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Inspection Summary


Overall summary & rating

Good

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an inspection in May 2016 to follow up on concerns raised at a previous inspection in January 2015. We found some aspects of the service had improved but others continued to be in breach of regulation. Specifically, we found the provider requires improvement for safe and effective services, good for caring and responsive services and inadequate for well led. We rated the practice as requires improvement overall. Following the inspection in May 2016, the practice sent us an action plan explaining what actions they were going to take to meet regulations.

We carried out an announced comprehensive follow up inspection at Long Barn Lane Surgery on 17 January 2017. We carried out this inspection to check the practice was meeting the regulations and to consider whether sufficient improvements had been made. 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, with the exception of fridge temperature recording.
  • 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.
  • Child immunisation rates were below national average for most of the standard immunisations.
  • Some patient health screening data showed the practice was below the national average, although they were in line with local averages.
  • 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 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.

The areas where the provider should make improvements are:

  • Ensure governance arrangements include monitoring of daily fridge temperature  recording.

  • Ensure patients referred under the two week wait referral process are followed up.

  • Ensure all staff, who are eligible, have received a yearly appraisal.

  • Continue to encourage patients to attend for smoking cessation, health screening and childhood immunisations.

  • Continue to review patient feedback and address concerns relating to care and treatment and telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 March 2017

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.

  • The practice had undertaken numerous risk assessments and reviews to ensure safety across both practice sites was maintained. Any issues identified were quickly followed up and discussed at meetings to ensure progress was sustained.

  • Emergency medicines and equipment had been reviewed and stock was monitored to ensure nothing was out of date.

However,

  • We found some gaps in the medicine fridge temperature recording logs.

Effective

Good

Updated 21 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) 2015/16 showed patient outcomes were mostly at or above average compared to the national average. Exception reporting was 14% which was above the national average of 10%. The practice showed us their figures for 2016/17 and this showed a reduction in exception reporting.

  • The practice had improved their smoking cessation rates, had completed 96% of care plans for unplanned admissions and had begun to update care plans for patients with a learning disability.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Immunisation rates were below the national standard for many standard childhood vaccines.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

However,

  • Not all staff had received an appraisal in the last 12 months. We saw appraisal meetings had been arranged for all staff during January and February 2017.

Caring

Good

Updated 21 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed mixed results with some patients rating the practice lower than others for some aspects of care. For example, 77% of patients said the GP gave them enough time compared to the CCG average of 81% and the national average of 87%.

  • 94% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 94% and the national average of 95%.

  • Patients said they were treated with compassion, dignity and respect and most said 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 21 March 2017

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.

  • Feedback from patients reported that access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually available the same day. Some patients also expressed dissatisfaction with accessing the practice by telephone.

  • 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 21 March 2017

The practice is rated as good for providing well-led services.

  • 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.

  • 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. All risks identified as incomplete during the inspection in May 2016 had been undertaken and actions implemented.

  • The practice had set up a clinical governance committee which met regularly to review policies. Over 150 practice policies had been reviewed and new policies introduced, such as the patient non-attendance policy.

  • 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.

  • All staff had received inductions but not all staff had received regular performance reviews.

Checks on specific services

People with long term conditions

Good

Updated 21 March 2017

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

  • The practice had improved their care planning for patients with long term conditions who were at risk of hospital admission. The practice had been acknowledged by the clinical commissioning group (CCG) for having the highest patient uptake (29%) for alternative services to hospital admission than other practices across the four CCGs in West Berkshire.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Data for diabetes indicators showed 75% of patients with diabetes had achieved a target blood sugar level of 64 mmol or less in the preceding 12 months. This was comparable to the CCG average of 72% and national average of 78%.

  • Longer appointments and home visits were available 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.

Families, children and young people

Good

Updated 21 March 2017

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

  • 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.

  • The practice prioritised on the day appointments for children aged under three years. Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives and health visitors.

  • 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 below the national standard for many standard childhood immunisations.

  • 76% of women aged 25 to 64 years had a record of a cervical smear test in their notes in the preceding five years compared to the CCG average of 78% and national average of 81%.

Older people

Good

Updated 21 March 2017

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 patients 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.

  • Data from the quality outcomes framework (QOF) from 2015/16 showed the practice had achieved 100% for many clinical indicators affecting this patient group, including patients with atrial fibrillation (a heart rhythm disorder) and hypertension (high blood pressure).

Working age people (including those recently retired and students)

Good

Updated 21 March 2017

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 clinics, a text messaging appointment reminder and cancellation service and telephone appointments for working patients who were unable to attend the practice during their core opening hours.

  • 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 21 March 2017

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

  • Data from 2015/16 showed 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 89% and national average of 84%.The practice had already met their target for this indicator for the period 2016/17 and had achieved 97%.

  • 87% of patients with a diagnosed mental health condition had received an agreed care plan in the preceding 12 months compared to the CCG average of 91% and national average of 89%.

  • 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.

  • 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 21 March 2017

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.

  • During our inspection in May 2016, the practice had not completed any care plans for patients with a learning disability. The practice had commenced initiating care plans for patients with a learning disability. At the inspection in January 2017 the practice had undertaken nine care plans out of 24 patients (38%). They had confirmed appointments for the remaining 15 patients and were confident they would achieve 100% by the end of the March 2017.

  • The practice offered longer appointments for patients who were vulnerable, including carers and patients with a learning disability.

  • There was a patient flag for vulnerable patients on the practice’s computer system, but it was not obvious to all users.

  • 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 hosted a substance abuse clinic for local patients with drug and alcohol misuse.

  • 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. The practice had been commended by the local safeguarding team for a 100% response rate to safeguarding queries.