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Inspection Summary


Overall summary & rating

Good

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East Hill Surgery on 19 April 2016. Overall the practice is rated as good.

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

  • Staff members were aware how to raise concerns, and report safety incidents. The policy showed the practice complied with the requirements of the duty of candour. Safety information was recorded and any issues identified were shared with staff members.
  • Risks to patients were assessed and documented. The system to assess risks included those associated with; premises, equipment, medicines, and infection control.
  • Patient care was planned and provided to reflect best practice using recommended current clinical guidance.
  • Patient comments were positive about the practice during the inspection and they told us treatment was with consideration, dignity and respect. Members of the practice patient participation group told us they were involved with practice development.
  • Information regarding how to complain was available at the practice and in an easy to read format. A request on their practice website asked patients to fill out a form at the practice, or speak with the practice manager.
  • Patient’s comments were mixed regarding making an appointment with a named GP, some patients preferred the open surgery each morning and others preferred to pre-book all their appointments. There were always urgent appointments available on the day they were requested.
  • The practice had suitable facilities and equipment to treat patients and meet their requirements.
  • The leadership structure at the practice was known and understood by all the staff members we spoke with. They told us they were supported in their working roles by the practice management and the GPs.

The areas where the provider should make improvement are:

  • Improve the identification of patients that are carers.

  • Carry out infection control audits in line with guidance

  • Consolidate and use one emergency call system for staff members when dealing with an emergency situation.

  • Continue to update and review all practice policies and procedures to ensure they meet current legislation and guidelines.

  • Implement a system to ensure that the defibrillator shared with the neighbouring practice is checked so that it is in working order and that the adult and child pads are within their expiry dates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 July 2016

The practice is rated as good for providing safe services.

  • There was a system in place and staff members knew how to raise concerns, and report safety incidents. Incidents and lessons learned were shared with staff members in practice meetings.

  • When things went wrong patients received an explanation or an apology when appropriate. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had developed processes to keep people safe and safeguarded from abuse.

  • Risks to patients were assessed and managed these included premises, equipment, medicines, and infection control. However although monitoring and checks to ensure standards of cleanliness and hygiene were taking place infection control audits were not being undertaken.

  • The practice shared a defibrillator with the practice next door housed in the shared building. There was no system in place between the two practices to ensure that the defibrillator was in working order and that adult and child pads were within their expiry dates.

  • We were shown three emergency systems during our visit which could lead to confusion and time lost when staff members need to call other staff members in an emergency situation.

Effective

Good

Updated 21 July 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were above average compared with local and national practices.

  • Patient care was planned and provided in a way that reflected best practice and followed recommended current clinical guidance.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment in a primary care environment.

  • Clinical audits undertaken at the practice showed the GPs used auditing to improve the practice service quality and patient outcomes.

  • There was a system in place to ensure that staff received supervision and appraisals.

  • Staff communicated with multidisciplinary teams to understand and meet the varied complexities of people’s needs.

Caring

Good

Updated 21 July 2016

The practice is rated as good for providing caring services.

  • Data from the ‘National GP Patient Survey’ published January 2016 showed patients rated the practice higher than others for numerous aspects of care.

  • Patients said they were treated with compassion, dignity, respect, and were involved in decisions about their care and treatment.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice coded patients who were carers, although the number identified was below the national average. We found they were missing opportunities to identify carers.

Responsive

Good

Updated 21 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 local Clinical Commissioning Group to secure improvements to services where these were identified.

  • Appointment times and availability were flexible to meet patient needs. Same day urgent appointments were available. Home visits and telephone consultations were provided as needed.

  • The practice offered its patients access to book appointments with a GP and order repeat prescriptions online. There is also a text service to remind patients of appointments they had booked to reduce them being forgotten and patients not attending.

  • The practice had suitable facilities and was adequately equipped to treat and meet patient’s needs.

  • There were accessible toilets and baby changing facilities available in the premises.

  • Information about how to complain was available and easy to understand.

Well-led

Good

Updated 21 July 2016

The practice is rated as good for being well-led.

  • The practice had an aim to deliver high quality care and promote good outcomes for patients. Staff members told us they knew the aims and ethos of the practice.

  • Staff members told us they were supported by GPs and the practice management.

  • The practice had a number of policies and procedures to govern activity and held regular governance meetings. Some of the policies required a review and updating.

  • There was a system for governance which was supported by the practice policies and the delivery of good quality care and patient outcomes. This included arrangements to monitor and improve patient care and identify risks.

  • The provider was aware of and complied with the requirements of the ‘Duty of Candour’ this was seen in their approach to safety incidents to be open and honest. Information was shared with staff to ensure appropriate practice action and lessons from incidents were learnt.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group at the practice was keen to support the practice and was active in their efforts.

  • There were arrangements to monitor and improve patient care and identify risks.

  • The practice sought feedback from their staff members and patients, to gain insight into their needs.
Checks on specific services

People with long term conditions

Good

Updated 21 July 2016

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

Patients in this population group had a named GP and a structured annual review to check their health and medicine needs were met. Those patients with complex needs received joint care from their named GP that worked with relevant health care professionals to deliver multidisciplinary care. Examples of the care provided were:

  • The practice delivered both enhanced services and the local diabetic service. The diabetic lead GP and practice nurse attended training and meetings to ensure the practice could meet the extra work required for the delivery of the local service requirement. National data for diabetes showed overall that the practice scored was comparable or higher with other national practices for example: The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less scored 91% compared with national practices that scored 78%.

  • The practice held clinics for long term condition patients. They also provided an in-house blood taking service and echocardiography (ECG) clinics. The practice clinical quality performance was 98% which was 4% higher than practices nationally.

  • The practice was the sole health provider for a local unit which cares for 20 patients with a specific genetic condition. A dedicated GP from the practice provided a weekly ward round to meet the complex needs of these patients. The practice offered annual health checks for their LD patients.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 21 July 2016

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances who were at risk.

  • Immunisation rates were high for all standard childhood immunisations.

  • Parent told us their children were treated in an age-appropriate way and recognised as individuals.

  • The national quality performance data showed the percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years at the practice was 86% compared with the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • Patients at the practice had access to online appointment booking and could order their repeat prescriptions.

  • Staff members at the practice had access to a practice specific child protection policy and procedures.

  • The practice offered inter-uterine device (IUD) fitting and removal.

  • There were also contraceptive services, including the fitting and removal of contraceptive devices, child health surveillance, and attendance at child protection forums by the GP and practice manager.

  • There was a policy regarding Gillick competence and permission to information share with parents/ carers if children under 16 attended alone.

  • Looked after children that were temporary residents in the area were registered with the practice, to ensure continuity, on-going monitoring and that their records were fully updated.

Older people

Good

Updated 21 July 2016

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

The practice offered personalised care to meet older people’s needs and offered home visits for those with mobility or enhanced needs. All patients in this population group had a named GP. Examples of the care provided were:

  • Identification of vulnerable older patients through the unplanned admissions avoidance scheme.
  • Patients followed-up and reviewed six months after hospital treatment.
  • Patients over 75 years of age with heart disease asked to complete a depression questionnaire as it is known that patients in this category can have hidden depression. There was a 90% return rate of questionnaires and those scoring over five that were not already coded as having depression, were contacted and offered support and advice.
  • Review of end of life patients regularly at multidisciplinary meetings. Information was shared with the out of hours provider computer system if consent to share information had been given.
  • Regular medicine reviews and use of blister packs for weekly dispensing in partnership with local pharmacies
  • Shared care with community matrons and other admission avoidance schemes to enable well communicated care in the community.
  • All patients over the age of 65 offered a flu vaccination in dedicated Saturday clinics every year with the offer of pneumococcal and shingles vaccines on the same day. Data showed high rates of seasonal flu/pneumonia/shingles vaccination rates for this practice. Patients were also vaccinated opportunistically in consultations to save them returning for the dedicated clinic.
  • The practice held a register of patients that were also carers. They had identified 0.82% of their population as carers; this was below the national average of between 1% and 3%.

Working age people (including those recently retired and students)

Good

Updated 21 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had responded to the needs of the working age population, those recently retired and students. Examples of care provided:

  • An online service to book appointments, and order repeat prescriptions.

  • Telephone consultations were available with doctors and nurses.

  • A range of health promotional services such as smoking cessation, weight management, health checks, and flu vaccination clinics outside week day core hours.

  • Late evening and Saturday morning pre-booked appointments.

  • Contraceptive services, women’s health, and screening services that reflect the needs of this population group.

  • Online access to records with on-going maintenance of computerised records for students and temporary patient reviews/ appointments offered.

  • A full range of health promotion was offered including online services.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice met the needs of people from within this population group for example:

  • Yearly review of mental health care plans this included a review of their health and mental health parameters in their care plans and an update of other details for example their ‘next of kin’ and mental health status.

  • The ability to provide care and treatment to patients with complex behaviours living with mental health issues. This was due to long serving staff members having an understanding and knowledge of these patients. The practice provided people experiencing poor mental health information about how to access support and voluntary groups.

  • The practice followed up patients who had attended accident and emergency from this population group.

  • For those patients prescribed with potentially addictive medicines the practice issued limited supplies and kept them under close supervision.

  • The maintenance of a dementia register with up to date next of kin contact details, with any decisions made in advance, for example, statements of resuscitation, preferred place of care decisions, or information regarding their ‘Lasting Power of Attorney’ if one existed.

  • 87%of patients at the practice diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

  • 96% of patients at the practice with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months which is higher than the national average of 89%.

People whose circumstances may make them vulnerable

Good

Updated 21 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice provided services to meet the needs of people from within this population group for example:

  • Longer appointments for patients with a learning disability were available. There were 26 patients that had been identified as living with a learning disability and all had been offered an annual learning disability check.

  • Staff knew how to recognise the signs of abuse in vulnerable adults and children, they were also aware of their responsibilities. This included information sharing, documentation of safeguarding concerns and who to contact. Practice staff knew they could ask the safeguarding lead at the practice for advice if they had any concerns.

  • Home visits were offered to those patients unable to attend for routine or emergency care, including vaccination.

  • Homeless temporary patient GP service offered and a good relationship with the local homeless organisation that refers patients to the practice.

  • Maintenance of an unplanned admissions list consisting of vulnerable patients.

  • Communication with the out of hour’s computer system to share information outside practice working hours.

  • Open access morning surgery for those unable to keep appointments.