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Inspection Summary


Overall summary & rating

Good

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blundellsands Surgery on 12 November 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Safeguarding systems were in place and staff demonstrated their understanding of these. However, we found that requests for safeguarding reports were not always met.

  • The practice reviewed data to improve performance, but where unable to provide examples of completed audit cycles.

  • The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice.

  • Feedback from patients about their care was consistently and strongly positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

  • 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.
  • 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
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

  • Ensure all requests for safeguarding reports are met, and that reports are submitted to safeguarding review boards in the required format.

Additionally, there are areas where the practice should make improvements.

The practice should

  • Ensure that audits started are completed and meet the clear definition of the clinical audit cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 November 2016

Improved systems had been developed and implemented, to ensure that any requests for child safeguarding reports were being met by GPs at the practice. A system of audit had been used to check and measure improvements. Where any request for a safeguarding report had not been met within required timescales, the practice used the significant event process to record, investigate and analyse reasons why this had occurred. The results of the audit and any changes to practice were shared with all clinicians and staff.   

Effective

Good

Updated 7 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 assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits we were shown were not completed audit cycles. We did see that the practice used data to review performance and to make changes to how they provided effective interventions. However, the second cycle of assessment and review, required to complete audits and show changes made had been effective, was missing.

  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 7 January 2016

The practice is rated as good for providing caring services.

  • Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 7 January 2016

The practice is rated as good for providing responsive services.

  • It 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 conducted an audit on the older practice patients to score their risk of becoming frail. Further work planned was aimed at providing services alongside other stakeholders that met the needs of this patient group, whilst still in the community.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 January 2016

The practice is rated as good for providing well-led services.

  • It 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

  • 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 7 January 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 indicators from data for care of patients with diabetes, showed the practice achieved scores above the national average.

  • Longer appointments and home visits were available when needed; we saw plans in place to ensure patients were provided with the help they needed to stay well during the winter months.

  • 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, for example working with community and Macmillan nurses for those patients receiving palliative care.

Families, children and young people

Good

Updated 7 January 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. However, GPs did not always complete and submit child safeguarding reports for safeguarding review panels.

  • 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 had taken steps which had been effective, to increase the uptake of cervical screening.

  • 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 7 January 2016

The practice is rated as good for the care of older patients. We found:

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

  • The practice updated it’s registers for older patients on a monthly basis, constantly applying a risk stratification tool to identify those patients in danger of unplaned admission to hospital.

  • The practice had a GP who led on the Care Home Innovation Project (CHIP), which aimed to enable care home residents to enjoy the best quality of life and care within their usual place of residence and reduce unnecessary urgent care investigation and admission.

Working age people (including those recently retired and students)

Good

Updated 7 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 it offered to ensure these were accessible, flexible and offered continuity of care.

  • The practice had responded to demand from patients in this population group, and provided extended hours surgeries in the form of early bird and commuter clinics, as well as late evening opening on two nights each week.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 January 2016

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

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    A recent review of data on dementia prevalence and diagnosis had led to more effective management of these patients, and closer working links with other community clinicians.

  • 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.

  • 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 7 January 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 and those with a learning disability.

  • It offered longer appointments for people with a learning disability.

  • 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. Citizens Advice Bureaux were at the practice each fortnight and patients could access these services via the practice.

  • 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. However we saw that the practice did not complete and submit safeguarding reports in respect of people identified as being vulnerable.