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Dr D Cowen & Partners Good Also known as Northfields Surgery

Inspection Summary


Overall summary & rating

Good

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Cowen & Partners (also known as Northfields Surgery) on 9 February 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Most risks to patients and staff were assessed and well managed however there were some areas that necessitated review.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they felt the practice offered an excellent service and staff were helpful, caring, professional and kind and treated them with dignity and respect.
  • Information about services and how to complain was available and easy to understand.
  • 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 equipped to treat patients and meet their needs. Due to building constraints there was no dedicated toilet for disabled patients however the general toilet had been adapted to address this.
  • 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

  • Ensure a mercury spill kit is available to deal with any spillage from the mercury gauge blood pressure monitor kept at the practice.

  • Ensure that regular fire drills are carried out.

  • Review the arrangements in place for the disposal of cytotoxic waste.

  • Review the frequency of infection control audits carried out to ensure they comply with recommended guidance.

  • Ensure that water temperature checks are carried out to reduce the risk of legionella.

  • Review the arrangements in place for the storage of emergency medicines and equipment to ensure timely access and security of all emergency medicines.

  • Advertise the availability of translation services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 May 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Most risks to patients and staff were assessed and well managed however there were some areas that necessitated review.

Effective

Good

Updated 17 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits linked to medicines management and prescribing schemes demonstrated quality improvement.

  • 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.

  • The practice had services in place to promote healthy lifestyles, including offering cervical screening and childhood immunisations with uptake rates comparable to local and national averages.

Caring

Good

Updated 17 May 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice above or at local and national averages for consultations with GPs and nurses.

  • Patients said they felt the practice offered an excellent service and staff were helpful, caring, professional and kind and treated them with dignity and respect.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice had a protocol for identifying carers and offered them appropriate support and information.

Responsive

Good

Updated 17 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS London and Clinical Commissioning Group to secure improvements to services where these were identified, for example, through reviewing referral data and unplanned admissions with local practices and using this to improve services.

  • Patients said they found it easy to make an appointment with a named GP and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 17 May 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • 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 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

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 17 May 2016

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

  • The practice offered diabetic patients an extended appointment for medical review with the practice nurse and GP to create individualised care plans.

  • The practice engaged in local enhanced services to identify patients with complex medical needs at risk of hospital admission and invite them for review to create integrated care plans aimed at reducing these risks.

  • Longer appointments and home visits were available when needed.

  • GPs had special interests in clinical areas such as cardiology and gynaecology and shared their expertise to support colleagues.

  • Quality and Outcome Framework (QOF) data for 2014/2015 showed the practice was performing in line with local and national averages for long-term conditions indicators.

  • The practice was in the process of introducing out of hospital services such as electrocardiograms (ECG), spirometry and 24 hour blood pressure monitors.

Families, children and young people

Good

Updated 17 May 2016

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

  • There was a named lead for safeguarding children and the practice maintained a register of vulnerable children. Staff had received role appropriate safeguarding training and were aware of their roles and responsibilities to raise concerns.

  • The practice held twice weekly postnatal clinics with extended appointments for mother and baby checks.

  • The practice offered childhood immunisations in line with national guidance and uptake rates were comparable to local averages.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 17 May 2016

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

  • The practice engaged in local enhanced services to identify older patients at risk of hospital admission and invite them for a review to create integrated care plans aimed at reducing this risk.

  • All patients over the age of 75 years were invited for annual health checks and medication review.

  • Home visits were available for patients unable to attend the practice due to illness or immobility.

  • Staff had received safeguarding vulnerable adults training and were aware of their roles and responsibilities to raise concerns.

Working age people (including those recently retired and students)

Good

Updated 17 May 2016

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

  • The practice offered extended hour appointments for patients unable to attend the surgery during working hours. Telephone consultations were also available daily with the duty doctor.

  • There was the facility to book appointments and request repeat prescriptions online.

  • The practice offered temporary registration for students returning home during term holidays requiring medical services.

  • The practice nurse offered extended appointments, travel advice and immunisations as required. 

People experiencing poor mental health (including people with dementia)

Good

Updated 17 May 2016

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

  • 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

  • The practice offered opportunistic screening for dementia during routine appointments and annual health checks with referral on to local memory services if required.

  • The practice had engaged with the local Shifting Settings of Care scheme to support patients experiencing poor mental health transitioning from secondary care to community services. The practice was supported by a designated Primary Mental Healthcare Worker when managing these patients.

  • The practice maintained a register of patients experiencing poor mental health and these patients were invited to annual health checks and medication review. Patients were sent text message and letter reminders of these appointments to encourage attendance.

  • One of the GPs was completing a diploma in mental health and attended frequent CCG led training sessions that enabled them to share expertise and disseminate learning.

People whose circumstances may make them vulnerable

Good

Updated 17 May 2016

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

  • The practice maintained a register of patients with learning disabilities and these patients were invited to annual health checks with an extended 50 minute appointment with the GP and practice nurse.

  • 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 various support groups and voluntary organisations.

  • The practice maintained a carer’s register and proactively sought to identify carers and offer them additional support including referral to local carer’s services and annual health checks.

  • The practice had a protocol to improve access for patients with hearing impairment. An alert was added to patient notes to inform staff they may require extra assistance, for example double appointments, collecting the patient from the waiting room and interpreters when required.

  • There was a named lead for safeguarding vulnerable adults and the practice maintained a register of vulnerable patients with alerts on their electronic records.

  • 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.