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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Prospect Surgery on 14 December 2016. 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and 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 told us 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.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Implement a process to monitor any patterns or trends that might be emerging with significant events and complaints.

  • Monitor that all staff are up to date with mandatory refresher training.

  • Improve the system for identifying carers.

  • Develop a written strategy and supporting business plan which outlines their vision and plans for the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 March 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found 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 were informed as soon as practicable, received an apology and were told about actions taken to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.

  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 20 March 2017

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were comparable to or above the local CCG and national average.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 20 March 2017

The practice is rated as good for providing caring services.

  • Data from the GP national survey showed that patients rated the practice comparable to or above the local CCG and national average.

  • Survey information we reviewed showed that 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 accessible.

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

  • There was a carer’s register and information was available on the practice website and in the waiting room for carers on support services available for them.

Responsive

Good

Updated 20 March 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example;

    • the practice worked with the CCG and the community staff to identify their patients who were at high risk of attending accident and emergency (A/E) or having an unplanned admission to hospital. Care plans were developed to reduce the risk of unplanned admission or A/E attendances.

    • Telephone consultations were available for working patients who could not attend during surgery hours or for those whose problem could be dealt with on the phone.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Patients we spoke with 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 evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 20 March 2017

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 this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity

  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff had received inductions, annual performance reviews and training opportunities and attended staff meetings.

  • The provider was aware of the requirements of the duty of candour. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

  • The practice proactively sought feedback from staff and patients

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

Checks on specific services

Older people

Good

Updated 20 March 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. Patients over the age of 75 had a named GP.

  • The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans which were regularly reviewed.

  • They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; compared to the local CCG average of 93% and the England average of 98%.

People with long term conditions

Good

Updated 20 March 2017

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 89%. This was above the local CCG average of 83% and the England average of 80%.

  • Longer appointments and home visits were available when needed.

  • Patients with LTCs 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 GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Practice nurses visited patients at home to do long term conditions reviews and administer flu vaccinations during the flu season.

Families, children and young people

Good

Updated 20 March 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 or who failed to attend hospital appointments.

  • Immunisation rates were high for all standard childhood immunisations. Immunisation rates were comparable to the local CCG average and above the England national average. For example, rates for immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 89% to 100% compared to 86% to 98% for the local CCG and 73% to 95% for the England national average.

  • Children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 81%. This was comparable to the local CCG average of 83% and the England average of 81%.

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

  • Combined appointments with the GP and practice nurse were arranged at eight weeks post-delivery. This enabled the mother’s post-natal check and baby’s first immunisations to be carried out in one appointment and avoided having to visit twice.

  • We saw good examples of joint working with midwives, health visitors and school nurses. The practice monitored any non-attendance of babies and children at vaccination clinics. The practice nurses contacted the parents of children who did not attend for vaccinations and worked with the health visiting service to follow up any concerns.

Working age people (including those recently retired and students)

Good

Updated 20 March 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.

  • Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

  • Extended hours appointments were available with GPs and practice nurses three mornings a week.

  • Minor surgery and joint injections were provided at the practice so patients did not have to attend hospital to access these services.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

People whose circumstances may make them vulnerable

Good

Updated 20 March 2017

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

  • The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

  • The practice offered longer appointments for people with a learning disability.
  • Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice 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.

  • Telephone interpretation services were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 March 2017

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

  • Nationally reported data from 2015/2016 showed 91% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local CCG average of 85% and England average of 84%.

  • The practice carried out advanced care planning for patients with dementia.

  • Nationally reported data from 2015/2016 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 94%. This was comparable to the local CCG average of 90% and above the England average of 89%.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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.