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Archived: Estover Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 13 September 2016

Letter from the Chief Inspector of General Practice

We carried out an inspection of Estover Surgery on the 9 August 2016. This review was performed to check on the progress of actions taken following an inspection we made on 4 November 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 9 August 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 11 February 2016. This can be done by selecting the 'all reports' link for Estover Health Centre on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

  • The practice had improved the health and safety for patients by improving the arrangements for managing medicines (vaccines).

  • Patient safety had been improved by introducing more robust recruitment checks of locum staff.

  • Improvements to records had improved patient safety. This had included ensuring the confidentiality of patient records, ensuring fire safety records were available and identifying a lead GP who would be responsible for safeguarding vulnerable patients at the practice.

  • Staff had received additional training to show they had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice had gathered feedback from patients through the surveys and complaints received. The practice had begun to establish a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 September 2016

Effective

Good

Updated 13 September 2016

Caring

Good

Updated 13 September 2016

Responsive

Good

Updated 13 September 2016

Well-led

Good

Updated 13 September 2016

We found governance arrangements for considering risks had now been considered. For example;

  • Improvements to the arrangements for managing medicines (vaccines) had been made.

  • More robust recruitment checks were now in place.

  • Improvements to the storage and availability of records had improved

  • There was now a lead GP who was responsible for safeguarding vulnerable patients at the practice.

  • Staff had received additional training to show they had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice had begun to establish a patient participation group.

Checks on specific services

People with long term conditions

Good

Updated 11 February 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.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice encouraged patient self-management. For example, patients with a chronic lung disease (chronic obstructive respiratory disease) were assessed and supplied a home rescue pack (containing steroids and anti-biotics) to keep so they could start taking them immediately if chest symptoms present.

Families, children and young people

Good

Updated 11 February 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 who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Immunisation rates were high for all standard childhood immunisations.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals. For example, the practice was part of the C card scheme. This allows teenage patients to obtain condoms by registering and using their C Card at the reception desk. In this way they do not have to make an appointment or explain their reason for visiting the practice, which they may find embarrassing.
  • The latest published figures for the percentage of women aged 25 – 64 whose notes record that a cervical screening test had been performed in the last 5 years was 90.18% compared to the national average of 88.18%.
  • Appointments were available outside of school hours; the premises were suitable for children and babies.
  • We saw good examples of joint working with midwives and health visitors. The health visiting team shared on-site premises with the practice.

Older people

Good

Updated 11 February 2016

  • The practice offered personalised care to meet the needs of the older people in its population.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable with local CCG and national averages, for example in the percentage of older patients with a fragility fracture who are currently treated with an appropriate bone-sparing agent.
  • The percentage of people aged 65 or over who received a seasonal flu vaccination was comparable with the CCG and national averages.
  • Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.
  • Patients aged 75 and older had a named GP within the practice. They could, however, book to see either of the GP partners.

Working age people (including those recently retired and students)

Good

Updated 11 February 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.
  • Appointments could be booked up to six weeks in advance.
  • There were evening appointments every Wednesday.
  • The nursing team held flexible appointments so that working people could be seen earlier than normal clinic times if these patients requested this.
  • Repeat prescriptions could be requested on-line.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

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

  • 83.33% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was in line with the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • It 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.
  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 11 February 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 and those with a learning disability.
  • It offered longer appointments for people with a learning disability and carried out annual health checks for these patients.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had 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.