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Inspection Summary


Overall summary & rating

Good

Updated 8 July 2016

Letter from the Chief Inspector of General Practice

In December 2015 a comprehensive inspection of Rush Hill Surgery, Bath was conducted, during that inspection we found concerns related to the management of blank prescription security and the systems to monitor this risk. The report setting out the findings of the inspection was published in March 2016. Following the inspection the practice sent us an action plan detailing how they would improve on the areas of concern.

We carried out an announced focused inspection of Rush Hill Surgery on 9 June 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvement since our last inspection on 17 December 2015. We have re-rated the practice overall as good. Specifically, they had made improvements to the provision of safe services. The ratings for the practice have been updated to reflect our findings.

At this inspection we found:

• Risks to patients were assessed and well managed.

• Systems were in place to monitor and ensure the security of blank prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 July 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.

Effective

Good

Updated 8 July 2016

Caring

Good

Updated 8 July 2016

Responsive

Good

Updated 8 July 2016

Well-led

Good

Updated 8 July 2016

Checks on specific services

People with long term conditions

Outstanding

Updated 10 March 2016

The practice is rated as outstanding for the care of people with long-term conditions. For example, all the indicators for diabetes were higher than the national average;

  • The percentage of patients with diabetes, on the register, who have had influenza immunisation (2014 to 2015) was 98.26% (which was higher than national average 94.45%)

  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less (2014 to 2015) was 86.86% (higher than national average of 80.53%).

  • The percentage of patients with high blood pressure having regular blood pressure tests was 88.62% compared to the national average of 83.65%.
  • The practice worked with a local pharmacist, hospital consultant and diabetic nurse specialist to implement a more clinically and cost effective blood glucose testing kit which had proven benefits for patients with diabetes. Although this was a CCG wide scheme the practice achieved approximately 60% uptake compared to the CCG average of approximately 30% by implementing a personalised recall system and ensuring the process was integrated across the nursing, pharmacy and reception team.

  • The practice was working proactively to share examples of good practice including an electronic template for asthma management prescribing which had been published and shared across local practices.

All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 10 March 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 practice supported the C card system to young people. This was where young people could ask for condoms and chlamydia testing kits with no appointments or questions.

  • The practice’s uptake for the cervical screening programme was 80.71%, which was comparable to the national average of 81.83%

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

  • We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 10 March 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. 25% of patients over 75 had a personalised care plan.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice had developed electronic templates to ensure best practice. For example care plans contained a link to upload the files directly to the Out of Hours provider website.

Working age people (including those recently retired and students)

Good

Updated 10 March 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.

  • 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 had acted on feedback relating to accessing appointments and had introduced a phone automated appointment service so patients could now book appointments anytime of the day or night.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 March 2016

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

  • Performance for mental health related indicators was better than the national average.For example;

  • The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 94.87% compared to a national average of 88.47%
  • The dementia diagnosis rate was 94.23 % which was better than the national average of 84.01%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • It carried out advance care planning for patients with dementia, and signposted patients and carers to support groups and voluntary agencies.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 10 March 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 those with a learning disability.

  • It offered longer appointments for people with a learning disability or complex health needs.

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

  • It had told 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 lead GP for safeguarding had undergone additional safeguarding training with local government and multiagency teams, and cascaded the learning and training to the practice. For example, they recently cascaded two recent updates relating to female genital mutilation and radicalisation.