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Inspection Summary


Overall summary & rating

Good

Updated 8 January 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Boundary House Surgery on the 1 October 2014. Overall we have rated the practice as good. We found all five domains were rated as good.

Our key findings were as follows:

The feedback received from patients was positive. Patients spoke positively about the practice staff and described them as friendly, supportive, efficient and caring. The practice results for the national GP patient survey 2013 were higher than the clinical commissioning group (CCG) and national average. Ninety two per cent of patients rated their experience of making an appointment as good and 97% patients said their last appointment was convenient.

We found the service was responsive to patient’s needs. The practice understood the needs of the practice population and had systems in place to meet their needs. Patients we spoke with were generally happy with the appointment system.

However, there were also areas of the practice where the provider needs to make improvements.

Importantly, the provider should:

  • Ensure risk assessments are documented to confirm whether all members of staff required a criminal records check using the Disclosure Barring Service (DBS).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 January 2015

The practice is rated as good for providing safe services. Systems were in place for reporting and responding to incidents. The practice discussed significant events during clinical team meetings, which were attended by the GPs and nursing staff. The district nursing team were also invited. The practice had comprehensive safeguarding policies and procedures in place to protect vulnerable patients. The practice had management of medicines policies and procedures in place. There was a clear policy for maintenance of the cold chain and action to take in the event of a potential failure. The practice was clean, tidy and well maintained.

Effective

Good

Updated 8 January 2015

The practice is rated as good for providing effective services. GPs and nurses demonstrated how they ensured they follow national clinical guidelines. Patients had their needs assessed and care planned in accordance with best practice. The practice routinely collects information about patients care and outcomes. Training needs were identified during staff appraisals. The practice carried regular clinical audits and these were discussed at clinical meetings and learning was shared with staff. We found the practice worked with other service providers to meet people’s needs and manage complex cases. There was liaison with the local Community Mental Health Team (CMHT) and the local Child and Adolescent Mental Health Teams (CAMHS). Joint working enabled the practice to utilise expertise and services these organisation offered.

Caring

Good

Updated 8 January 2015

The practice is rated as good for providing caring services. Patient feedback from surveys, comment cards and verbal feedback was positive. Patients spoke positively about the practice staff and described them as friendly, supportive, efficient and caring. We saw staff treated patients with kindness and respect. The practice had systems in place to protect confidential information. Accessible information was provided to help patients understand the care available to them.

Responsive

Good

Updated 8 January 2015

The practice is rated as good for providing responsive services The practice understood the needs of the practice population and had systems in place to meet their needs. A range of clinics and services were offered to patients, which included family planning and minor illness clinics. Patients we spoke with were generally happy with the appointment system. The GP national survey 2014 showed 97% of patients said their last appointment was convenient and 79% were seen by their preferred GP. The practice had a system for handling complaints and concerns. The practice reviewed complaints received and ensured they learnt from them.

Well-led

Good

Updated 8 January 2015

The practice is rated as good for being well-led. The practice had a clear focus to deliver high quality care and promote good outcomes for patient. Staff had clear areas of responsibilities and knew who to approach for advice when required. The practice involved patients to improve the services they provided to them. This was achieved in various ways, such as patient survey. All staff had regular training and development opportunities. Staff had received regular supervision and appraisal to discuss individual support needed to develop their knowledge and skills. The practice had number of policies and procedures to govern activity and regular governance meeting had taken place. There were systems in place to monitor and improve quality and identify risk.

Checks on specific services

Older people

Updated 8 January 2015

Overall the practice provided good quality care to older patients. The practice worked well with external organisations in delivering care to older patients, including palliative and end of life care. All patients who were 75 years of age and over had a named GP. Home visits were arranged for frail and elderly patients. Flu jabs were offered to elderly patients and the uptake was good. The premises and services had been adapted to meet the needs of the older and frail patients.

People with long term conditions

Updated 8 January 2015

Patients with long-term conditions were seen at the practice and supported to manage their health, care, and treatment. The practice held regular clinics for long terms conditions such as diabetes and coronary heart disease. These clinics were led by the nurses, who were able to get immediate support from GPs if they found anything of concern. We found referrals to specialist such as endocrinologist were made in a timely manner and in line with local pathways. This ensured patients were able to get the support and treatment they needed. All patients with long term conditions were offered on the day appointments. Care for patients with several long term conditions was streamlined to ensure they were able to conduct all appropriate tests in on one visit. Disease registers were maintained that identified patients with long term conditions. There were recall systems in place to ensure patients with long term conditions received appropriate monitoring and support.

Families, children and young people

Updated 8 January 2015

The practice ran various clinics to support this patients group. These included antenatal clinics, postnatal care, childhood vaccinations & immunisations, sexual health and family planning. The practice achieved 98% on their child immunisation compared to a national average of 95%. All patients under age of five years were seen by GP and offered on the day appointment. The practice had good working relationship with the local Child and Adolescent Mental Health Teams (CAMHS).

Working age people (including those recently retired and students)

Updated 8 January 2015

The practice provides a range of appointments between 8:00am and 6pm Monday to Friday. The practice offered evening appointments to accommodate this patient population group. The practice also offered telephone consultations and offered advice via email. Alternative systems were introduced to allow all patients who were unable to attend the practice due to work commitments to book appointments and order their prescriptions online.

People whose circumstances may make them vulnerable

Updated 8 January 2015

There were no barriers for patients in vulnerable circumstances. People wishing to register at the practice were always accepted. The practice maintained a learning disability register and these patients received an annual review. The practice had comprehensive safeguarding policies and Mental Capacity Act 2005 (MCA) procedures. We found that staff were familiar with these. All staff had received safeguarding training. The practice provided medical services in a safe way to local groups who were particularly vulnerable.

People experiencing poor mental health (including people with dementia)

Updated 8 January 2015

Patients with mental health care needs were registered at the practice. Patients with needs related to substance misuse attended the practice and were referred to external organisations for further support. The practice had good working relationship with the local Community Mental Health Team (CMHT).