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Inspection Summary


Overall summary & rating

Good

Updated 22 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West End Surgery on 23rd August 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.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained 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.
  • Only 64% of patients said they could get through easily to the practice by phone compared to the national average of 73%.
  • Some 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. Other patients told us the telephone lines were busy in the mornings.
  • The practice had good facilities and was equipped to treat patients and meet their needs. However there were areas of health and safety that needed improvement such as the calibration of one type of equipment.
  • 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.

The areas where the provider should make improvement are:

  • Review systems and processes to ensure that all clinical equipment is calibrated regularly.

  • To review the practice processes for identifying current smokers and giving advice on the benefits of stopping smoking
  • Improve the access to the practice for making appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 February 2017

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. When things went wrong reviews and investigations were thorough and lessons learned were communicated widely enough to support improvement.

  • Risks to patients who used services were assessed and action was taken to reduce risks.

  • Not all clinical equipment was calibrated to ensure it was working properly. This was rectified by the end of the inspection visit.”

     

     

  • We read the Health and Safety policy and a risk assessment of the building and environment that had been undertaken for staff or patients.

  • The practice had also commissioned an external company to monitor the risks associated with Legionella, and we observed some advice had been sought.

Effective

Good

Updated 22 February 2017

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 .We saw evidence of planned audit programmes. Medicine reviews for patients on long term treatments were undertaken every six months.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice had a good range of clinical skills within the team. The GPs attended regular learning events hosted by the clinical commissioning group (CCG). One of the nurses attended both locality and CCG nurse meetings. One practice nurse had just completed a degree in Long Term Conditions; another had almost completed an Infection Prevention and Control update with a further session to attend. One of the administrative staff was the lead for customer relations and had trained reception staff on ‘motivational interviewing’ techniques.

  • There was evidence of appraisals and personal development plans for all staff. Staff told us that any training needs identified at appraisal were met.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. There were clear pathways for patients managed through Integrated Care Teams and with other practices within the locality.

Caring

Good

Updated 22 February 2017

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 22 February 2017

The practice is rated as good for providing responsive services.

  • Practice staff 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.

  • We saw comprehensive patient care plans relevant to elderly patients. The care plan template was developed locally by a Consultant Geriatrician.

  • 64% of patients said they could get through easily to the practice by phone compared to the national average of 73%.
  • However some 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. When we spoke to patients, they reported that sometimes the telephone lines were busy in the morning. During the practice opening times there is a nominated duty doctor.

  • The practice had good facilities.

  • The practice had an application under consideration for refurbishment and expansion of the current premises.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded openly, transparently and promptly. We saw contemporaneous hand written outcomes of complaints by telephone contact with patients.

  • Learning from complaints was shared with staff and stakeholders. We were able to cross reference complaints which were discussed at the all staff meeting and were recorded in the minutes.

  • There were extra ‘Sit and Wait’ clinics especially for young children.

Well-led

Good

Updated 22 February 2017

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. There are two practice managers one responsible for business management and the other with responsibility for operational 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 for care delivery.

  • 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. We saw the minutes of staff meetings where significant event s and learning outcomes were shared with some staff.

  • The practice proactively sought feedback from staff. The patient participation group was due to hold their first meeting in September 2016.

  • There was a focus on continuous learning and improvement at the practice.

Checks on specific services

People with long term conditions

Good

Updated 22 February 2017

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

  • We saw the call and recall systems in place to encourage patients to attend reviews. The practice had a manager responsible for the recall system.

  • The Quality and Outcome Framework (QOF) clinical data for exception reporting for the practice, relating to Diabetes Mellitus (combined overall totals) is 13% compared to the CCG at 14% and a national average of 11%

  • 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, coordinated through the Integrated Care Teams.

  • Two practice nurses had a lead for Long Term conditions, one for diabetes and the other for respiratory conditions.

Families, children and young people

Good

Updated 22 February 2017

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 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years, the rates achieved for the practice were 81% in line with the CCG and national rate of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses, with meetings scheduled on a regular basis.
  • There was an extra sit and wait clinic for young children.

Older people

Good

Updated 22 February 2017

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 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.

  • The practice has developed an Integrated Care Team in conjunction with local practices, which offers a full assessment of patients with complex health and social care needs.

  • The practice undertook admission avoidance reviews for vulnerable patients with long term conditions

  • The GPs showed us documentation relating to patients residing in care homes had care plans.

  • The practice worked closely with the local pharmacy and offered a variety of ways for patients to access prescribed medicines. We saw how prescription requests were handled on the day and the communication between the practice and the pharmacy.

  • The practice worked closely with the local older peoples mental health services.

Working age people (including those recently retired and students)

Good

Updated 22 February 2017

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.

  • There was a wide selection of self-help leaflets available in the waiting area.

  • The practice had extended the hours of the phlebotomy (blood tests) service to enable patients who work to attend.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 February 2017

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

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

  • The practice 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.

  • 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.

  • The practice chaired the multidisciplinary team meetings attended by partners, management and health and social care professionals.

People whose circumstances may make them vulnerable

Good

Updated 22 February 2017

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.
  • The practice offered longer appointments for patients with a learning disability.
  • 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.