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First 4 Health Group - Stratford Village Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 14 June 2017

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 20 April 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us evidence and actions detailing what they would do to meet the legal requirements. We conducted a focused inspection on 24 May 2017 to check that the provider had followed their plans and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 20 April 2016 we found the following area where the practice must improve:

  • Implement robust arrangements for child protection.

Our previous report also highlighted the following areas where the practice should improve:

  • Undertake quality improvement initiatives to monitor and improve outcomes for patients.
  • Ensure all staff are appropriately trained in basic life support.
  • Review the system for identifying patients who are carers.
  • Consider how to ensure patients with a hearing disability can be communicated with.
  • Ensure that its child protection IT system and policy remain up to date and robust.
  • Seek to understand and address low GP patient survey results of patients feeling treated with care and concern for both nurses and GPs.
  • Engage with patients to understand and address difficulties in making an appointment.
  • Look at how it can improve aspects of clinical performance for people experiencing poor mental health.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk 

During the inspection on 24 May 2017 we found:

  • Arrangements for child protection were current and effective.
  • The practice had undertaken quality improvement activity including completed audits such as to lower rates of inadequate cervical screening tests and to ensure rapid follow up for patients requiring cancer screening or treatment.
  • Clinical and non-clinical staff were trained in basic life support.
  • Arrangements for identifying patients who are carers and communication for patients with a hearing disability had been reviewed and were appropriate.
  • GP patient survey results scores had improved for patients feeling treated with care and concern for nurses and GPs and being able to get an appointment and were comparable to local and national averages.

  • 2015-2016 clinical performance data for people experiencing poor mental health showed the practice was performing in line with local and national averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 June 2017

The practice is now rated good for delivering safe services.

At our last inspection on 20 April 2016 we found that most safety systems and processes and monitoring risks to patients were well managed. However, code references to identify protected children on the practice IT system did not correspond with those on the policy. Child protection systems were not aligned or sufficiently robust. We also found non clinical staff had not received annual basic life support training.

At this inspection we found that the practice had implemented actions to ensure that all these issues had been addressed. The practice had updated and aligned its safeguarding children policy and codes to identify vulnerable children effectively and followed up on individual cases appropriately. Clinical and non-clinical staff had received annual basic life support training.

Effective

Good

Updated 14 June 2017

Caring

Good

Updated 14 June 2017

Responsive

Good

Updated 14 June 2017

Well-led

Good

Updated 14 June 2017

Checks on specific services

People with long term conditions

Good

Updated 8 June 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 was comparable with the CCG and national averages over all at 86% compared to the CCG average of 87% and the national average of 89%
  • The percentage of patients with hypertension having regular blood pressure tests was 86%, which was comparable with the CCG average of 84% and national average of 84%
  • Longer appointments and home visits were available when needed.
  • 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 14 June 2017

Older people

Good

Updated 8 June 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 percentage of patients with rheumatoid arthritis, on the register, who had had a face-to-face annual review in the preceding 12 months was 91% which was the same as CCG and national averages.
  • The practice nurses provided home visits to deliver routine checks for older housebound patients with chronic diseases.
  • The practice had a system to identify palliative care patients and reviewed them monthly at multidisciplinary meetings.

Working age people (including those recently retired and students)

Good

Updated 8 June 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 had identified that it had a high proportion of working age women on its list and hosted a weekly consultant led gynaecology clinic, provided contraceptive services such as oral contraceptives, depot injections and IUCD (coil) implantation and removal, and breast health awareness sessions on site.
  • 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 hosted physiotherapy and consultant led musculoskeletal clinics once per week.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 June 2016

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

  • 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%
  • 2014-2015 data showed that performance for mental health related indicators was 75%, which was comparable to the CCG average at 87% and below the national average of 93%; however, 2015-2016 data showed the practice had improved and was performing in line with both local and national averages.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 and had held a support group for men with mental health problems
  • 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 8 June 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 patients with a learning disability, 81% of these patients had received an annual health check.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example it referred homeless people and travellers to a local specialist service.
  • 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.