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Bancroft Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orford Lodge Surgery on 13 December 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services.

The full comprehensive report from the 13 December 2016 inspection can be found by selecting the ‘all reports’ link for Orford Lodge Surgery on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

  • Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Safe care and treatment.

The area identified as requiring improvement during our inspection in December 2016 was as follows:

  • Formalise the system for checking the monitoring of high risk medicines ensuring all patients receiving high risk medicines are monitored appropriately and within recommended timescales.

This inspection was an announced focused inspection carried out on 24 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified on our previous inspection on 13 December 2016. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good.

Our focused inspection on 24 July 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

  • The provider had a cohesive procedure in place to ensure that effective monitoring of high risk medicine was carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 August 2017

The practice is rated as good for providing safe services.

  • The practice had implemented a system to ensure that all patients who had been prescribed high risk medicines were reviewed and monitored appropriately.

Effective

Good

Updated 20 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed the practice had performed well, obtaining 94% of the total points available to them, for providing recommended care and treatment to their patients. This showed patient outcomes were comparable with local and national averages.
  • Staff referred to guidance from the National Institute for Health and Care and Excellence (NICE) and used it to assess and deliver care in line with current evidence based guidance.
  • The practice was engaged in an ongoing programme of clinical audits, which demonstrated a commitment to quality improvement, professional development and patient care.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Personal and professional development was actively encouraged and supported across all staff roles.
  • There was clear evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. The practice staff participated in regular multidisciplinary meetings to meet the needs of patients and deliver appropriate care and support.

Caring

Good

Updated 20 March 2017

The practice is rated as good for providing caring services.

  • The identification of the needs for individual patients was at the centre of planning and delivery of services at the practice. Practice staff reviewed the needs of its local population and engaged with NHS England and East and North Herts Clinical Commissioning Group to secure improvements to services where these were identified.
  • All of the data from the national GP patient survey showed that outcomes were higher than local and national averages for all aspects of care. For example, 100% of patients at the practice said the last nurse they saw was good at treating them with care and concern; this was higher than the CCG average of 90% and national average of 91%.
  • Patients reported they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, staff facilitated and supported patient groups with coffee mornings which encouraged information sharing and reduced social isolation. Staff were engaged with innovative service development ideas and shared learning was supported across the practice.
  • 95% of patients described their overall experience of the practice as good; this was higher than both the local CCG average of 82% and the national average of 85%.
  • Feedback received from patients from the completed CQC comment cards was consistently positive. Patients told us they were impressed by the professional attitude and caring approach of the staff.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. For example, 94% of patients stated the GP they saw was good at involving them in decisions about their care. This was higher than both the local CCG average of 78% and the national average of 82%.
  • We observed a strong patient-centred culture, where staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • 100% of patients said they had confidence and trust in the last nurse they saw or spoke to, compared to the local CCG and the national average of 97%
  • The practice had identified 181 patients registered as carers, which represented approximately 2% of the practice list. A carers ‘champion’ was to continue the work to identify and support patients who were carers.

  • Information for patients about the services available was easy to understand and accessible. The practice had an informative practice leaflet and a comprehensive website. Posters were on display and leaflets were available in the waiting area.

Responsive

Good

Updated 20 March 2017

The practice is rated as good for being responsive to people’s needs;

  • The identification of the needs for individual patients was at the centre of planning and delivery of services at the practice. Practice staff reviewed the needs of its local population and engaged with NHS England and East and North Herts Clinical Commissioning Group to secure improvements to services where these were identified.
  • 88% of patients said the receptionists at the practice were helpful, compared to the CCG average of 83% and a national average of 87%.
  • 78% of patients described their experience of making an appointment as good, compared to the CCG average of 66% and the national average of 73%.
  • Urgent appointments were available the same day, with pre-bookable appointments with the health care assistant, nurses and GPs available up to eight weeks in advance.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. A phlebotomy service was provided at the practice so that patients did not have to attend the local hospital.
  • Information about how to complain was available and easy to understand. Evidence demonstrated the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders as appropriate. The practice also encouraged positive feedback and celebrated success appropriately.

Well-led

Good

Updated 20 March 2017

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

  • The practice had a clear vision, with the delivery of safe and high quality care as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • 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 practice had systems in place to review, update and amend policies and procedures to ensure best practice guidelines were incorporated and followed by staff.
  • Localised performance indicators were in place to monitor delivery of services. Information was used to benchmark delivery of services, patient satisfaction levels and to identify areas of good practice and areas for development.
  • The practice regularly and proactively sought feedback from staff and patients, which it acted on. The practice had an engaged and active patient participation group.
  • 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 20 March 2017

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

  • All these patients had a named GP and a structured annual review to check their needs were being met. For those patients with the most complex needs, the named GP worked closely with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen at the surgery on a regular basis and invited to attend specialist nurse-led clinics as appropriate.
  • The practice offered longer appointments to these patients and home visits were available when needed.
  • Effective arrangements were in place to ensure patients with diabetes were invited for a review of their condition, with dedicated clinics provided by trained staff. For example, 98% of the patients on the diabetes register had an influenza immunization in the preceding 01 August 2015 to 31 March 2016, compared to local CCG average of 96% and national average of 94%.
  • Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice had 52 patients on its palliative care register and 22 of these patients had received a health check in 2015/16.The practice held regular Gold Standard Framework (GSF) meetings

Families, children and young people

Good

Updated 20 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.
  • 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 provided appointments 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.
  • Immunisation rates for standard childhood immunisations were higher than local CCG and national averages. The practice provided flexible immunisation appointments.
  • The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services.
  • Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. Positive links with the community midwife team and liaison with health visitors formed a positive and collaborative approach.

  • 80% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average of 83% and the national average of 81%.

Older people

Good

Updated 20 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. GPs were able to offer home visits to those patients who were unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
  • The practice had clear objectives to avoid hospital admissions where possible.
  • GPs made home visits to elderly patients and ensured that patients’ medicines were reviewed regularly and where possible other routine tests were undertaken without the need for patient admission to hospital.
  • Patients in this group had access to a dedicated telephone number at the practice, for use in an emergency.
  • The practice had taken part in a local Vanguard project, working with pharmacists in residential nursing homes, aimed at creating more integrated services between health and social care.

Working age people (including those recently retired and students)

Good

Updated 20 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice had adjusted the services it offered to ensure that appointments were accessible, flexible and offered continuity of care, with extended opening hours on Wednesday evenings and Friday and Saturday mornings.
  • The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.
  • A full range of health promotion and screening that reflected the needs of this age group, for example smoking cessation and weight management.
  • Data showed 54% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 59% locally and 58% nationally.
  • Data showed 71% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 72% locally and nationally.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 March 2017

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

  • 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 provided dedicated GP services to two specialist mental health units in the county.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and had received training in dementia awareness.
  • 78% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the local CCG average of 86% and the national average of 84%.
  • For patients on the dementia register, the practice had a lead member of staff with responsibility for developing and improving delivery of services for patients with mental health and health promotion. Staff had received dementia awareness training.
  • The patient participation group was leading plans for a local initiative to raise awareness of ‘dementia friendly’ options, within the practice and externally with community leaders.
  • The practice had supported patients experiencing poor mental health about how to access support groups and voluntary organisations, with links to support services, such as counselling and referrals to the Improving Access to Psychological Therapies service (IAPT).
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01 April 2015 to 31 March 2016) was 85%, compared against the local CCG average of 92% and the national average of 89%.
  • The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 20 March 2017

The practice is rated as outstanding, for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances. For example, a number of patients registered at the practice were homeless people and the practice was able to recognise how services should be adapted to support the patient’s lifestyle. The practice provided dedicated GP services to residents at a homeless hostel. The practice offered longer appointments for patients with a learning disability. The practice had 53 patients registered with learning difficulties and 25 of these patients (47%) had received a health check in 2015/2016. The practice had made regular and repeated attempts to contact the remainder of the patients and had offered additional support to enable them to attend.

  • The practice had recorded 181 carers on their register, which was approximately 2% of the total patient list, and had generated positive links with carers and community groups. A member of staff had recently taken on the role of carers champion and further development work was planned.
  • The practice regularly worked collaboratively with other health care professionals in the case management of vulnerable patients.
  • The practice had a system in place to identify patients with a known disability, with staff able to create a ‘flag’ on the patient’s record. This ensured appropriate consideration was given to decisions about the patients circumstances.
  • The practice informed vulnerable patients about how to access support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children and the protocol to follow for reporting concerns.
  • 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. For example, the practice held weekly meetings to discuss patients who had not attended their appointment to follow up on any concerns as a result.