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Archived: Dr M Hargreaves & Dr P Thakrar Good Also known as The Village Practice - Cowplain Surgery

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr M Hargreaves and Dr P Thakrar on 22nd March 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.
  • 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.
  • 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, apart from the availability of a defibrillator and a risk assessment for this.
  • 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.

  • Some staff were trained in child safeguarding to a higher level than required, including nurses to level 3. The practice manager had attended training at level 5 (managing staff who safeguard children).

We found areas of outstanding practice:

  • Feedback from patients who use the service was continually positive with a strong visible patient centred culture.

  • The practice delivered additional support for socially isolated older patients, for example, the practice telephoned socially isolated patients on Christmas day to provide support.

  • The practice had implemented a local policy to ensure that patients received phone call support following bereavement at one, three, six and 12 months afterwards.

The areas where the provider must make improvement are:

  • Review the arrangements for emergency care at the practice and consider purchasing a defibrillator or complete a risk assessment.

The areas where the provider should make improvement are:

  • Ensure the staff at the practice undertake regular fire drills.
  • Ensure prescriptions are tracked and managed safely in the practice, including when held in GPs own bags.
  • Review the systems for tracking samples sent from the practice for testing to ensure that results are tracked and reported in a timely manner.
  • Review the systems in place for clinical coding to make sure it accurately reflects care given to patients with specific medical condition and national guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 4 July 2016

The practice is rated as Requires Improvement for providing safe services.

  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe, for example, the practice system for monitoring prescription pads held in GPs own bags. In addition, the practice system for tracking samples sent for testing was found to be in need of review to enable tracking and reporting to be timely.
  • There was an effective system in place for reporting, discussing and the recording of 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 some clearly defined and embedded systems, however, not all processes and practices were embedded to keep patients safe and safeguarded from abuse. For example, the practice had no fire drills and had not risk assessed the need for emergency equipment such as a defibrillator.

Effective

Good

Updated 4 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework 2014/2015 showed patient outcomes were at or above average for the locality and 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 4 July 2016

The practice is rated as outstanding for providing caring services.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, they telephoned socially isolated patients during times when the practice was closed in order to offer support.

The practice nurses had implemented a system whereby they telephone every patient discharged from hospital to check their social support system and medicine requirements.

  • Data from the National GP Patient Survey dated July 2015 showed patients had rated the practice higher than others for several aspects of care. Feedback from patients about their care and treatment was consistently positive.
  • Survey data showed 95% of patients said the GP gave them enough time compared with the CCG average of 89% and the national average of 87%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We received 66 cards on the day of the inspection supporting this.
  • 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 4 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 South East Hampshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice received a summary report from the CCG incident reporting system to help them identify themes for improvement across the wider health and social care system.
  • 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 4 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. Staffs were clear about the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by management.
  • Practice specific policies were implemented and were available to all staff and were, held on paper and computer. However, the management of risks were not always checked. Examples of risks not being appropriately managed included the security of prescriptions issued for GPs held in their personal bags, the frequency of fire drills and the monitoring of clinical coding to identify and resolve errors.
  • 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 focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of patients 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. Care-plans were written with patients who had been identified as being of risk in order to support this and to ensure their wishes were known and recorded...
  • Diabetes data for the practice was above or in line with national indicators.

The percentage of patients with a diagnosis of diabetes, on the practices register, whose latest blood pressure reading was at an acceptable level was 91%. This is higher than the Clinical Commissioning Group average of 80% and the NHS England average of 79%.

  • Longer appointments and home visits were available when needed.
  • All patients with a diagnosed long term condition 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.

Nurses at the practice had devised and implemented a template to support patients to take their medicines; this was known as the pill card. This acted as a prompt to support patients to take the correct medicine at the correct time of day, allowing patients to keep their own record.

Families, children and young people

Good

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • A total of 80 % of patients diagnosed with asthma, on the register, who had had an asthma review in the last 12 months this was above the national average of 75% and above the CCG average of 71%.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Cervical screening data was 82% of eligible women had been screened this is above the national average of 74% and above the CCG average of 82%.
  • 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, health visitors and school nurses.

The practice had trained all GPs and nursing staff to level 3 safeguarding children 

Older people

Good

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. Specifically, the practice provided a year of support phone calls for patients who had suffered bereavement.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • Home visits were made to those older patients who did not attend for routine regular appointments. This ensured that patients had access to emergency care
  • Patients who were identified as without family or were socially isolated received a phone call on Christmas day to provide social support by staff.

Working age people (including those recently retired and students)

Good

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of working-age patients (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. For example, the Saturday clinic and early morning openings were aimed at working age patients.
  • 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 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

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

  • A total of 94 % of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, this was higher than the national average of 84%.
  • 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 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of patients 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.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • The practice 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.
  • The practice had a policy of telephoning patients who had recently been discharged from hospital, to reassure them and to monitor their needs.