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Inspection Summary


Overall summary & rating

Good

Updated 20 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springfield Surgery on 30 September 2015. The overall rating for the practice at that time was requires improvement. The full comprehensive report from that inspection can be found by selecting the ‘all reports’ link for Springfield Surgery on our website at www.cqc.org.uk.

This inspection was undertaken on 01 December 2016 to determine if the practice had made improvements since our last inspection. Overall the practice is now rated as Good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice had instilled a clear system to ensure risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Feedback received from patients from the completed CQC comment cards was positive. Patients told us they were impressed by the professional attitude and caring approach of the staff.
  • Dispensary staff showed us standard procedures which covered all aspects of the dispensing process (these are written instructions about how to safely dispense medicines). We saw evidence of regular review of these procedures in response to incidents or changes to guidance in addition to annual review.
  • Members of the patient participation group (PPG) we spoke with were positive about the practice and the care provided. The practice met regularly with the PPG and responded positively to proposals for improvements.
  • Infection prevention and control systems were comprehensive and environmental checks, including legionella testing were all up to date
  • 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.
  • The practice occupied a purpose built health centre, had good facilities and was well equipped to treat patients and meet their needs.
  • 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.
  • Risks to patients were assessed and well managed. The practice had defined systems, processes and practices to review and assess ongoing risks.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had created an easy to read pictorial letter and information leaflet for patients with learning disabilities. This assisted the practice when inviting these patients for a health review, to explain treatment and enable the patients to give feedback to GPs and nurses about their care.

The provider should make improvements in the following area:

  • Continue to identify and support carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 April 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. A policy and guidance was available for all staff to access on the practice computer system. Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, information and a written apology. They were told about any actions taken to improve processes to prevent the same thing happening again.
  • Appropriate arrangements for legionella testing and infection prevention and control were in place. Staff had received appropriate training to manage these areas.
  • Systems and processes within the dispensary ensured medicines were managed safely, including arrangements for controlled drugs.
  • The practice had well defined and clearly embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • Risks to patients were assessed and well managed. The practice had defined systems, processes and practices to review and assess ongoing risks.

Effective

Good

Updated 20 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with local and national averages. For example, the most recent published results showed the practice achieved 100% of the total number of points. This was comparable with the CCG average of 98% and the national average of 95%.
  • Staff assessed needs and delivered care in line with current evidence based guidance. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met patients’ needs.
  • In an attempt to reduce the levels of those patients who did not attend for their appointment, the practice had introduced a text messaging system.
  • Clinical audits demonstrated quality improvement. There had been 18 clinical audits undertaken in the last two years, nine of these were completed audits where the improvements made were implemented and monitored.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 20 April 2017

The practice is rated as good for providing caring services.

  • Recent data from the national GP patient survey showed 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. For example, 86% of patients said the last GP they saw was good at involving them in decisions about their care, compared to the CCG average of 83% and the national average of 82%.
  • Members of the patient participation group (PPG) we spoke with were positive about the practice and the care provided.
  • Information for patients about the services available was easy to understand and accessible, both in the patients waiting area and on the practice website.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified 105 patients as carers, which was approximately 1% of the practice list. A carers ‘champion’ was to continue the work to identify and support patients who were carers.The practice had created a comprehensive welcome pack for newly registered patients, with information about the practice, the services available and the surrounding facilities.
  • A range of noticeboards in the waiting area provided information about additional support available and signposted patients to other agencies, such as Cruse, Sure Start, AGE UK and Northamptonshire Carers.
  • We observed a strong patient-centred culture, where staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • 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 April 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with NHS England and the Nene Clinical Commissioning Group to secure improvements to services where these were identified.
  • 86% of patients were able to get an appointment to see or speak to someone the last time they tried compared to the CCG average of 79% and the national average of 76%.
  • Urgent appointments were available the same day, with pre-bookable appointments with, nurses and GPs available up to weeks in advance.
  • 96% of patients said the last appointment they got was convenient, compared to the CCG average of 92% and the national average of 92%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had made arrangements for those patients with hearing difficulties to be able to email for appointments.
  • 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 April 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 reviewed and discussed with staff.
  • High standards were promoted and 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.
  • The governance framework at the practice supported the delivery of the vision. This included arrangements to monitor and improve quality of services and to identify and manage 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 (PPG). The practice had 12 members in the Patient Participation group and an additional 220 patients signed up for the virtual PPG.
  • The provider had created sytems on the patient database which alerted clincians to possible prescribing conflicts and other situations which may require separate risk assessment.
  • The provider was aware of and complied with the requirements of the duty of candour. The practice 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 April 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 diabetes related indicators was similar to the local and national averages. For example, the percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification was 96% compared to the CCG and the national average of 89%.
  • Longer appointments and home visits were available for these patients 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.
  • 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 targets to reduce hospital admissions for respiratory conditions.
  • The practice regularly reviewed their Quality Outcomes Framework (QOF) performance to identify if there were any areas which required additional focus, particularly for those patients with long-term conditions.

Families, children and young people

Good

Updated 20 April 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 had a policy to contact young people on their 16th birthday, to give information about the practice and explain about entitlement to patient confidentially.
  • The practice provided appointments outside of school hours and the premises were suitable for children and babies. Child immunisations were available at any time and not restricted to specific timed clinics.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. Safeguarding meetings and information sharing ensured appropriate communication was in place.
  • Childhood immunisation rates for the vaccinations given were higher than CCG and national averages. For example, the practice achieved a 94% target for childhood immunisation rates for the vaccinations given to under two year olds compared to the national average score of 91%.
  • The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 82% and the national average of 81%.

Older people

Good

Updated 20 April 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, and offered home visits and urgent appointments for those with enhanced needs.
  • A vaccination programme was in place for older people including, seasonal flu jabs, shingles and pneumococcal vaccinations.
  • Patients aged over 75 years were offered an annual health check.
  • The practice identified patients who may require additional support as TLC patients on their computer system. This flag alerted staff to any special consideration relevant to individual patients.
  • A coffee morning had been established to enable elderly patients and local residents to combat loneliness and social exclusion.

Working age people (including those recently retired and students)

Good

Updated 20 April 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.

  • Extended hours were provided from 7.30am to 7.30pm on Wednesday and from 8.30 until midday on Saturday. This was especially useful for working patients who could not attend during normal opening hours.
  • 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. For example, smoking cessation and weight management.
  • The practice actively encouraged patients to attend cancer screening programmes, for example:

  • 74% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 77% and the national average of 72%.
  • 61% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 60% and the national average of 58%.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 April 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 and provided advice and support for patients experiencing poor mental health about how to access support groups and voluntary organisations.
  • Performance for mental health related indicators was similar to the local and national averages. 98% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, compared to the CCG average of 85% and the national average of 84%.
  • Referrals were made to the IAPT team (Improving Access to Psychological Therapies) and the Wellbeing team members visited the practice weekly.
  • 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 100%, 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia. Staff were in the process of completing dementia awareness training.

People whose circumstances may make them vulnerable

Good

Updated 20 April 2017

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

  • The practice had a register of carers who were also patients, they had identified 105 patients as carers, which was approximately 1% of their list as carers and offered them flexible appointment booking, health checks and flu vaccinations. The carers lead offered assistance and advice on the different type of support available.

  • The practice held a register of patients living in vulnerable circumstances including travellers, homeless people and those with a learning disability. The practice also provided services to a group of travellers registered with the practice.
  • The practice was able to recognise how services should be adapted to support the patient’s lifestyle. For example, the practice identified patients as TLC special patients who may need additional time in appointments or assistance with mobility or who may have been recently bereaved.
  • The practice had designed pictorial letter to invite patients for their annual review and an information leaflet to explain to them what the health check would be like for them.
  • The practice offered longer appointments for patients with a learning disability. The practice had 20 patients registered with learning difficulties and 18 of these patients had received a health check in 2015/2016.
  • 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 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.