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Dr R Baghdjian & Dr Marcus Jacobs Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Baghdjian and Dr Marcus Jacobs Surgery on 6 January 2017. 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 mostly assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. In most cases staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients were highly positive about their experiences at the practice. They 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 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 offered an extended hours clinic on a Sunday for those patients who could not attend during normal working hours. This, along with the way the practice had designed its appointment system assured us that any patient requesting an appointment the same day would have access to one.

The areas where the provider should make improvement are:

  • Action plans should be documented following infection prevention and control audits and include details of action taken as a result of audit findings.

  • The planned training for staff should be completed, for example training around ECG tests for the health care assistant and vaccination update training for nurse practitioner.

  • The newly updated scanning and read coding protocol should be embedded into practice and an audit process initiated to ensure clinicians have sight of all necessary correspondence.

  • The content of policies and procedures should be updated routinely to reflect current guidance and legislation.

  • The prescription logging system should be extended to ensure the location of all blank scrips is recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 March 2017

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. Staff demonstrated awareness of changes to protocols as a result of significant events.

  • When things went wrong patients received support, truthful information, and an appropriate 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 mostly assessed and well managed. While there were some gaps around the completion of workplace safety risk assessments, the practice confirmed immediately after the inspection that these were being undertaken.

  • We noted the most recent infection control audit that had been completed did not document any actions taken to address issues identified.

  • While there was a system in place to log blank hand written prescription pads, it was not comprehensive enough to account for the scripts stored in the nurse practitioner’s consultation room.

Effective

Good

Updated 3 March 2017

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. However we did note that in some cases formalised role specific training or update training had not been undertaken. The practice assured us this was being addressed.

  • 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.

  • We identified risks in the practice’s process of managing incoming mail. The practice acted immediately to formalise its processes through the implementation of a revised protocol although the introduction of an associated audit process would provide a further safeguard and assurance of compliance with the protocol.

Caring

Good

Updated 3 March 2017

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 told us they were consistently highly satisfied with their care and said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. They told us an attitude whereby nothing was too much trouble was exhibited by both clinical and non-clinical staff.

  • 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 3 March 2017

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.

  • The practice offered an extended hours clinic on a Sunday for working patients who could not attend during normal opening hours.

  • 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 prioritised patient access to appointments and took pride in the fact that patients requiring a same day appointment would not be turned away.

  • 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. However, verbal complaints were not formally recorded. Recording complaints made verbally in addition to written complaints would facilitate more effective trend analysis and maximise learning outcomes as a result.

  • The practice offered an anticoagulation service where patients’ bloods were tested and their anticoagulant medicine reviewed and dose changed as required. This meant they did not need to attend a hospital specialist anticoagulant clinic.

Well-led

Good

Updated 3 March 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The practice prioritised ensuring good access 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. However, we noted that some policies contained out of date information despite having been reviewed by the practice recently.

  • 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 evidence of continuous learning and improvement.

Checks on specific services

People with long term conditions

Good

Updated 3 March 2017

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.

  • The practice’s QOF results for diabetes indicators were higher than local and national averages.

  • 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 offered an anticoagulation service where patients’ bloods were tested and their anticoagulant medicine reviewed and dose changed as required. This meant they did not need to attend a separate specialist anticoagulant clinic.

Families, children and young people

Good

Updated 3 March 2017

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 higher than local and national averages 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 practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 84% and the national average of 81%.

  • 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

Good

Updated 3 March 2017

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 liaised with staff in the treatment room housed in the building and operated by community staff to facilitate mutually convenient appointments for patients, therefore reducing the need for multiple trips to the health centre.

  • The practice held regular palliative care multidisciplinary meetings to ensure the needs of patients nearing the end of life were being met.

Working age people (including those recently retired and students)

Good

Updated 3 March 2017

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.

  • Extended hours appointments were offered each Sunday for those patients who could not attend during normal working hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 March 2017

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

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 89% compared to the CCG average of 91% and 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 in the preceding 12 months was 98% compared to the CCG average of 94% and national average of 89%.

  • 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 3 March 2017

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 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.

  • 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.