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Inspection Summary


Overall summary & rating

Good

Updated 27 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Jackson, Chapman, Hodson & Speed on 25 February 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.
  • 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.

We saw areas outstanding practice:

  • The practice fully funded a vehicle and employed a driver to transport patients, to appointments at the practice or local hospital and deliver urgent medicines to patients. The driver had received training in first aid and basic life support and visited, to check all was well, for older patients who were housebound and frail that had not been seen by the practice for several weeks.
  • The practice had worked with other local practices, on a forward weekend planning initiative. If GPs had concerns regarding deterioration of a patients health over the weekend when the practice was closed, appointments could be made for them at the local hospital with the Bath emergency medical service for their health to be reviewed. Analysis by the practice showed that this initiative had prevented approximately 40 hospital admissions over a 12 month period.

The areas where the provider should improvements are:

  • Curtains around examination couches should be installed to maintain dignity and privacy of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 April 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 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 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 27 April 2016

The practice is rated as good for providing effective services.

  • 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. The practice worked closely with local consultants and invited them to the practice to deliver educational sessions, to continually update knowledge and skills.

  • 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. The practice worked well with the local drug and alcohol service and homeless hostel to support and effectively care for patients.

  • Data from the Quality and Outcomes Framework showed patient outcomes were lower than for the locality and compared to the national average in some areas however these were investigated further by the GP specialist advisor on the day of the inspection who saw there were coding errors, which the practice were working to resolve. Clinical care was found to be in line with guidelines.

Caring

Good

Updated 27 April 2016

The practice is rated as good for providing caring services.

  • 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.

  • Data from the National GP Patient Survey showed patients rated the practice lower than others for several aspects of care, however the practice had taken action to address this by increasing the number of partners in the practice and discussions had taken place to increase the length of appointment times.

    However:

  • Consulting rooms had no curtains around the examination couches to maintain patients privacy and dignity during examinations. This was fedback on the day of the inspection and we were shown evidence of the practices’ intention to install curtains around examination couches.

Responsive

Good

Updated 27 April 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. The practice had worked with other local practices on a forward weekend planning initiative. If GPs had concerns regarding deterioration of a patients health over the weekend when the practice was closed, appointments could be made for them at the local hospital with the Bath emergency medical service for their health to be reviewed.

  • 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.

  • An additional clinic was run on a Monday morning throughout the winter months to meet increased patient demand.

  • 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.

  • The practice fully funded a vehicle and employed a driver for patients to get to the practice, attend hospital appointment and other duties as identified by the practice that would benefit patients.

Well-led

Good

Updated 27 April 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 this.

  • 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.

  • 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 strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 27 April 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.

  • The percentage of patients with diabetes, on the register, in whom the last blood test was within the target range in the preceding 12 months (2014 to 2015) was 85% compared to the 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 27 April 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.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (2014 to 2015) was 86% compared to the national average of 82%.

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

Older people

Good

Updated 27 April 2016

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 people 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.

  • Transport was provided by the practice for older patients to access appointments at the practice and the local hospital and delivered urgent medicines. The driver had received training in first aid and basic life support and visited, to check all was well, for older patients who were housebound and frail, that had not been seen by the practice for several weeks.

Working age people (including those recently retired and students)

Good

Updated 27 April 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.

  • A walk in and wait surgery was available each morning as well as telephone consultations and Saturday morning clinics to facilitate working age patients having effective access to health care services.

  • The practice was proactive in offering online services and a mobile phone app 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 27 April 2016

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

  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.

  • 73% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%. This was investigated further by the GP specialist advisor on the day of the inspection who saw there were coding errors, which the practice had since resolved. Clinical care was found to be In line with guidelines.

People whose circumstances may make them vulnerable

Good

Updated 27 April 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, 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 people.

  • 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 undertaken additional training to ensure expertise to support vulnerable people was available, for example domestic violence training.