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Dr George Bhima Good Also known as Dr Bhima Surgery

Inspection Summary


Overall summary & rating

Good

Updated 3 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Dr George Bhima on 27 April 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.
  • 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.
  • 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.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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.

We saw areas of outstanding practice

The GP carried out follow up home visits at weekends and bank holidays to those patients that were ill and/or vulnerable who would benefit from a visit.

When the surgery was due to be closed for bank holidays the practice contacted all patients over the age of 75 to ask if they had enough medication and offered a call from the GP.

However there was one area where the practice should make improvements:

The practice should complete the task of obtaining DBS checks for those staff acting as chaperones.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 June 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 3 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were lower than average compared to the national average. However, the practice had a low, often nil exception rate affecting the average achievement considerably. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 3 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice the same as 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.
  • The GP carried out home visits at the weekend and bank holidays for patients that were ill and/or vulnerable.
  • Reception staff would ring patients that had asked to be reminded and those suffering from poor memory to remind them, on the day, of their appointment.
  • When the surgery was closed for bank holidays the practice contacted all patients over the age of 75 to ask if they had enough medication and offered a call from the GP.
  • All staff in the practice had undertaken customer care training.

Responsive

Good

Updated 3 June 2016

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.
  • Patients said they found it easy to make an appointment with the named GP and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 3 June 2016

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.
  • All referrals were processed within 24 hours of receiving them from the GP.
  • The practice contacted patients that had not had contact with the surgery for three years to check if the patient was still living at the address shown and take appropriate action.
  • 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 practice did not currently have a patient participation group but plans were in place to work with a member of the CCG in order to address this.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 3 June 2016

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.
  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5mmol/l or less was 76% compared to the CCG average of 79% and national average of 80%
  • Longer appointments and home visits were available when needed.
  • All patients with a long term condition were seen on the same day.
  • 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.

Families, children and young people

Good

Updated 3 June 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.
  • 70% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was below the CCG average of 80% and national average of 81%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • All patients under the age of 18 years were offered appointments on the same day.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 3 June 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. All patients over the age of 75 had a care plan in place.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • All patients over the age of 75 were contacted by the practice and offered health checks and immunisations appropriate for that age group.
  • All patients over the age of 75 would be offered same day appointments or home visits, as required.
  • The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
  • When the surgery was due to be closed for bank holidays the practice contacted all patients over the age of 75 to ask if they had enough medication and offered a call from the GP.

Working age people (including those recently retired and students)

Good

Updated 3 June 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 offered telephone consultations for patients that required them.
  • The practice were part of a group of practices that offered patients access to a GP or practice nurse at evenings, weekends and bank holidays.
  • The practice offered “RU Clear” screening which which is a confidential sexual health screening service.
  • The practice offer electronic prescribing which means that a patient can nominate a pharmacy where the GP sends prescriptions to, making the whole process more efficient and convenient for the patient.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 June 2016

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

  • 55% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 83%. These achievement figures were affected by a low or nil exception rate. The practice had identified errors in coding which they had rectified showing an improvement in figures.
  • 33% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which was lower than the national average of 88%. These achievement figures are affected by the nil exception rate.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.

People whose circumstances may make them vulnerable

Good

Updated 3 June 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.
  • 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.
  • All staff were trained in safeguarding to a level appropriate to their role. The practice plans were to train all staff to a level 3 safeguarding.
  • The GP carried out home visits at weekends and bank holidays to those patients that were ill and/or vulnerable.