You are here

Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Posterngate Surgery on 30 November 2015 and 1 December 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients and staff were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and any decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • There were same day urgent appointments available on the day of inspection and everyday. We were told every effort was made to support continuity of care.
  • The practice had very good facilities. The practice was equipped to treat patients and meet their needs.
  • There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

  • The practice, as part of SHIELD (The Selby Area Federation of GP Practices), had won an innovation fund to develop social prescribing. This fund was used initially to support the local voluntary service to produce an up to date data base of available voluntary social care organisations. Patients were now referred to the most appropriate services. There was evidence that it was having a positive impact on patients and /or their carers. As well as reducing unplanned hospital admissions.
  • The named GPs had assessed patients with a geriatrician at the local care and nursing homes to assess and meet the needs of their patients. This also prevented long journeys to hospitals for these patients who were mainly frail and elderly. In conjunction with the community matron, they had implemented anticipatory care plans with hospital admission avoidance planning incorporated.
  • The practice was part of the Selby Community Hub which was an innovation funded project from the CCG. This was to integrate Health and Social Care, using multi-disciplinary services to help reduce unplanned hospital admissions and to shorten hospital stays. As yet the evidence was anecdotal however, it was very positive about sharing care and improving patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 2016

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and they were managed well.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training was planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services. Data showed that patients rated the practice above 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 14 January 2016

The practice is rated as good for providing responsive services. They reviewed the needs of their local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said it was always easy to make an appointment with their named GP. There was continuity of care, with urgent appointments available the same day. The practice had good facilities. The practice was equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed how the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 January 2016

The practice is rated as good for being well-led. There was a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a leadership structure and staff felt supported. The practice had a number of policies and procedures to govern activity and they held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which was then acted on. The patient participation group (PPG) was active. Staff had received inductions, performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 14 January 2016

The practice is rated as good for the care of people with long-term conditions (LTCs). Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. All of these patients had care plans in place. Four GPs and one of the practice nurses (PN) had completed further training in Diabetes care and management. The PN could initiate insulin therapy so patients did not need to travel to attend Diabetic services in secondary care (hospital). They had a named GP and a structured annual review to check that their health and medication needs were being met. This patient group was actively managed; those patients who did not attend were followed up and received further support to ensure their needs were assessed and updated. Longer appointments and home visits were available when needed. For those patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver multidisciplinary packages of care.

Families, children and young people

Good

Updated 14 January 2016

The practice is rated as good for the care of families, children and young patients. We saw good examples of joint working with midwives and health visitors. Women’s health was a priority and there was a full range of contraception services available. 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 adults were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 14 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for these patients were good for conditions commonly found in older people. This patient group numbers were higher than the CCG average and the national average reported for GP practices. However, the practice offered proactive, personalised care to meet the needs of their older patients and they had a range of enhanced services, for example, in dementia and end of life care. All patients in this age group had been informed of their named GP; who co-ordinated their care and treatment. The practice was responsive to the needs of older patients. Care reviews were with their named GP and often in their own home. There were regular multi-disciplinary meetings (with other health and social care professionals) to establish appropriate care packages to help prevent admission to hospital.

Working age people (including those recently retired and students)

Good

Updated 14 January 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 they offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services and the GPs were happy to consult via the telephone and email when appropriate. There was a full range of health promotion and screening that reflected the needs of this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice was pro-active when detecting patients with dementia. They supported these patients to consider advance care planning for their future, when appropriate.

Patients experiencing poor mental health were told about the various support groups and voluntary organisations which were available. There was a system in place to follow up patients who had attended accident and emergency (A&E) when they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 14 January 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 those with a learning disability. They all had a named GP who provided continuity of care. They had carried out annual health checks ,many in their own home, for patients with a learning disability and all of them had received a follow-up, where necessary.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. In addition the practice had a medication policy to reduce over use of medicines which may cause harm to these patients. They signed a contract with the practice which formed an agreement for joint planning of care and treatment. These patients were signposted to various support groups and voluntary organisations, when appropriate. 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.