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Streatham Common Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 13 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.
  • The practice had a strong culture of learning and improvement, and supported staff to develop their skills and roles within the practice.
  • 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 staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice patient participation group was actively involved in the running and future development of the practice, as well as engaging with the patient population.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice patient participation group (PPG) was closely involved in the running of the practice, organising health promotion events and improving practice performance. In addition to monthly PPG meetings with guest speakers, annual patient surveys and regular health talks, the PPG chair had been invited to attend receptionist meetings and was given a tour of the practice staff areas to better understand how it was run. The PPG had also campaigned to win funding from the local Clinical Commissioning Group to install television screens in the practice; these screens were used to play a short film made by the PPG about its work and local health issues. A PPG newsletter was posted to patients who were being invited to attend chronic illness reviews, and also to housebound patients, in an effort to reach out to these groups of patients. The PPG, with the support of the practice had helped to establish a network of PPGs in the Lambeth area in order to discuss local issues and share information, as well as developing its own set of “gold standards”, and a toolkit which had been sent to all practices in the area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 February 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.

  • 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.

  • Safeguarding concerns were discussed at daily clinical meetings, and the practice routinely contacted the families of children who did not attend hospital appointments.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 10 February 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.

  • The practice had a robust system 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 10 February 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 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 10 February 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.

  • 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.

  • 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 had promoted its online repeat prescription service which had seen an increase in usage from 4% of all repeat prescriptions to 70% over the previous year.

Well-led

Good

Updated 10 February 2017

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 were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. There were high levels of constructive staff engagement.

  • There was a strong focus on continuous learning and improvement at all levels within the practice. The practice participated in numerous research studies and practice patients were invited to join these studies.

  • Staff were encouraged and supported to develop their skills. One receptionist at the practice had trained to become a health care assistant and was qualified to foundation degree level; another member of the reception team had obtained an NVQ in business administration and the practice nurse prescriber was training to become an advanced practitioner. A newer member of the reception team had been encouraged to train other non-clinical staff in the use of their document management system.

  • The patient participation group (PPG) was closely involved in the running of the practice and engaging with the patient population. This included the development of a “gold standard” PPG toolkit, campaigning for funds to install televisions in the waiting area, and recording a short film about the work of the PPG and local health issues.

  • There was a clear leadership structure and staff felt supported by management, for example the practice employed a buddy system whereby each member of staff had a “buddy” within the practice to provide mutual support and mentorship, staff told us this was beneficial to them.

  • 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.

Checks on specific services

People with long term conditions

Good

Updated 10 February 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. A named doctor was responsible for reviewing all hospital discharge summaries, contacting the patient and ensuring appropriate follow up action was taken.

  • Performance for all diabetes related indicators was 92%, which was comparable to the Clinical Commissioning Group (CCG) average of 86% and the 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.

Families, children and young people

Good

Updated 10 February 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 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, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 80% and the national average of 82%.

  • 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 10 February 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 provided coordinated care and support to the residents of two local care homes and two local nursing homes.

Working age people (including those recently retired and students)

Good

Updated 10 February 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.

  • The practice had taken steps to improve the take up of the electronic prescribing service, following a review of repeat prescribing carried out by an external organisation.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 February 2017

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

  • The practice was participating in a community incentive scheme funded by the local Clinical Commissioning Group for patients who had a serious mental health illness, and had been discharged from the local NHS mental health trust. The scheme provided access to a named, qualified mental health liaison nurse, a link worker from the local community mental health team and hub services including peer support, psychiatric assessment, social support.

  • The number of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 87%, compared to the CCG average of 88% and the national average of 84%.

  • Overall performance for mental health related indicators was 100%, which was above the CCG average of 91% and the national average of 93%.

  • 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.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • The practice hosted sessions from an alcohol and drugs advisor on the premises.

People whose circumstances may make them vulnerable

Good

Updated 10 February 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 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.

  • 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.