Streatfield Surgery

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on Streatfield Surgery on the 18 November 2015. At the time, we found the practice was breaching legal requirements in relation to its recruitment and training and equipment and medicines check. The practice was rated as requires improvement for providing safe care. Following the comprehensive inspection, the practice submitted an action plan, outlining what they would do to ensure the care they provided was safe and met the legal standard required by CQC.

We undertook this focussed inspection on 1 September 2016 to check that the practice had followed their plan and to confirm that they were now providing safe care. This inspection did not include a visit to the practice. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Streatfield Surgery on our website at www.cqc.org.uk.

Overall the practice was rated as Good.

Following the focussed inspection we found the practice to be good for providing safe care.

Our key findings across all the areas we inspected were as follows:

• The practice had carried out an electrical appliance test in September 2016, to ensure all electrical equipment were safe to use.
• The practice had implemented a fridge temperature log for all fridges in the practice that stored medicines.
• The practice had a formal induction programme for newly appointed staff and a practice specific recruitment policy, which specified the recruitment checks which were required and these were in line with the relevant guidance.
• We saw newly appointed staff had pre-employment checks carried out as per guidance in Schedule 3, including written references and DBS checks (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• We saw evidence of clinical staff having completed basic life support training in the past 12 months. The practice also provided us with a documented risk assessment carried out in line with the national resuscitation council. This showed that non-clinical staff did not received annual basic life support training but they were trained to recognise cardiorespiratory arrest and would be able to get help from a clinical member of staff to carry out CPR.   
• We saw evidence that a fire risk assessment and infection control audit was carried out by the GP partners and management team for the practice in the last 12 months. We saw any actions identified were recorded and documented to show improvements had been made.
• The practice provided us with a sample of staff meeting minutes, which showed discussions that took place in meetings including outcomes and actions.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 January 2016

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

• The percentage of patients at the practice with a long standing health condition (54.2%) was similar to the national average (54%), and those with health related problems in daily life (38.8%) was lower than the national averages (48.8%).
• Nationally reported data showed that outcomes for patients with long term conditions was good.
• The GPs and nursing staff had lead roles in chronic disease management.
• 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.
• Patients at risk of hospital admission were identified as a priority and discussed at weekly clinical meetings and monthly multidisciplinary team meetings.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions.
• Longer appointments and home visits were available when needed.

Updated 28 January 2016

The practice is rated as good for the care of families, children and young people.

• Children aged zero to four represented 5.7% of the practice population (national average 6.0%); children aged five to 14 represented 10.5% (national average 11.4%); and those aged under 18 years represented 13.9% (national average 14.8%). The income deprivation level affecting children was 21 compared to the national average of 22.5.

• Newly registered children under 16 underwent a health check with the health care assistant or nurse, and a GP ensured there were no child safety issues.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, there was joint working with the health visitors to discuss children on the child protection register.
• Urgent access appointments were available for children who were unwell.
• Immunisation rates for standard childhood immunisations were either below or in line with the CCG averages.
• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.
• Appointments were available outside of school hours and the ground floor of the premises was suitable for children and babies.
• The practice offered antenatal and postnatal services.

Updated 28 January 2016

The practice is rated as good for the care of older people.

• The percentage of older patients registered at the practice was similar to national averages. Patients over the age of 75 represented 7.9% (national average 7.6%), and patients over the age of 85 represented 2.1% (national average 2.2%). The income deprivation level affecting older people was 25 compared to the national average of 22.5.
• All patients over the age of 75 had a named GP and were informed of this.
• The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, which included offering the shingles vaccination and avoiding unplanned admissions to hospital.
• Monthly multidisciplinary team meetings were used to review care plans and discuss those with enhanced needs. Referrals to community rehabilitation and rapid response services were used to jointly manage patients in their own home.
• The practice were responsive to the needs of older people, and offered longer appointments, home visits and rapid access appointments for those with enhanced care needs.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions.

Updated 28 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The number of patients in paid work or full-time education was above the national average, 67% compared to 60.2%.

• 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 a website which offered facilities to book appointments and order repeat prescriptions online. Text messaging was used for confirming appointments and health promotion.
• Telephone consultations were offered for patients who could not attend the practice. Late appointments were available until 20:00 on Tuesday and Thursday. These were prioritised for working patients.
• There was a full range of health promotion and screening that reflected the needs for this age group, including NHS health checks for patients aged 40 to 74.

• The practice’s uptake for the cervical screening programme was 88.8%, which was above the CCG and national averages of 77.4% and 81.8% respectively.

Updated 28 January 2016

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

• The practice held a register of patients of patients with dementia, depression, and poor mental health.
• In 2014/15 performance for mental health related indicators was above the CCG and national averages (practice 100%; CCG 92.9%; national 92.8%).
• Nationally reported data showed that outcomes for patients which dementia was good. For example, the practice’s performance for dementia related indicators was above the CCG and national averages (practice 100%; CCG 92.4%; national 94.5%). The practice carried out advance care planning for patients with dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 28 January 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 housebound patients, carers, those with a learning disability, and patients receiving end of life care.
• It offered longer appointments for vulnerable patients who may need it. Housebound patients and those who could not access the practice were supported via home visits.
• 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.