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Pinhoe Surgery Good Also known as Pinhoe & Broadclyst Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 14 September 2016

Letter from the Chief Inspector of General Practice

We carried out a desk top review of Pinhoe Surgery on 1 August 2016. This review was performed to check on the progress of actions taken following an inspection we made on 28 November 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest Inspection on 1 August 2016 we found the provider had made the required changes.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 3 March 2016. This can be done by selecting the 'all reports' link for Pinhoe Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

  • The practice had improved health and safety for patients by implementing robust arrangements for managing medicines, including vaccines, in regard of their recording, handling, storing and security.

  • Improvements to patient safety had been made by ensuring robust arrangements were in place for Patient Group Directions. These had been adopted by the practice to allow nurses to administer medicines in line with legislation..

  • The practice had improved health and safety for patients by implementing safe infection control procedures including an audit of all areas, updating the infection control policy and protocols. All clinical staff had training updates planned to reinforce the measures already taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 September 2016

The practice is rated as good for providing safe services.

At our previous inspection in November 2015 we rated the practice as requires improvement for providing safe services. We found that although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. Areas of concern included, appropriate management of infection control and risks associated with medicines management.

At our follow-up review on 1 August 2016 we looked at areas the practice needed to respond to. Records and information reviewed demonstrated improvements had been made in all required areas including infection control and medicines management, specifically the management and storage of vaccines.

Effective

Good

Updated 3 March 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 demonstrated quality improvement.

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

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

  • The practice nurses performed complex leg ulcer dressings in the practice following extended training at the local hospital with community nurses who specialised in tissue viability.

  • An additional service was provided by staff at the practice for patients with indwelling intravenous lines used for prolonged treatments. For example, chemotherapy, long term antibiotics and intravenous feeding. Patients were normally required to go to hospital for management of this intravenous line. However, staff at the practice had completed extended training to enable patients to receive care locally, at the practice.

Caring

Good

Updated 3 March 2016

The practice is rated as good for providing caring services.

  • The practice was caring and had an active carer and patient support network which had identified lonely, isolated or vulnerable patients. Clyst Caring Friends was a group based at the practice that provided voluntary services and support, which promoted well-being and reduce isolation

  • Patients said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. We also saw that staff treated patients with kindness and respect, and maintained privacy and confidentiality.

  • < >he practice scored highly on the National GP Patient Survey from July 2015. Results showed patients were happy with the care received. 92% of patients said their GP treated them with care and concern (compared to 82% nationally). 90% said the last nurse they spoke to was good at treating them with care and concern (CCG average 81.9%, national average 78%).

Responsive

Good

Updated 3 March 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. For example the practice had previously offered extended hours and, early morning and evening appointments. However, take-up had been poor so this had been stopped. The practice was keeping this under review.

  • 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.

  • The practice nurses performed complex leg ulcer dressings in the practice following extended training at the local hospital with community nurses specialising in tissue viability. The practice nurses had also worked with the dermatology department at the local acute trust to obtain training and advice. Pinhoe Surgery staff input meant patients were able to receive this complex treatment at the practice avoiding the need to attend the community leg ulcer clinic on the other side of the city.

  • An additional service was provided by staff at the practice for patients with indwelling intravenous lines used for prolonged treatments such as chemotherapy, long term antibiotics and intravenous feeding. Patients were normally required to go to hospital for management of this intravenous line. However, staff at the practice had completed extended training to enable patients to receive care locally, at the practice.

  • 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 3 March 2016

The practice is rated as good for being well-led.

  • 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 had just become a face to face group with the first meeting planned for January 2016.

  • 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 March 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine 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.

  • The practice employed experienced nurse practitioners who ran chronic disease clinics.The Practice nurses had completed all levels of leg ulcer dressings and had good access to tissue viability specialists for support and guidance.

  • The practice provided enhanced services for near patient testing including in-house International Normalised Ratio monitoring (INR). This reduced the burden on hospital clinic waiting times and providing a more cost-effective and convenient service for patients in their local health communities. This had proved very popular with patients prescribed warfarin as they could be tested and received their ongoing dose regime at the same appointment.

  • Nurses were trained in the care of patients with indwelling intravenous lines used for prolonged treatments. For example, chemotherapy, long term antibiotics and intravenous feeding. Patients were normally required to go to hospital for management of this intravenous line. However, staff at the practice had completed extended training to enable patients to receive care locally, at the practice.

Families, children and young people

Good

Updated 3 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 good 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. However, there was minimal health promotion information available for younger people to signpost them to support groups or provide them with information in areas that maybe specific to them. For example sexual health or chlamydia testing.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. The practice always offered same day GP appointments to children when requested. There were after school appointments with a nurse for children and young people who need immunisations or asthma reviews.

  • We saw good examples of joint working with midwives, health visitors and school nurses. A community midwife ran a weekly clinic from the practice. They had access to the clinical system and was able to liaise with GPs as required.

  • Meetings were held with health visitors and school nurses every 6 months to ensure that information was appropriately shared and that any families at risk were identified and supported.

Older people

Good

Updated 3 March 2016

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

  • The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

  • Comprehensive support was available for older people aimed at reducing the risks associated with social isolation and lowering unplanned hospital admissions. Home visits, if necessary were provided for frail people as well as rapid access appointments for those with enhanced needs. Named staff had link roles to adult social care homes to provide continuity of care and treatment for patients living there. The practice had frequent contact with community teams and participated in weekly meetings with other healthcare professionals to discuss any concerns. Innovative support systems were in place run through a charity set up and chaired by a senior GP at the practice. These included a befriending service, patient transport and access to the local day centre.

Working age people (including those recently retired and students)

Good

Updated 3 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 March 2016

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 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.

  • Two depression and anxiety counsellors visited the practice weekly so that patients could get rapid access in a more convenient location.

People whose circumstances may make them vulnerable

Good

Updated 3 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 homeless people, and those with a learning disability. It offered longer appointments for people with a learning disability. There was a person centred approach, which ensured people with communication needs received information in a format that was most appropriate for them. The practice had completed 93% of annual health checks 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.

  • 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.