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Inspection Summary


Overall summary & rating

Good

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out a focused inspection of University Health Service on 6 December 2016 to check that action had been taken since our previous inspection in April 2015. At the inspection in April 2015 the practice was rated as good overall. The practice was good for Effective, Caring, Responsive and Well Led services.

However we found that the practice required improvement in the Safe domain due to breaches of regulations relating to safe delivery of services. We found that the practice had not ensured that emergency medicines were available, fit for purpose and within the expiry date.

The practice had not ensured that staff recruitment checks were completed in full and the practice needed to carry out risk assessments to identify those members of staff who required a Disclosure and Barring Services check (this check identifies whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

We inspected the practice on 6 December 2016 to check that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection of University Health Service on our website at www.cqc.org.uk

Our key findings for this inspection were as follows:

The provider had made improvements:

  • Recruitment arrangements included all necessary employment checks for all staff had been carried out.
  • The practice carried out risk assessments to identify those members of staff who required a Disclosure and Barring Services check.
  • New medicines had been purchased and they were now all within the expiry date. Systems had been put in place to ensure that emergency medicines were regularly checked and recorded.

The practice is now rated good for Safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 January 2017

The practice is rated as good for providing safe services.

  • Recruitment arrangements included all necessary employment checks for all staff had been carried out.

  • The practice carried out risk assessments to identify those members of staff who required a Disclosure and Barring Services check.

  • New medicines had been purchased and they were now all within the expiry date. Systems had been put in place to ensure that emergency medicines were regularly checked and recorded.

Effective

Good

Updated 20 August 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Significant events were taken seriously and responded to in a timely manner. Patients’ needs were assessed and care was planned and delivered in line with current guidance. This included assessing capacity and promoting good health. Not all staff had received training appropriate to their roles.

Caring

Good

Updated 20 August 2015

The practice is rated as good for providing caring services. Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 20 August 2015

The practice is rated as good for providing responsive services. It 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. Patients said they found it easy to make an appointment with a named GP and that 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 that the practice responded quickly to issues raised. Complaints we looked at were investigated to a satisfactory conclusion for the patient.

Well-led

Good

Updated 20 August 2015

The practice is rated as good for being well-led. The practice had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management.

The practice proactively sought feedback from patients and had an active virtual patient participation group. There was evidence of appraisals and personal development plans in place for some staff but gaps were found for administration and practice management. The practice had a number of policies and procedures to govern activity, but some of these were overdue a review. There was also a limited number of systems in place to monitor and improve quality and identify risk.

Checks on specific services

Older people

Good

Updated 20 August 2015

The practice is rated as good for the care older people.

The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice part funded a nurse with two other local practices to help care for patients aged 75 and over who provided an assessment service either in the practice or at home as required.

Whilst the practice only had a 66 patients aged 75 and over. Each patient had a named, GP who provided a personalised, tailored service to the patient. For example, some GPs visited patients while they were in hospital. Care plans were offered for patients aged 75 and over to try to avoid unplanned hospital admissions. Home visits were carried out for housebound patients and the clinical staff liaised with carers where appropriate. Some patients also had a direct contact number for the reception office manager who would assist with many and varied queries which were not always health related.

People with long term conditions

Good

Updated 20 August 2015

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

Longer appointments were available on patient request and GPs assessed and treated all patient’s needs in a single consultation to avoid them returning for further appointments. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care to provide continuity of care and avoid hospital admissions.

Opportunistic health checks were carried out for patients seeing the nurse or health care assistant for other reasons. Checks included height, weight and blood pressure. The administration team recalled patients with long term conditions and also those on medicines that required special monitoring to ensure that they had all the relevant blood tests. The practice achieved maximum points on the quality register in this area. A recent diabetes audit identified the practice as providing one of the highest levels of service in the local clinical commissioning group area for patients with this condition.

Families, children and young people

Good

Updated 20 August 2015

The practice is rated as good for the care of families, children and young people.

Three GPs offered obstetric appointments and children were always seen on the same day in duty clinics. The practice had a recall system for six week checks for new born babies and patients were followed up if they did not attend (DNA) appointments. All families were asked to complete a ‘supplemental registration form’ which detailed all persons living at the household to assist in safeguarding.

The practice achieved 90% in childhood immunisation targets, and it ran mainly set clinics but very often booked patients outside of these to accommodate the child’s parent who worked or had home commitments. The nurse running the immunisation clinic called parents personally if a child did not attend. If there were two or more appointments missed then the matter was highlighted to the practice safeguarding lead and the child’s records were coded accordingly.

A dedicated member of the administration team completed searches periodically and sent out letters/telephone calls/emails to parents of newly registered children when there wasn’t any immunisation history and if they hadn’t had all their immunisations according to the UK schedule so information could be provided to update the child’s record.

Working age people (including those recently retired and students)

Good

Updated 20 August 2015

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

The practice offered telephone consultations face to face appointments, some email based consultations and patients could book appointments on-line using Patient Access. Choose and book systems for secondary care referrals was available which allowed patients to book their hospital appointments around their lives.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Patients who lived out of the area could register with University Health Service under the ‘Choice of GP’ scheme. The practice offered text message reminders to patients for booked appointments and also a facility for patients to cancel their appointments by text.

People whose circumstances may make them vulnerable

Good

Updated 20 August 2015

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

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 worked closely with the University and medical school to support vulnerable students. Visits were made to vulnerable housebound patients. If a patient who was homeless wanted to register, staff would, in the first instance, direct them to the Homeless Health Care Team who specialised in their care and rehabilitation. If a patient who was registered with the practice became homeless for whatever reason, staff would endeavour to keep them on their patient list to ensure continuity of care.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 August 2015

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

Patients with poor mental health were seen sometimes weekly or more, based on their need. Daily and weekly prescriptions were given if required and patients were not removed from the practice list if they moved outside the area (at GP request) so as not to destabilise their treatment for their mental health. Patients were given longer appointments by default and reception staff knew them all very well and would always give an appointment on the day if they request this. GPs attended multidisciplinary meetings as requested and reviewed patients’ mental capacity as required. The practice had a register of patients with mental health diagnoses and those living with dementia and an annual review was offered routinely. It also carried out advance care planning for patients living with dementia.