You are here

Inspection Summary


Overall summary & rating

Good

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tower House Surgery on 22 June 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.
  • 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.
  • The practice used innovative and proactive methods to improve patient outcomes. For example, extra services were implemented to support children and adolescents with mental health concerns and for patients with alcohol dependency.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • 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.
  • 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.

We saw one area of outstanding practice:

The practice identified a higher number of children and young people who were presenting with mental health concerns and either had a long wait for a Child & Adolescent Mental Health Service (CAMHS) referral or would not quite meet the criteria the practice had assessed the need for a supplementary service. They had applied for and received additional funding from the clinical commissioning group to commission a child psychology service. Over the last 12 months the service had seen and assessed 26 children following referral from a GP. All referrals were considered appropriate by the psychologist. The cases seen were those which did not meet the threshold for CAMHS but were in crisis. Following assessment follow on sessions were provided for each patient. The service supported patients through anxiety, low mood, behavioural and identity issues. A course of treatment was completed or used to stabilise while awaiting referral to a specialised service. We identified a number of cases were a positive impact was seen for patients in managing their health, providing social and personal support or help for the families with younger children in crisis or need of mental health support.

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

  • To review monitoring of patient care to ensure where exception reporting is high that other ways of engaging patients are explored, to ensure that minority communities and cultures are encouraged to attend for national screening procedures and health reviews.

  • To ensure that the stock of emergency medicines are risk assessed and made clearer to staff.

  • To explore more ways of identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 September 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.

  • Risks to patients were assessed and well managed.

  • The practice had the necessary equipment for dealing with emergencies, although the management of emergency medicines was confusing for staff, which could cause delays if they were needed.

  • Recruitment checks were conducted in line with current legislation.

Effective

Good

Updated 9 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits 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.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 9 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for all aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • 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.

Responsive

Good

Updated 9 September 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and clinical commissioning group (CCG) to secure improvements to services where these were identified. For example, a psychological support service for children and young people with mental health concerns was commissioned, by applying to the CCG for funding to provide an additional service and were successfully awarded funding. We identified a number of cases were a positive impact was seen for patients in managing their health, providing social and personal support or help for the families with younger children in crisis or need of mental health support.
  • The practice had identified a need for further support for patients with alcohol and substance misuse, a GP with a particular interest managed this support service, with communication from specialist services, including prescribing medicines to help with withdrawal symptoms.
  • 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 surgery had responded to results from surveys by the patient participation group and had increased appointment times by 10%.
  • 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 and other stakeholders.

Well-led

Good

Updated 9 September 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 9 September 2016

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 showed the practice had achieved 75% of targets which was lower when compared to the CCG average (91%) and the national average (89%), exception reporting for diabetes related indicators was 10%, comparable to the CCG average (9%) and national average (11%).

  • Longer appointments and home visits were available 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.

Families, children and young people

Good

Updated 9 September 2016

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. Immunisation rates were average for all standard childhood immunisations.

  • 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.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • Due to the number of children and young people who were presenting with mental health concerns and either had a long wait for a Child & Adolescent Mental Health Service (CAMHS) referral or would not quite meet the criteria the practice had assessed the need for a supplementary service. They acquired additional funds to commission a child psychology service which had a positive impact on their health and well being.

Older people

Good

Updated 9 September 2016

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.

  • The practice worked with multi-disciplinary teams in the care of older vulnerable patients.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. For example, the number of emergency admissions per 1,000 population was 12, compared to the CCG average of 12 and the national average of 14.

Working age people (including those recently retired and students)

Good

Updated 9 September 2016

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’s uptake for the cervical screening programme was 92%, which was higher than the CCG average of 84% and the national average of 82%,however,exception reporting for cervical screening was high.

    We saw evidence of screening and recall programmes were impacted by patients not attending for screening. The practice had not considered alternative ways of engaging with patients whose first language was not English or from different Asian communities.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 September 2016

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

  • 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

    98% of patients with psychoses had an agreed, documented care plan. 19% of these were exception reported. The practice had failed to identify other ways of engaging with these patients.

  • 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.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency 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.

People whose circumstances may make them vulnerable

Good

Updated 9 September 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for all patients.
  • 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 supported patients with alcohol misuse problems by communicating and working with specialist services, including prescribing medicines to help with withdrawal symptoms.
  • 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.