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Inspection Summary


Overall summary & rating

Good

Updated 14 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Drs Stockton and Thompson on 1 June 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they 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 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 were registered to issue foodbank vouchers and had a close working relationship with the local foodbank charity.
  • All staff employed by the practice had received a disclosure and barring check (DBS check). (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).
  • Although the practice had good facilities and was well equipped to treat patients and meet their needs, they were located in an extremely small building which had been temporary since 2008. The practice had been granted funding, in principal, for a new build and were awaiting planning permission from the local council.
  • Due to restrictions with the building, the practice were unable to have a hearing loop and unable to offer electronic prescribing of prescriptions.

  • There was a clear leadership structure and staff felt supported by management both personally and professionally. The practice proactively sought feedback from staff and patients, which it acted on.

One area of outstanding practice that we saw was:

One of the GPs in the practice developed and carried out a pilot delivering regular workshops in a local Childrens Centre. The workshops, which were interactive, were to cover key messages to parents and grandparents about conditions such as common rashes, assessing dehydration, the differences between viruses and bacteria and monitoring head injuries. They were then advised about how to access care. The pilot was able to show a reduction in A&E and walk-in centre attendances and after the pilot finished the workshops were taken forward and delivered by the childrens community nurse team.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 July 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 things went wrong patients received reasonable support, truthful information, and a 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 14 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 July 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.
  • 100% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%.
  • 99% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the national average of 91%.
  • 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.
  • The practice were registered to issue foodbank vouchers and had a close working relationship with the local foodbank charity.

Responsive

Good

Updated 14 July 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.
  • 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 a cancellations list each day where if a patient contacted the surgery to cancel an appointment, the practice would phone another patient, waiting for an appointment, to offer it to them.
  • 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 14 July 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 it.
  • The practice had core values and a mission statement which were agreed and written by GPs and all staff. Posters were placed throughout the surgery for staff and patients.
  • The practice held regular away days for all staff.
  • There was a clear leadership structure and staff felt supported, both professionally and personally, 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 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.
  • Staff skills and preferences were taken into account and the practice had appointed both clinical and administration leads for all population groups and all clinical and non clinical work areas.
  • Staff development was actively encouraged and supported with some staff adding to, or changing from an administration role to clinical roles such as a phlebotomist and the practice manager had previously been a receptionist with the practice.
  • All staff were multi skilled so that cover was arranged during staff holidays and sickness.
Checks on specific services

People with long term conditions

Good

Updated 14 July 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.
  • 93% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the national average of 88%.
  • The practice offered flexible pre bookable appointments including longer appointments and home visits when needed.
  • All these 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.
  • The practice carried out pre diabetic screening and monitored patients with a higher risk of developing the condition.
  • The practice encouraged patients to better understand and self manage their condition.
  • The practice had a monthly recall system in place and were pro-active in following up non attenders.
  • The practice GPs monitored patients prescribed anti rheumatic drugs (DMARDs) and anti coagulation drugs.

Families, children and young people

Good

Updated 14 July 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.
  • 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.
  • 85% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was above the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • All children aged under 16 were offered same day appointments if required.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The practice signposted patients to local support groups such as Sure Start and breast feeding peer support.
  • Appointments were available for contraceptive services including coil fitting and contraceptive implants.

Older people

Good

Updated 14 July 2016

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

  • Patients aged over 75 had a named GP and a structured annual review to check their health and medicine needs were being met. For those patients with the most complex needs, the named GP worked with the relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice offered proactive, personalised care to meet the needs of the older patients 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 practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
  • The practice offered carers support, knowledge and were able to signpost them to other support services.

Working age people (including those recently retired and students)

Good

Updated 14 July 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 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 offered extended hours until 7pm on Tuesday and Wednesday evenings and lunchtime appointments for patients that were unable to attend during normal surgery hours.
  • Due to restrictions on the building, the practice were unable to offer electronic prescribing which would enable patients to nominate a pharmacy to collect their repeat prescriptions from.
  • The practice offered R U Clear which is a confidential sexual health screening service. The practice promoted the service at local youth events including festivals.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 July 2016

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

  • 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 83%.
  • 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which is comparable to the national average of 88%.
  • 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.
  • Patients suffering from poor mental health were offered longer appointments if needed.
  • All staff had received dementia awareness training and one of the GPs had become a dementia friend.
  • Patients suffering from anxiety were offered appointments before or after surgery as required.
  • 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.
  • 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 14 July 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, military veterans and those with a learning disability.
  • The practice offered longer appointments and screening for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice supported local military veterans by displaying their art work and any money gained was given back to the military veterans charity.
  • 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.
  • Due to restrictions on the building the practice were unable to offer the use of a hearing loop.
  • The practice had links with the local food bank allowing clinicians to issue vouchers to provide food for those in need.
  • Vulnerable patients were given a by-pass telephone number to contact the surgery which would assist with admissions avoidance.