benefitted both patients and the practice.

However there were areas of practice where the provider should make improvements:

To review the reasons for the high level of exception reporting in respect to cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and an annual summary of significant events and complaints was posted on the website and in the waiting room.

  • 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 23 December 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.

Caring

Good

Updated 23 December 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 most 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.

  • Alerts were added to patients’ records to highlight special needs requiring longer appointments.

  • When young adults turned 16 they were sent information on their rights regarding confidentiality and what the practice and other services could offer them.

Responsive

Good

Updated 23 December 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 a representative of the local wellbeing service worked within the practice. The wellbeing service was a joint project between the NHS and borough and county councils whereby vulnerable individuals or families could receive advice, guidance, help and support locally to improve their health and lifestyles. The clinicians within the practice could refer patients to the service.

  • 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 via an emergency clinician 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, patients and other stakeholders.

Well-led

Good

Updated 23 December 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 23 December 2016

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

  • Nursing staff had roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Each GP had special interests and overall responsibility for a long term condition (LTC).

  • Registers were held of patients with each LTC and were used to identify, recall and monitor patients with each condition.

  • Self-management was promoted and a Wellbeing Advisor was based at the practice for holistic care, advice, support and sign-posting to other organisations (voluntary sector and social care).

  • The practice worked with the local Medicines Management team who carried out audits and ensured that they prescribed effectively and appropriately.

  • Other specific services included psoriasis clinics, reviews of patients with stoma products by a GP and acupuncture also carried out by one of the GPs.

  • The percentage of patients with diabetes, on the register, in whom the last long term glucose level was 64 mmol/mol or less was 84% (clinical commissioning group (CCG) average 80%, national average 78%).

  • 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 practice worked with a local hospice, district nurses and community matrons in managing patients approaching the end of life, following a nationally recognised framework.

Families, children and young people

Good

Updated 23 December 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 similar or higher than the local clinical commissioning group rates, and similar to or lower than the national rates, 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, and we saw evidence to confirm this.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 90% (CCG average 81%, national average 82%).

  • All patients were seen on the day if requested and children were seen first if attending for triage.

  • The midwives ran ante-natal clinics at the practice. Post-natal checks were carried out at six weeks.

  • Doctor and practice nurse appointments were co-ordinated for baby’s eight week check and first immunisations.

  • Flu vaccines were offered to pregnant women and children. Clinics were available after school and on Saturdays. The practice had an interest in patients with gestational diabetes.

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

  • We saw that the practice regularly met with midwives and health visitors.

  • To welcome children, together with their patient participation group (PPG), the practice held an art competition with prizes for children who entered, and continued to display the entries around the surgery.

  • The practice wrote to patients who turned 16, informing them of the confidential nature of their consultations and aspects of access to make it easier for them to contact them. They also trialled after school drop-in sessions.

Older people

Good

Updated 23 December 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.

  • Each nursing and residential homes had a named GP to enhance continuity of care. Larger homes had weekly/fortnightly ward rounds to proactively review patients and plan care. Homes could use the practice bypass number.
  • The practice worked with the home managers and Community Matrons to reduce inappropriate 999 calls or unnecessary unplanned admissions, and had set up systems to ensure patient wishes were met regarding their preferred place of death.
  • Home visits occurred daily and clinicians met up and discussed housebound patients at the end of morning surgery. One of the GPs met the community matron monthly to discuss the management of patients on their caseload. Additionally the practice held quarterly multi-disciplinary team meetings.
  • Patients identified at risk of unplanned admissions were offered a personalised care plan, which (with consent) was shared with the Out of Hours and ambulance services.
  • All patients over 65 were notified of their named accountable GP.

Working age people (including those recently retired and students)

Good

Updated 23 December 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 including viewing records, making appointments, ordering prescriptions, and emailing. They sent texts for appointment reminders, information regarding for example flu clinics, and accepted text cancellations.

  • They offered a full range of health promotion and screening that reflected the needs for this age group.

  • The practice used the Electronic Prescription Service to transfer prescriptions to patients’ pharmacy of choice.

  • The practice offered extended surgery hours from 7.30am every weekday and on Tuesday afternoons until 8pm for patients who found it difficult to attend during regular hours. Appointments could be made for GPs, phlebotomy and new patient checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 December 2016

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

  • 81% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 94% (CCG average 93%, national average 88%).

  • One GP was the dementia and Mental Capacity Act lead for the practice and the practice had recently increased their prevalence figures for dementia from 58.5% to 74%.

  • Staff had a good understanding of how to support patients with mental health needs and dementia. They were Dementia Awareness trained and were aware to raise concerns should a show signs of cognitive impairment.

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

  • Patients with complex mental health needs were invited for annual physical/psychological reviews and 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, they could also self-refer to in-house psychological therapies or counselling.

People whose circumstances may make them vulnerable

Good

Updated 23 December 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 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.

  • The practice provided care for a local home for people with learning difficulties.

  • 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.

  • Annual reviews were carried out at a location which the patient was most comfortable with.

  • The practice used an interpreter/translator as required and had trained a member of staff in sign-language. Alerts were added to patients’ records to highlight special needs requiring longer appointments.

  • The practice made it as easy as possible for all women to be seen and fully register all children to ensure they had access to immunisations.

  • The practice welcomed homeless patients, liaised with local support groups, and used the practice address or their mobile as a point of contact. They worked with the local alcohol & addiction multi-disciplinary team counsellor.

  • The practice had a carer’s lead who liaised with carers and a local carer’s association. They prescribed carer breaks and actively seek out young carers. Alerts are added to highlight the potential need for flexibility. They offered annual checks for carers with a clinician and also a member of the carers association.

  • They had recently organised a number of coffee mornings in conjunction with their patient group for more isolated patients.