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The Garden City Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Garden City Surgery on 20 September 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. However, the practice had not carried out any recent fire drills.
  • Infection control processes were in place but there had been no audits to monitor them and identify any potential improvements.
  • 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.
  • The GP partners arranged professional development events with local consultants from secondary can and included topics such as diabetes management, COPD management, heart failure management. This forum improved direct links with secondary care colleagues and provided direct access for clinical advice.
  • Patients said they were satisfied with the care they received and thought staff were approachable, committed and caring. Patients told us they felt involved in decision making about the care and treatment they received.
  • 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.
  • The practice facilities were equipped to treat patients and meet their needs. Consultation rooms were available on the ground floor for patients who could not manage the stairs. There were access enabled toilets and an automatic door at the entrance. All staff had received deaf awareness training.
  • 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 improvements are:

  • Carry out regular fire drills so staff are familiar with actions to take in the event of a fire.
  • Complete audits to monitor infection control processes in place.
  • Continue to encourage patients to attend cancer screening such as cervical and breast cancer.
  • Continue to identify and support carers within the practice population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons learnt were shared at staff meetings to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received support, 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. Staff had received training relevant to their role.

  • Risks to patients were assessed and well managed. However, the practice had not carried out any recent fire drills.

  • Infection control processes were in place but there had been no audits undertaken to monitor and identify any potential improvements.

Effective

Good

Updated 17 March 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. For example,

    performance for chronic obstructive pulmonary disease was comparable to the local and national averages. The practice achieved 97% of available points, with 9% exception reporting, compared to the local CCG average of 97%, with 12% exception reporting, and the national average of 96%, with 13% exception reporting.

  • Staff assessed needs and delivered care in line with current evidence based guidance. Staff had access to guidelines from NICE (National Institute of Clinical Excellence) and used this information to deliver care and treatment that met patients’ needs.

  • Clinical audits demonstrated quality improvement. There had been four clinical audits undertaken in the last two years, two of these were completed audits where the improvements made were implemented and monitored.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The GP partners arranged professional development events with local consultants from secondary care and included topics such as diabetes management, COPD and heart failure management. This forum improved direct links with secondary care colleagues and provided direct access for clinical advice.

  • 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 17 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey, published July 2016, showed patients rated the practice comparably with others for several aspects of care. For example, 91% of patients said the GP was good at listening to them compared to the local clinical commissioning group (CCG) average of 88% and the national average of 89%.

  • 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.

  • The practice had identified 79 patients as carers which was approximately 1% of the practice list. There was an identified carers lead and written information was available to direct carers to the avenues of support available to them. Carers were offered flexible appointment bookings so they could attend the practice at a convenient time.

Responsive

Good

Updated 17 March 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 East and North Hertfordshire Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice held an anti-coagulation monitoring clinic for patients to avoid them attending the local hospital for blood tests. This service included home visits for housebound patients.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care.

  • There were ‘sit and wait’ appointments for urgent needs. These were available from 10.30am to 11.30am and 5.30pm to 6pm daily.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. Consultation rooms were available on the ground floor.

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

Well-led

Good

Updated 17 March 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. 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.

  • The practice was part of a federation of practices who were working together to provide healthcare services locally for patients.

Checks on specific services

People with long term conditions

Good

Updated 17 March 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.

  • Performance for diabetes related indicators was comparable to the local and national averages. The practice achieved 95% of available points, with 13% exception reporting, compared to the CCG average of 89%, with 9% exception reporting, and the national average of 90%, with 12% exception reporting.

  • 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.

  • The GP partners arranged professional development events with local consultants from secondary can and included topics such as diabetes management, COPD management, and heart failure management. This forum improved direct links with secondary care colleagues and provided direct access for clinical advice.

  • One of the practice nurses was trained as an expert educator in diabetes.

Families, children and young people

Good

Updated 17 March 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 people who had a high number of A&E attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations. For example, the practice achieved a score of 9.6 out of 10 for childhood immunisation rates for the vaccinations given to under two year olds compared to the national average score of 9.1.

  • The practice’s uptake for the cervical screening programme was 76%, which was slightly lower than the CCG average of 83% and the national average of 82%.

  • 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 and health visitors.

  • The nursing staff were also trained to give sexual health and family planning advice.

Older people

Good

Updated 17 March 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 people in its population.

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

  • The GPs visited a local care home once a week in addition to urgent visits and telephone advice as required.

  • Annual health checks were offered to all patients over 75 years of age.

Working age people (including those recently retired and students)

Good

Updated 17 March 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.

  • Telephone consultations were available for patients who unable to attend the practice.

  • There were online appointment booking and prescription requests in addition to the electronic prescribing service that reflected the needs for this age group.

  • The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. For example,

    1. 68% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 72% and the national average of 72%.

    2. 56% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 59% and the national average of 58%.

  • Students at home from university during holiday times were offered temporary registration with the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2017

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

  • 75% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months.

  • Performance for mental health related indicators was comparable to the local and national averages. The practice achieved 100% of available points compared to the CCG average of 94% and the national average of 93%.

  • 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 support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended A&E 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 17 March 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 homeless people and 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 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 practice had identified 79 patients as carers which was approximately 1% of the practice list. There was an identified carers lead and written information was available to direct carers to the avenues of support available to them. Carers were offered flexible appointment booking so they could attend the practice at a convenient time.