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Inspection Summary


Overall summary & rating

Good

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

In April 2016, during our previous comprehensive inspection of Sheet Street Surgery, we found issues relating to the safe delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements; in order to ensure that fire safety procedures and checks are fully implemented. In addition the practice was asked to develop an action plan to address the issues identified during their most recent fire risk assessment.

We also found that the practice did not have an appropriate process for the handling of blank prescription forms. Furthermore, the practice needed to ensure that all staff had undertaken training including safeguarding, health and safety, equality and diversity, fire safety, infection control and basic life support.

We also found that the practice needed to develop and implement a clear action plan to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health and patients at risk of unplanned admission. The practice also needed to encourage carers to register as such, in order to enable them to access the support available via the practice and external agencies.

Finally at our previous inspection, we also found that the practice needed to ensure partnership details are updated to the practices Care Quality Commission (CQC) registration.

Following the last inspection, the practice was rated as requiring improvement in safe services, and good for effective, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of fire policies and procedures, and documents relating to the tracking and monitoring of prescriptions, to demonstrate the range of improvements they had made, since our last visit. The practice also further supplied a chart outlining the areas the practice had attempted to improve and an updated staff training record document.

We found the practice had made improvements since our last inspection in April 2016.

At this inspection we found that:

  • The practice had instructed an independent company to re-assess the risk of fire in the practice.

  • The practice had reviewed and updated their fire policy.

  • Improvements had been made to the processes used to handle blank prescriptions.

  • Steps had been taken to address the security issues surrounding blank prescriptions.

  • Systems were now in place to ensure the processes used to handle blank prescriptions were both safe and effective.

  • Staff had undergone training in a wide range of areas. Including safeguarding, equality and diversity, fire safety, infection control and basic life support.

  • The practice had supplied a copy of their training records, to demonstrate the steps taken to improve the previous training issues found.

  • Systems were now in place to monitor training.

  • Steps had been taken to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health, and patients at risk of unplanned admission.

  • Action had been taken to encourage carers to register as such to enable them to access the support available via the practice and external agencies.

The areas where the provider should make improvements are:

  • Continue to ensure all registration details are up to date on the Care Quality Commission database.

  • Ensure all members of staff complete health and safety training, and address any gaps in training staff may have.

Following this desk based inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 7 April 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 March 2017

Since our last inspection in April 2016, the practice was found to have undertaken work to address the previous issues identified in April 2016. These include:

  • Instructing an independent company to re-assess the risk of fire in the practice.

  • Reviewing and updating the practice fire policy.

  • Improving the processes used to handle blank prescriptions.

  • Addressing the security issues surrounding blank prescriptions.

  • Providing training for members of staff in a wide range of areas. Including safeguarding, equality and diversity, fire safety, infection control and basic life support.

  • Supplying a copy of practice training records, to demonstrate the steps taken to improve the previous training issues found.

  • Ensuring systems were now in place to monitor training.

  • Taking steps to improve the outcomes for patients with learning disabilities, patients experiencing poor mental health, and patients at risk of unplanned admission.

  • Taking action to encourage carers to register as such to enable them to access the support available via the practice and external agencies.

Effective

Good

Updated 1 March 2017

Caring

Good

Updated 1 March 2017

Responsive

Good

Updated 1 March 2017

Well-led

Good

Updated 1 March 2017

Checks on specific services

People with long term conditions

Good

Updated 4 May 2016

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

  • There were clinical leads for 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 patients with long term conditions had a named GP and a structured annual review to check that 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 4 May 2016

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

  • 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 patients who had a high number of A&E attendances.
  • Immunisation rates were comparable to the CCG average for all standard childhood immunisations.
  • The practice’s uptake for the cervical screening programme was 79%, which was lower than the national average of 82%.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 4 May 2016

The practice is rated as good for the care of older patients. 

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The premises were accessible to those with limited mobility. However, the front door was not automated and the practice did not provide a low level desk at the front reception. We saw an evidence to confirm that the practice was planning to replace the front door in two weeks’ time.
  • There was a register to manage end of life care.
  • There were good working relationships with external services such as district nurses.

Working age people (including those recently retired and students)

Good

Updated 4 May 2016

The practice is rated as good for the care of working-age patients (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.
  • For example, the practice offered extended hours appointments Monday to Friday from 6:30pm to 9pm, and every Saturday and Sunday from 9am to 12pm and 2pm to 7pm at Kings Edward Hospital (funded by Prime Minister’s Access Fund).
  • In addition, the practice was going to offer extended hours appointments at the premises from next week every Tuesday and Wednesday morning from 7am to 8am and every Tuesday evening from 5:30pm to 7:30pm.
  • The practice was proactive in offering online services and telephone consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 May 2016

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

  • Performance for dementia face to face review was better than the CCG and national average. The practice had achieved 88% of the total number of points available, compared to 83% locally and 84% nationally.
  • 50% of patients experiencing poor mental health were involved in developing their care plan in last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
  • Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 4 May 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
  • It offered annual health checks for patients with learning disabilities. Health checks were completed for two patients out of 12 patients on the learning disability register. Care plans were not completed for any patient on the learning disability register.
  • Longer appointments were offered to patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • 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.