You are here

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2016

We carried out an announced comprehensive inspection at Garswood Surgery on the 3rd November 2015. Overall the practice is rated as good.

Our key findings were as follows:

  • There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Staff understood and fulfilled their responsibilities to raise concerns and report incidents.

  • The practice was clean and tidy. The practice had good facilities in a large purpose built building with disabled access and a lift to the first floor.
  • The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments.

  • There was a robust system in place to undertake audits at the practice and improve patient care.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

  • Patients spoke highly about the practice and the whole staff team. They said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistent and strongly positive.

  • The practice sought patient views about improvements that could be made to the service, including having a Patient Participation Group (PPG).
  • Information about services and how to complain was available and easy to understand. The practice proactively sought feedback from staff and patients, which it acted upon.
  • There was a clear leadership structure with delegated duties distributed amongst the team and staff felt supported by management. The staff worked well together as a team.

  • Quality and performance were monitored.

We saw areas of outstanding practice including:

  • The practice staff organised a number of community initiatives. Previously they had held a fundraising day for MacMillan cancer research and invited their patients and staff to help with the fundraiser. They had organised a coffee day in December 2015 for their patients and invited various groups to come and meet their patients during the event. Organisations such as the falls risk team and the memory clinic staff were due to attend to help raise awareness amongst their patients and the community in regard to the support and services they could offer.

  • One GP had collected data over the last 20 years and carried out a yearly audit on patient deaths. They encouraged the practice to reflect each year on all deaths to look at any factors that could be preventable or reflect on the care given. Whilst no areas of concern were identified within the audits the staff had put a lot of work into reflecting and mitigating any risks. The data collated looked at any preventable factors for their death e.g. smoking, alcohol and helped increase awareness amongst GPs with health promotion and looking into the background of patients problems. The GP was due to present the data and research for publication this year.

  • In 2014-2015 the practice won an award called a ‘GOLD Quality Placement Award.’ This was for mentoring and teaching undergraduate medical students from a local university and was based on undergraduate feedback regarding the quality of their placement and teaching.

  • The practice introduced a tailor made recall system in 2007 which won an award in 2011 for its innovation. It offered a high quality system offering more checks than usual recall systems which ensured the clinical management of patients to be safe and robust. Almost every aspect of patient management with the exception of medication reviews was dealt with using the clinical systems diary facility. Patients were pro-actively managed to avoid deterioration in their health outcomes, for example: cholesterol, weight management and asthma management. Patients were seen holistically for their co morbidities in one appointment and birthday reviews offered a ‘One stop shop’ approach optimising appointments. The system helped the practices management of avoiding unplanned admissions and the proactive case management of vulnerable patients. The system facilitates the identification of patients who found it difficult to attend reviews and smear tests and as a result the practice had put in strategies to accommodate the needs of these patents with late and early morning appointments and home visits.

However there were areas of practice where the provider should make improvements:

  • Ensure all staff files evidence the necessary checks such as references to show safe recruitment of staff.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The practice did not have an annual review of events but they did discuss them at regular intervals within staff meetings. Lessons were learned and communicated within the practice. The premises were clean and tidy. Safe systems were in place to ensure medication, including vaccines were well managed. There were sufficient numbers of staff. Recruitment checks were carried out and most staff files were well managed. Just one staff file lacked evidence of necessary checks such as two references that needed to be in place to show safe recruitment.

Effective

Outstanding

Updated 7 January 2016

The practice is rated outstanding for providing effective services. The practice used innovative and proactive methods to improve patient outcomes. The practice proactively engaged patients to promote their well-being. The practice introduced a tailor made recall system which provided a high quality system which ensured the clinical management of patients to be safe and robust. The practice monitored its performance data and had systems in place to improve outcomes for patients. Staff routinely referred to guidance from the National Institute for Health and Care Excellence (NICE). Patients’ needs were assessed and care was planned and delivered in line with best practice and national guidance. One GP had collected data over the last 20 years and carried out a yearly audit on patient deaths. They encouraged the practice to reflect each year on all deaths to looks at any factors that could be preventable or reflect on the care given. The practice is an approved ‘Yellow Fever’ vaccination centre. (Yellow fever is a serious viral infection that can be prevented with a vaccination.)

Caring

Good

Updated 7 January 2016

The practice is rated as good for caring.  Patients’ views gathered at inspection demonstrated they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We observed a strong patient-centred culture. We also saw that staff treated patients with kindness and maintained confidentiality. We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on. Staff helped people and those close to them to cope emotionally with their care and treatment. Data from the National GP Patient Survey published July 2015 showed that patients rated the practice as comparable and exceeded in several aspects of care compared to local and national averages. Some staff had worked at the practice for many years and understood the needs of their patients well.

Responsive

Good

Updated 7 January 2016

The practice is rated as good for providing responsive services.

It reviewed the needs of its local population and engaged with the local Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Services were planned and delivered to take into account the needs of different patient groups. The practice had good facilities and was well equipped to treat patients and meet their needs including access to disabled facilities, hearing loop and translation services. Information about how to complain was available and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 7 January 2016

The practice is rated as good for being well led.

It had a clear vision and strategy. Governance arrangements were underpinned by a clear leadership structure with delegated roles and staff felt supported by management. The practice had a number of policies and procedures to govern activity. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on and had an active PPG. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions, treatment and screening programmes.

The practice had a very effective system in place to make sure no patient missed their regular reviews for long term conditions. Home visits were undertaken to housebound patients or those residing in residential care or nursing homes. The practice had an in-house phlebotomy clinic and a GP led warfarin clinic which they also offered to their housebound patients.

Families, children and young people

Good

Updated 7 January 2016

The practice is rated as good for the care of families, children and young people. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. The practice offered family planning advice. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for all standard childhood immunisations.

Urgent access appointments were available for under-fives. The practice had baby feeding and changing facilities available to patients.

Patients were signposted to a health trainer working at the practice. The trainer would develop care and support needed for each individual patient to support them in good health.

Older people

Good

Updated 7 January 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

They kept up to date registers of patients’ health conditions. Home visits were made to housebound patients to carry out reviews of their health.

The

practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified older patients who were at risk of unplanned hospital admissions and developed care plans to support them.

Working age people (including those recently retired and students)

Good

Updated 7 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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, evening telephone appointments and early morning blood tests for working patients. 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. H

ealth checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 January 2016

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

The practice referred patients to the appropriate services. The practice maintained a register of patients with mental health problems in order to regularly review their needs. The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews and various specialists. The practice had onsite access to assessments with the Improving Access To Psychological Therapies (IAPT) team. They also promoted ‘Positive Mental training’ with access to audio downloads and CDs to offer self-help programmes for stress, depression and anxiety and for building confidence, coping and wellbeing. The practice also referred patients to the St Helens Chrysalis Centre (Local charity supporting adult women with mental health problems and domestic violence.)

People whose circumstances may make them vulnerable

Good

Updated 7 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. All staff were trained and knowledgeable about safeguarding vulnerable patients and had access to the practice’s policy and procedures and had received guidance in this. The practice offered referrals to local food banks for patients and referrals to local carer’s centres. They also supported patients with letters to their local housing offices.