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Inspection Summary


Overall summary & rating

Good

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Strensham Road Surgery on 27 October 2016. Overall the practice is rated as good.

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

  • There were proactive arrangements to safeguard children and vulnerable adults from abuse, and these met with the requirements of local agencies and current legislation.
  • The practice had a system to report and record incidents and significant events. Changes were implemented to prevent incidents happening again.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were higher than CCG and national averages. The most recent published results (for 2015/2016) showed the practice had achieved 100% of the total number of points available, compared with the Clinical Commissioning Group (CCG) average of 97% and the national average of 95%.The patient population had high levels of social deprivation and cultural diversity which made it more challenging to engage patients with services. This made the practice’s high level of performance in several key areas particularly impressive.
  • The practice used benchmarking alongside a program of clinical audit was used to monitor and improve the quality of patient care.
  • Staff demonstrated that they had the skills, knowledge and experience to deliver effective very high standard of care and treatment.
  • Results from the National GP Patient Survey published in July 2016 showed that the practice’s performance in patients’ satisfaction with the practice staff, the care they received and how they could access care and treatment was higher than average.
  • Staff we spoke with were patient focused and eager to provide a friendly and accessible service. We observed staff members to be helpful to patients and treat them with dignity and respect.
  • The practice recognised the needs of its population group and strove to offer the best care possible. For example staff spoke a number of different languages to accommodate the diverse local population.
  • The practice had also increased its appointment availability to meet patient demand, and at the time of the inspection was offering 19% more appointments per year than the national average.
  • Information was available to help patients understand the complaints system. There was an up to date complaints and comments leaflet displayed in the patient waiting area and this had a feedback form attached. Details of how to complain were also included in the practice leaflet and on the website.
  • Staff described the culture of the practice as warm and friendly and felt able to share concerns and address problems as a team.
  • The practice was aware of the requirements of the duty of candour and systems were in place to ensure compliance with this.
  • The practice was committed to continuous learning and improvement and actively sought feedback from staff and patients, as well as sharing learning with other organisations to promote good practice.

We saw two areas of outstanding practice:

  • The practice had begun running its own screening program in 2003 with the aim of identifying patients at risk of a long term condition before they became symptomatic. The practice reviewed patients identified as being at risk at six monthly intervals to monitor their progress. As a result the practice was able to reduce the risk of these patients developing long term conditions. For example, of the patients identified as at risk of developing diabetes, over 50% were no longer at risk following the involvement of the practice.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were higher than CCG and national averages, particularly excelling in breast and cervical cancer screening, childhood immunisations and all long term conditions. The patient population had high levels of social deprivation and cultural diversity which made it more challenging to engage patients with services. This made the practice’s high level of performance particularly significant when compared with averages in the local CCG area. The practice put a lot of effort into following up with patients who did not attend for screenings, examinations and treatments following invitation, and this work was often done by the senior GP outside of the practices opening hours.

The areas where the practice should make improvements are:

  • Continue to monitor stocks of emergency medicines and carry out a risk assessment to ensure the medicines held are appropriate.
  • Continue to review and encourage patient uptake of bowel cancer screening.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2017

The practice is rated as good for providing safe services.

  • The practice had a system to report and record incidents and significant events. Changes were implemented to prevent incidents happening again.
  • There were suitable arrangements to safeguard children and vulnerable adults from abuse, and these met with the requirements of local agencies and current legislation.
  • The practice had a system for managing patient safety alerts issued by external agencies including the Medicines and Healthcare products Regulatory Agency (MHRA). We checked a sample of recent alerts and saw that these had been actioned.
  • When things went wrong with care and treatment the practice took action to notify the patients involved and offer support if relevant. The practice manager met with patients face to face and offered them a written apology.
  • Staff we spoke with knew what to do in the event of a medical emergency and had the necessary training.
  • The practice had a number of medicines for use in an emergency; however, we noted there were two medicines on the recommended list of emergency medicines the practice did not stock. Following discussions with the practice, they decided that these would be included in their medicines list and these were ordered immediately.

Effective

Outstanding

Updated 28 April 2017

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were higher than CCG and national averages, particularly excelling in breast and cervical cancer screening, childhood immunisations and all long term conditions. The patient population had high levels of social deprivation and cultural diversity which made it more challenging to engage patients with services. This made the practice’s high level of performance particularly significant when compared with averages in the local CCG area.
  • The practice had begun running its own screening program in 2003 with the aim of identifying patients at risk of a long term condition before they became symptomatic. Screening appointments were offered to all patients aged 35 to 75 and were carried out by a doctor, nurse or health trainer. Patients were screened for health indicators including levels of blood glucose, cholesterol, blood pressure and body mass index. The practice reviewed patients identified as being at risk at six monthly intervals to monitor their progress. As a result the practice had managed to return over 50% of patients identified as being at risk of developing diabetes to the target range.
  • Staff had access to up to date evidence based guidance and used this information to deliver care and treatment that met patients’ needs.
  • The practice used benchmarking alongside a program of clinical audit to monitor and improve the quality of patient care.
  • Staff demonstrated that they had the skills, knowledge and experience to deliver effective very high standard of care and treatment.
  • Clinicians liaised with healthcare professionals from other services to fully understand and meet the complexity of patients’ needs.
  • Staff worked cooperatively as a small team and we saw evidence of annual appraisals and frequent staff meetings.
  • Staff were aware of their obligations and there were reliable systems in place for gaining consent and protecting confidentiality.

Caring

Good

Updated 28 April 2017

The practice is rated as good for providing caring services.

  • Results from the National GP Patient Survey published in July 2016 showed that the practice’s performance in patients’ satisfaction with the practice staff and the care they received was higher than average.
  • Staff we spoke with were patient focused and eager to provide a friendly and accessible service. We observed staff members to be helpful to patients and treat them with dignity and respect.
  • The practice made special arrangements for patients where necessary, for example ensuring death certificates were provided within 24 hours for patients whose religious beliefs required early burial.
  • We reviewed 36 comment cards, all of which provided positive feedback about the standard of care received. Patients particularly commented on the friendly manner of reception staff and that GPs were trustworthy and good at taking their concerns seriously. We also spoke with two patients who both said they were happy with the care the practice provided and found clinical staff very supportive.
  • The practice made information available to patients with a range of needs to ensure they could be informed about their care.

Responsive

Good

Updated 28 April 2017

The practice is rated as good for providing responsive services.

  • The practice recognised the needs of its population group and strove to offer the best care possible.
  • Approximately 60% of the practices patient list were Arabic speaking. GPs, the practice nurse, and all reception staff were able to translate for patients and spoke languages including Arabic, Urdu, Punjabi, Mirpuri and Farsi. Information was also displayed on a television screen in the waiting area and this was displayed in Arabic as well as English, to cater for the majority of the practice’s patients. External translation services were available for patients who required them and the practice website could be displayed in a variety of languages. The practice had a number of patients who did not speak English and were also unable to read in any language, and staff explained information to these patients verbally to help them understand the information they needed to know about their health.
  • Patients were able to access telephone consultations, longer appointments, home visits and same day appointments where necessary. The practice had also increased its appointment availability to meet patient demand, and at the time of the inspection was offering 19% more appointments per year than the national average.
  • Results from the National GP Patient Survey showed that patients’ satisfaction with how they could access care and treatment was generally higher than both local and national averages with the exception of waiting times.
  • Information was available to help patients understand the complaints system. There was an up to date complaints and comments leaflet displayed in the patient waiting area and this had a feedback form attached. Details of how to complain were also included in the practice leaflet and on the website.

Well-led

Good

Updated 28 April 2017

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

  • The practice had a mission statement which stated that prevention is better than cure. This was supported by aims to improve the overall health of patients and accommodate the needs of the local community. Staff were clear about their roles and responsibilities and knew who clinical and non-clinical leads were.
  • Staff told us the practice held informal daily briefings and clinical meetings. There were quarterly whole practice meetings which were minuted and audio recorded for staff who were unable to attend.
  • Staff described the culture of the practice as warm and friendly and felt able to share concerns and address problems as a team.
  • The practice was aware of the requirements of the duty of candour and systems were in place to ensure compliance with this.
  • The practice was committed to continuous learning and improvement and actively sought feedback from staff and patients, as well as sharing learning with other organisations to promote good practice.
Checks on specific services

People with long term conditions

Outstanding

Updated 28 April 2017

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

  • The practice maintained registers of patients with long-term conditions and used these in conjunction with an effective recall system to ensure that patients with long term conditions were reviewed at the required intervals.
  • The practice had begun running its own screening program in 2003 with the aim of identifying patients at risk of a long term condition before they became symptomatic. Screening appointments were offered to all patients aged 35 to 75 and were carried out by a doctor, nurse or health trainer. Patients were screened for health indicators including levels of blood glucose, cholesterol, blood pressure and body mass index. The practice reviewed patients identified as being at risk at six monthly intervals to monitor their progress. As a result the practice had managed to return over 50% of patients identified as being at risk of developing diabetes to the target range.
  • Performance for diabetes related indicators was consistently higher than local and national averages. For example, 83% of patients had a blood glucose measurement within the target range in the previous 12 months, compared with the CCG average of 77% and the national average of 78%. Exception reporting was 6%, significantly lower than the CCG and national averages which were both 12%. 99% of patients with diabetes had a blood pressure reading within the acceptable range, considerably higher than the CCG and national averages of 78%. Exception reporting was 0%, whereas the CCG average was 8% and the national average 9%. 100% of patients with diabetes had a record of a foot examination and risk classification in the previous 12 months, again considerably higher than the CCG average of 90% and the national average of 88%. The practice’s exception reporting for this indicator was 0%, once again lower than the CCG average of 5% and the national average of 8%.
  • The practice’s performance for patients with a variety of other long term conditions was also above average. For example the percentage of patients with chronic obstructive pulmonary disease (COPD) who had been reviewed within the previous 12 months, including a breathlessness assessment, was 100%. This was similar to the CCG average of 92% and the national average of 90%. The practice’s exception reporting for this was 0%, significantly lower than the CCG average of 7% and the national average of 11%. 99% of the practice’s patients with asthma had received a review in the previous 12 months, compared with the CCG average of 76% and the national average of 75%. The practice had exception reported 0% of patients for this indicator, whereas the CCG average was 3% and the national average was 8%.
  • The practice offered health promotion clinics on weight reduction, heart disease, cholesterol, hypertension, diabetes and asthma for patients who needed this input. The practice encouraged health promotion by providing information and referrals to support services.
  • Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care.

Families, children and young people

Good

Updated 28 April 2017

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

  • Staff assured us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Immunisation rates were higher than the national average for all standard childhood immunisations.
  • It was the practice’s policy to offer all children aged under five years same day appointments.
  • The practice’s uptake for the cervical screening programme was 99%, which was significantly higher than the CCG average of 80% and the national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Clinicians held frequent meetings which the local health visitor and midwife were invited to. During these meetings children on the at risk register were discussed. The practice also held a specific register for children at risk of female genital mutilation and staff had completed training in this area of safeguarding.
  • Clinical staff demonstrated their understanding of Gillick competence and Fraser guidelines, and why these needed to be considered when providing care and treatment to young patients under 16. The Gillick test is used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Fraser guidelines related specifically to contraception, sexual health advice and treatment.

Older people

Good

Updated 28 April 2017

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

  • The practice provided home visits and urgent appointments for older patients who needed them.
  • Patients aged over 75 were offered an annual health check.
  • Where appropriate the practice added older people to their Case Management and Unplanned Admission Avoidance registers and carried out care planning and frequent reviews.
  • The practice offered the flu vaccine to older patients. During 2015/2016 the practice achieved 94% flu uptake for eligible patients aged over 65, which was the highest uptake in the CCG.
  • GPs carried out face to face reviews with over 75s who had been discharged from hospital.
  • The practice engaged with a local service which provided a roving doctor to visit patients’ at home when needed. This allowed patients to be seen quickly and safely when their request was made later in the day after the practice’s home visits had been carried out.

Working age people (including those recently retired and students)

Good

Updated 28 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • Patients could access online appointment booking and text messaging reminders for convenience.
  • The practice offered end of day appointments after 6pm to working people, and telephone consultations for who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours.
  • A full range of health promotion and screening was available, including well man and well woman checks and NHS health checks for those aged 40 to 74.
  • There were arrangements to direct patients to My Healthcare hub services for extended hours’ appointments when the practice was closed between 8am and 8pm seven days a week.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2017

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

  • The practice liaised with multi-disciplinary teams in the management of patients experiencing poor mental health, and these patients had care plans in place.
  • Patients could access Improving Access to Psychological Therapies (IAPT) counselling sessions through the practice.
  • Performance for mental health related indicators was higher than local and national averages. For example, 96% of patients experiencing poor mental health had a comprehensive agreed care plan documented in their records, which was higher than the CCG average of 91% and the national average of 89%. Exception reporting was 7%, in line with the CCG average of 8% and the national average of 13%. 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 87% and the national average of 84%. Exception reporting was 0% for this indicator, lower than the CCG average of 5% and the national average which was 8%.
  • The practice maintained a mental health register which it used to monitor patients and offer relevant information and services. For example, patients on the mental health register were entitled to an NHS health check.

People whose circumstances may make them vulnerable

Good

Updated 28 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Approximately 60% of the practices patient list were Arabic speaking. GPs, the practice nurse, and all reception staff were able to translate for patients and spoke languages including Arabic, Urdu, Punjabi, Mirpuri and Farsi. Information was also displayed on a television screen in the waiting area and this was displayed in Arabic as well as English, to cater for the majority of the practice’s patients. External translation services were available for patients who required them and the practice website could be displayed in a variety of languages. The practice had a number of patients who did not speak English and were also unable to read in any language, and staff explained information to these patients verbally to help them understand the information they needed to know about their health.
  • The practice had a large proportion of patients whose religious beliefs required burial within 24 hours of death. The practice had implemented special measures to accommodate bereaved families from these groups. GPs prioritised ensuring that death certificates were issued quickly for these patients to allow the burial to take place. GPs made themselves available to patients on weekends to facilitate this where necessary.
  • The practice held registers of patients living in vulnerable circumstances including those with a learning disability and patients at high risk of hospital admission. The practice offered longer appointments for patients with a learning disability.
  • The practice had protocols in place to register homeless people and those from traveller communities. There were also a number of patients registered with the practice who were resident in a local alcohol misuse rehabilitation centre. The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice offered additional services to carers such as a free annual flu vaccination and health check.
  • The practice had systems and processes in place to safeguard patients from abuse and staff were up to date with training. The practice regularly worked with other health care professionals in the case management of patients living in circumstances that made them vulnerable.