You are here

Caterham Valley Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 10 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caterham Valley Medical Practice on the 16 February 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 the skills, knowledge and experience to deliver effective care and treatment. 
  • Feedback from patients about their care was consistently and strongly positive. 

  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 June 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.

Effective

Good

Updated 10 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable with or higher than local and national averages. For example: the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 85.57% compared with a national average of 81.16%; the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 89.59% compared with a national average of 92.15%. 
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated ongoing 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 10 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care. For example, 91% said the last GP they saw or spoke to was good at treating them with care and concern, compared with a CCG average of 88% and a national average of 85%.
  • 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 10 June 2016

The practice is rated as good 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 to secure improvements to services where these were identified.
  • Data from the national GP patient survey showed patients rated the practice highly for several aspects of their ability to access services. For example 82% of patients said they could get through easily to the surgery by phone compared to the CCG average of 72% and national average of 73%; 73% of patients described their experience of making an appointment as good compared to the CCG average of 74% and national average of 73%.
  • 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.
  • 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 10 June 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 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 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 knowing about 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 10 June 2016

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

  • GP Partners 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 showed that some outcomes for long-term conditions were comparable with national averages. For example, the percentage of patients with diabetes in whom the last IFCC-HbA1c was 64mmol or less in the preceding 12 months was 79.79% compared with a national average of 80.4%.
  • Longer appointments and home visits were available when needed.
  • A well-being advisor provided advice and support to patients with long-term conditions, within the practice on one day each week. The advisor sign-posted patients to other support organisations, including the voluntary sector and social care services.
  • Patients received a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 10 June 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 relatively high for all standard childhood immunisations.
  • Nationally reported data showed that patient treatment outcomes were comparable with national averages. For example, 77 % of patients with asthma, on the register, had an asthma review in the preceding 12 months compared to a national average of 72%
  • 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.
  • 83.6% of eligible female patients had a cervical screening test compared to the national average of 81%.
  • The practice offered a walk-in surgery every morning and daily telephone triage appointments with the duty GP.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with health visitors.
  • The practice worked closely with community midwives who were based within the practice premises and ran twice weekly ante-natal clinics from the practice.

Older people

Good

Updated 10 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 patients and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had appointed a care co-ordinator who worked closely with the GPs to monitor patients at high risk of unplanned admissions and to ensure timely review of care plans.
  • The practice had a dementia lead and all staff had received dementia awareness training.
  • The practice provided care and support to patients who were resident in two nursing and five residential homes, each of which was supervised by a named GP. The largest nursing home received a regular weekly ward round.
  • The practice held monthly multi-disciplinary meetings and held strong links with the community matron, and district nursing staff who were based at the surgery.

Working age people (including those recently retired and students)

Good

Updated 10 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 offered extended hours appointments on two mornings and one evening each week for working patients who could not attend during normal opening hours.
  • Telephone appointments were available with a doctor or a nurse.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 June 2016

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

  • Performance for mental health related indicators was comparable with or above the national averages: 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a national average of 93%; the percentage of those patients who had a record of their alcohol consumption in the preceding 12 months was 95.7% compared with a national average of 92.4%; 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 83%.
  • 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.
  • Patients were able to self-refer to psychological therapies and counselling, which were offered in-house. The ability to self-refer was aimed particularly at male patients who had traditionally been reluctant to engage with such services.
  • 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 10 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 patients, travellers and those with a learning disability.
  • Care and support was provided to patients with a learning disability living in two nearby residential facilities.
  • The practice offered longer appointments for patients with a learning disability and flexible appointments for carers and those cared for.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • The practice well-being advisor informed 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.