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Inspection Summary


Overall summary & rating

Good

Updated 16 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Catherine’s Surgery on 28 April 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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 several areas of outstanding practice:

  • There was a dedicated nurse practitioner who visited housebound patients and those at risks of hospital admissions who also carried out annual reviews and review of long-term conditions. The practice worked with the other four practices in the building on a rotational basis to provide urgent home visits everyday and they all shared access to patient records so that the GP could view and update patient records when undertaking urgent home visits.

  • The practice provided two drop in clinics each week for children under the age of five. Patients can drop in and see either the GP who led in this population group or the advanced nurse practitioner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 June 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 things went wrong patients received reasonable support, truthful information, and a 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.

  • There was a cascade system in place for major disasters where each member of staff had a contact card and were allocated responsibility for contacting key people.

Effective

Good

Updated 16 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 16 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • 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.

Responsive

Good

Updated 16 June 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice participated in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.

  • There are innovative approaches to providing integrated patient-centred care. For example, the practice held monthly safeguarding meeting between clinicians at the practice and community based staff.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, when the PPG raised concerns that the parking facilities were not being used appropriately, the practice raised this with the management company who recruited additional staff to monitor the parking spaces and ensure patients attending the practices in the building had parking priority.

  • Patients can access appointments and services in a way and at a time that suits them. For example, in addition to extended hours and in response to patient feedback, the practice was open on Saturdays from 8am to 11.30am.

  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 16 June 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 it.

  • 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 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 16 June 2016

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.

  • The practice achieved 96% of the targets for care of patients with diabetes in 2014/15 which was above the clinical commissioning group average of 95% and national average of 89%.

  • 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.

  • In addition to a named GP, the practice also had trained nurse practitioners and assistant practitioners who managed the care of patients with long-term conditions. Data for 2014/15 showed that the practice’s profile for patient with a long-term condition was 62% compared to the clinical commissioning group of 55% and national average of 54%.

  • The practice changed its process for recalling patients for annual long-term condition reviews following feedback from patients. The practice now recalled patients on the month of their birthday which patients found easier to remember when their reviews were due. Patients could also have their other long-term conditions reviewed at the same appointment.

  • The practice ran chronic disease management clinic during the week led by a GP and supported by a team of nurse practitioners, assistant practitioners and healthcare assistants.

Families, children and young people

Good

Updated 16 June 2016

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.

  • 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.

  • The practice’s uptake for the cervical screening programme was 77% which was below the clinical commissioning group average of 84% and national average of 82%.

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

  • The practice provided two drop in clinics each week on Mondays and Fridays for patients under five years old. Those patients could drop in and see either the GP who led for this population group or the advanced nurse practitioner. The practice had initiated this in response to the lack of available health visitors to meet the needs of the local population especially around the branch surgery which was an area of higher deprivation. The purpose of this clinic was to ensure that all patients under five years old could be seen urgently without the need for triage before and after the weekend.

  • We saw the practice also held monthly safeguarding meeting between clinicians at the practice and community based staff and showed positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 16 June 2016

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.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. There was a dedicated nurse practitioner who visited housebound patients and was supported by an assistant practitioner.

  • The practice provided support to four local nursing and residential care homes. There was a dedicated team which comprised of a GP and a nurse practitioner who managed the care of patients in these homes. Weekly visits were provided to these homes and alternated between the GP and the nurse practitioner.

  • The nurse practitioner also managed the care of patients on the high risks register and was supported by the lead GP, an assistant practitioner and a member of the administrative team.

Working age people (including those recently retired and students)

Good

Updated 16 June 2016

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.

  • 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.

  • The practice offered extended hours on Tuesdays and Thursdays and in addition to this, they were open on Saturday mornings. Saturday clinics were nurse led and patients could pre-book appointments to see the nurse practitioners or advanced nurse practitioner.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 June 2016

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

  • 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above the clinical commissioning group (CCG) average of 86% and the national average of 84%.

  • The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 92% compared to the CCG average of 93% and national average of 88%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients living 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 16 June 2016

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 patients and those with a learning disability. The practice shared an example with us on how they worked with other organisations to support a homeless patient to be housed on the same day due to concerns around their health.

  • The practice offered longer appointments for patients with a learning disability. The practice supported two local learning disability homes.

  • Practice data showed that 30% of patients with a learning disability have had an annual health check. The practice told us the GP who led on health check for patients with a learning disability had recently left the practice and they were in the process of identifying a dedicated GP to continue with health checks for patients in this group.

  • The practice regularly worked with other health care professionals 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 Safeguarding GP lead ran safeguarding update training for staff once a year and other speakers were invited to attend the practice’s protected learning time.

  • The practice also held monthly safeguarding meeting between clinicians at the practice and community based staff.