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Inspection Summary


Overall summary & rating

Good

Updated 14 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 16 June 2015 – Good)

The key questions are rated as:

Are services safe – Good

Are services effective – Good

Are services caring – Good

Are services responsive – Good

Are services well-led - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Stanhope Mews Surgery on 5 December 2017 as part of our inspection programme.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Continue to review processes to improve uptake of cervical smears.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 February 2018

Effective

Good

Updated 14 February 2018

Caring

Good

Updated 14 February 2018

Responsive

Good

Updated 14 February 2018

Well-led

Good

Updated 14 February 2018

Checks on specific services

People with long term conditions

Good

Updated 24 September 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. 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. A GP and nurse had completed a programme to deliver advance care to diabetic patients and dedicated diabetic clinics were planned to be offered in the near future. The practice provided an in-house anticoagulation service for those patients on warfarin and provided in-house electrocardiogram (ECG) and ambulatory blood pressure monitoring services.

Families, children and young people

Good

Updated 24 September 2015

The practice is rated as good for the care of families, children and young people. The practice provided emergency walk-in clinics every morning from 9-11am, and every afternoon from 3-5pm to meet the needs of this population group. Reception staff identified young children and babies booked into the emergency clinics so that the GPs prioritised them. The practice worked closely with young families to ensure babies and children were immunised in a timely way. The health visitor attached to the practice ran in-house child health and well-baby clinics on Wednesday afternoons to support the needs of families with young children. The practice also ran regular family planning clinics providing patients which included gynaecological services, emergency contraceptive advice and maternity care. Opportunistic chlamydia screening was provided for those patients aged 17-25.

Older people

Good

Updated 24 September 2015

The practice is rated as good for the care of older people. The practice had a high number of older people with 14% of the patient list over 75 years old and 6% of these, over 90 years old. To meet their needs the practice proactively worked with district nurses and the palliative care team to case manage and care plan these patients. The practice also worked with a primary care navigator who acted as a care co-ordinator for older patients to help with their non-medical needs. The practices’ QOF performance in 2014 for palliative care indicators was 100% with a clinical prevalence above both CCG and national averages.

The practice identified older patients at high risk of admission to hospital and developed care plans during appointments with the patient. As part of this service patients over 70 years of age were invited into the practice or visited at home for annual health checks which included weight and blood pressure checks, hearing and memory tests and screening for depression and anxiety. At the time of our inspection there were 393 care plans in place for older patients. Older patients were on the Co-ordinate My Care (CMC) register to ensure all relevant health care professionals could access the care plans. Older patients were also treated as a priority in the practices’ triage system.

The practice had links with the Royal Hospital Chelsea and a named GP spent one day a week there providing care and treatment for the resident Chelsea Pensioners.

Working age people (including those recently retired and students)

Good

Updated 24 September 2015

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 an automated health POD which was available at any time for patients who wished to check their blood pressure, weight, height and other assessments without the need for an appointment. The practice ran early morning and evening clinics to cater for working age patients and students as well as early morning walk-in clinics. The practice recently went live on Twitter as a means to communicate relevant health-related bulletins and updates, and were about to go live with Skype appointments in late June 2015.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Longer appointments are offered to this patient group. Robust systems were in place to ensure patients commenced on anti-depressant medicines or with a new diagnosis of depression were followed up in a timely manner. The practice had an in-house counsellor who offered both NHS and private appointments for patients in this population group. The primary care navigator had links with specialist dementia nurses. The practice participated in a mental health initiative which invited patients on the mental health register in for annual health checks. Patients on long term anti-psychotic medicines were proactively contacted for regular reviews and blood tests and if they could not be contacted or did not attend, the practice alerted the patient’s community psychiatric nurse. GPs at the practice also attended annual meetings with consultant psychiatrists from Chelsea and Westminster Hospital to jointly review patients on the register and update treatment plans where necessary. The practice had a register of mental health patients and out of 96 patients on the register 94 had a care plan in place. Older patients were proactively screened for dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 September 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice had a learning disability register with nine patients on it and all had received an annual health check in the previous year. Most staff had received safeguarding adults training. The safeguarding lead GP attended local safeguarding meetings regularly and safeguarding was a standing item on the practice’s weekly meeting agenda. The practice had a primary care navigator who organised befriending and social help amongst other services for vulnerable patients. Where the primary care navigator was unable to help herself, patients were signposted to appropriate services. The GPs and nurses screened patients opportunistically for health problems associated with alcohol and drugs and referred patients to the community drug and alcohol clinic when necessary.