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Inspection Summary


Overall summary & rating

Good

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Chads Surgery on 23 November 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.
  • 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.
  • 83% of patients said they could get through easily to the practice by phone compared to the national average 73%.
  • 93% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the national average of 85%.
  • The patient participation group (PPG) was well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and the group had raised awareness to patients about the practice’ services.
  • The practice participated in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
  • Results from the NHS Friends and Family Test showed that 467 respondents (94%) would recommend the practice to family and friends.
  • Staff had lead roles that improved outcomes for patients such as a carer’s lead.
  • 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.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw three areas of outstanding practice:

  • There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. St Chads Surgery identified patients at risk of developing diabetes who were not on the diabetes register, and implemented changes that could help to delay or prevent the progression of this health condition. Changes offered to patients included lifestyle interventions and annual blood testing. The practice identified 138 patients who were not on the diabetes register and the practice developed a new information technology template to record their needs.

  • The practice developed a ‘tiered letter recall system’ so that patients need only attend one annual review to address multiple health concerns. For example, 783 patients with diagnoses of diabetes, chronic kidney disease and hypertension had these health issues addressed in a single annual review in the last year.
  • In 2015 and 2016, the practice received an award from the National Institute for Health Research (NIHR). The reward recognised the practice for developing innovative models of recruitment, and for consistently delivering its research findings to time and on target.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 January 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 25 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework for April 2015 to March 2016 showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • We saw a programme of clinical audits that included improvements for patient care.
  • 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 25 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (July 2016) showed patients rated the practice as comparable with other local practices 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.
  • The practice had identified patients who were carers and alerted them whenever a local carers group met. This provided an opportunity for carers to gain support and raised awareness of carer’s services locally.
  • Vulnerable patients who did not attend their scheduled appointments were contacted by a practice nurse, to check their welfare.
  • A member of staff acted as a carer’s lead. The carer’s lead had a direct link with the local care forum and referred suitable patients for specialised advice and guidance.

Responsive

Good

Updated 25 January 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 (CCG) to secure improvements to services where these were identified. For example, the practice was participating in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with regular appointments available the same day.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of patient feedback.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice worked with other health professionals to minimise unnecessary hospital admissions.
  • Patients were able to access the practice in ways to suit their needs. For example:

    • Patients could access the practice by telephone, and face-to-face.
    • The practice sent text reminders for appointments.
    • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
    • The practice offered extended morning and evening appointments during the week and on one Saturday morning a month, with a GP and nurse.

  • The practice increased the length of individual appointment times for patients with complex medical conditions.
  • The practice liaised with the local carer’s centre to help vulnerable patients book transport to the practice and the local hospital.
  • The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.
  • The practice initiated the use of a recognised clinical measure of fitness and frailty in older people to assess their health needs.
  • The practice identified patients at risk of developing diabetes and implemented changes that could help to delay or prevent the progression of this health condition.
  • The practice worked to provide inclusive services for younger patients, such as being a centre for the C Card Scheme, which enabled teenagers to access free methods of contraception.
  • The practice was a registered location for the Breastfeeding Welcome Scheme, which aims to facilitate greater acceptance and promotion of breastfeeding.
  • The practice developed a ‘tiered letter recall system’ so that patients need only attend one annual review to address multiple health concerns.
  • The practice referred patients to local community health improvement schemes. For example:

    • A scheme to help people with medical conditions such as diabetes and coronary heart disease (who are not normally active) to access a supported 12-week exercise programme. The scheme was run by Bath and North East Somerset Council in partnership with other local GP practices.
    • The Wellbeing College, to help with the management of their physical and mental health, and prevent long term conditions in the future.

Well-led

Good

Updated 25 January 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 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 provider 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.
  • Practice partners held an away day twice-yearly, to discuss issues such as management structure and partner responsibilities.
  • There was a strong focus on continuous learning and improvement at all levels within the practice. The practice received an award from the National Institute for Health Research (NIHR), for consistently delivering its research findings to time and on target.
  • The practice was observed by a team of experts by experience of disability, who use GP services, to improve the experience of patients with learning and other disabilities. The practice developed a quality check following the team’s recommendations.

  • St Chads Surgery helped to form a local organisation that works across the community to improve patient care through providing clinical (treatment and diagnostic) services to patients in a community setting.
  • The practice participated in a study to understand patient’s experiences of medically unexplained symptoms (MUS). Nine patients were referred to the practice’s symptom management clinic and following clinical and psychological review, some reported improvements and changes to their daily routines.
  • The practice collaborated with seven practices, to support patients who had been diagnosed with diabetes, heart failure or depression.
Checks on specific services

People with long term conditions

Good

Updated 25 January 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.
  • Performance for patients with long-term conditions compared with national averages. For example, 79% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
  • 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 routinely offered longer appointments for patients with complex medical needs.
  • The practice identified patients at risk of developing diabetes and implemented changes that could help to delay or prevent the progression of this health condition.
  • The practice developed a recall system so that patients need only attend one annual review to address multiple health concerns.
  • The practice collaborated with seven practices, to support patients who had been diagnosed with diabetes, heart failure or depression.
  • The practice referred patients to a scheme to help with medical conditions such as diabetes and coronary heart disease. The scheme enabled these patients (who are not normally active) to access a supported 12-week exercise programme.

Families, children and young people

Good

Updated 25 January 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 assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 85%, which was comparable to 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.
  • The practice worked to provide inclusive services for younger patients. For example, the practice was a centre for the ‘C Card Scheme’, which enabled teenagers to access free methods of contraception.
  • The practice was a registered location for the Breastfeeding Welcome Scheme, which aims to facilitate greater acceptance and promotion of breastfeeding.

Older people

Good

Updated 25 January 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 patients in its population.
  • Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • A carer’s lead worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
  • The practice initiated the use of a recognised clinical measure of fitness and frailty in older people to assess their health needs.
  • The practice offered home visits to review personalised care plans for older patients.

Working age people (including those recently retired and students)

Good

Updated 25 January 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 offered extended hours appointments in the morning and evening with a GP and nurse, as well as Saturday appointments for one morning a month.
  • Patients were able to book appointments and order repeat prescriptions online.
  • The practice offered text reminders for appointments.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 January 2017

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

  • 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with both the clinical commissioning group (CCG) average of 86% 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 their records in the preceding 12 months was 95%, which exceeded the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • Patients were referred to specialist mental health services that offer assessment and treatment when children and young people have emotional, behavioural or mental health difficulties.

People whose circumstances may make them vulnerable

Good

Updated 25 January 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.
  • The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.