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Inspection Summary


Overall summary & rating

Good

Updated 12 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Ivy Grove Surgery on 18 January 2016. The overall rating for the practice including are services safe was good. The full report dated 18 January 2016 can be found by selecting the ‘all reports’ link for Ivy Grove Surgery on our website at www.cqc.org.uk.

We carried out this focused announced inspection on 6 June 2017 in response to information we received from the Coroner concerning a serious incident. We visited Ivy Grove Surgery as part of this inspection to check that the practice had taken action to improve safety relating to the management of controlled drugs (medicines that require extra checks because of their potential for misuse), and ensure that significant events were appropriately reported and managed.

We reviewed the practice against part of one of the five questions we ask about services: are services safe. We found that the practice had carried out an action plan to address the above issues to improve patient safety. The evidence supported that the previous inspection rating of good for are services safe was still accurate.

Our key findings were as follows:

  • The practice had carried out an action plan to improve patient safety relating to the management of controlled drugs.

  • There was an open culture to reporting safety incidents and near misses.

  • The practice had taken action to ensure that significant events including serious incidents were appropriately reported, recorded and acted on to minimise the risk of further occurrences.

  • Following the inspection, the significant events policy was updated to detail all processes followed in practice. We received assurances that all staff had been made aware of this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 July 2017

  • The practice had carried out an action plan to improve patient safety relating to the management of controlled drugs.

  • There was an open culture to reporting safety incidents and near misses.

  • The practice had taken action to ensure that significant events including serious incidents were appropriately reported, recorded and acted on to minimise the risk of further incidents.

  • Lessons were shared with staff and improvements where made where required to provide care and treatment in a safe way.

  • Following the inspection, the significant events policy was updated to detail all processes followed in practice. We received assurances that all staff would be made aware of this.

Effective

Good

Updated 14 April 2016

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines, and other locally agreed guidelines. We also saw evidence that these guidelines were positively influencing and improving practice and outcomes for patients. For example, performance for diabetes related indicators was 98.8%, which was 5.7% above the local and 9.6% above the national average.

  • There was a proactive approach to improving outcomes for patients and ensuring the services were effective.
  • Importance was placed on supporting people to live healthier lives through health promotion and prevention, by offering regular health reviews and various screening checks. For example, 79.3% of women aged 50 to 70 years had been screened for breast cancer in the last 3 years, compared to a national average of 72.2% and a local average of 78.5%.
  • There was a programme of continuous improvement to develop the IT system, to ensure it was used to its full capability as a tool in providing high quality care.

  • The ongoing development of staff skills, competence and knowledge was integral to ensuring high quality care. Staff were actively supported to acquire new skills and share best practice. 

Caring

Good

Updated 14 April 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for most aspects of care. For example, 90% said the last GP they spoke to was good at treating them with care and concern compared to the local average of 86% and national average of 85%.

  • Feedback from patients was consistently positive about their care and the way staff treated them.

  • Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. 
  • Patients were respected and valued as individuals and their choices and preferences were acted on.
  • Staff were motivated and inspired to offer kind and compassionate care.  We observed a strong patient-centred culture.
  • The practice had implemented a carer’s strategy as part of their commitment to raising awareness, and increasing the support available to carers to carry out their role. 

  • Further systems had been put in place to ensure that patients that experienced bereavement received appropriate contact and support.

Responsive

Outstanding

Updated 14 April 2016

The practice is rated as outstanding for providing responsive services.

  • The services were delivered in a way to ensure flexibility, choice and continuity of care.
  • The practice took part in new initiatives, and provided additional in-house services to meet patients’ needs.

    The practice had implemented an innovative appointment system to further improve access for patients. One GP carried out all home visits and a further GP covered urgent health appointments, which enabled them to respond promptly to patient’s needs.

  • Patients told us they were usually able to get appointments or telephone consultations when they needed them.

  • The practice worked closely with other organisations and the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a recent project to align the local care homes to specific practices, had led to a more responsive service and improved continuity of care for patients.
  • The practice implemented suggestions for improvements and changed the way it delivered services, in response to feedback from patients and the patient participation group. For example, people wanted more evening appointments, and the practice increased the extended hours to two evenings a week.
  • Information about how to complain was available and easy to understand. There was an active review of complaints and how they were managed and responded to, and improvements were made as a result.  

Well-led

Good

Updated 14 April 2016

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

  • The practice had a clear vision and strategy to provide high quality care and safe services. The strategy was regularly reviewed and discussed with staff.
  • The staff team were forward thinking and continually strived to drive improvements to ensure the services were well-led.

  • There was effective teamwork and a commitment to improving patient experiences. High standards were promoted and owned by all staff.

  • There was a proactive approach to seeking out and embedding new ways of providing care and services. 
  • There was a clear leadership structure and staff felt supported by management. There was a high level of staff satisfaction and constructive engagement with staff.
  • There was a strong focus on continuous learning and improvements at all levels within the practice. For example, the practice had changed the entire working week to improve access for patients, and to

     

    free up time for learning and to ensure the services were well-led.

  • The practice actively sought feedback from staff and patients, which it acted on to improve the services. The practice had an active patient participation group, which influenced practice development.
Checks on specific services

People with long term conditions

Good

Updated 14 April 2016

The practice was rated as good for the care of people with long-term conditions.

  • The practice held a register of people with long term conditions.
  • Nursing staff had lead roles in the management of long-term conditions and completing patient reviews, having received appropriate training.
  • High importance was placed on patient empowerment and self-management of their condition. For example, prior to attending a review patients with diabetes received a copy of their test results and review form to help them to prepare for this.
  • The practice provided proactive care. For example, care plans were in place for patients with certain long-term conditions to enable them to self-manage changes in their health.
  • Patients received structured reviews, which included education and strategies to enable them to manage their conditions effectively. Various clinic appointment times had been extended to enable the nurses to carry out the above.
  • The practice had produced several information leaflets relating to long term conditions, to ensure patients had access to essential advice and information.
  • Where possible, patients with long term conditions and other needs were reviewed at a single appointment rather than having to attend various reviews.
  • The practice provided an in-house anticoagulation service. Patients also had access to abdominal aortic aneurysm screening at the practice. This enabled patients to attend local services.
  • Patients were sign posted to appropriate support groups.

Families, children and young people

Good

Updated 14 April 2016

The practice is rated as good for the care of families, children and young people.

  • Priority was given to appointment requests for babies and young children; they were seen the same day if unwell.
  • Appointments and telephone consultations were available outside of school and college hours. The premises were equipped and suitable for children and young people.
  • A wide range of medical advice and information was available on the practice website for parents, about childhood vaccinations, minor ailments and how to recognise if a child has a serious illness.

  • Comprehensive systems were in place to identify and follow up children at risk of abuse, or living in disadvantaged circumstances.The practice held a register of children at risk of abuse or harm.

  • Children and young people had access to Safe Speak counselling and support service. Patients from other practices could also attend this.
  • Childhood immunisation rates were high. Rates for under two year olds ranged from 95.7% to 100% and for five year olds ranged from 95.3% to 100%. A robust system was in place for following up children who did not attend their vaccine.
  • The practice provided maternity care and family planning services, including contraceptive implants.
  • Chlamydia screening was encouraged in young people; there was an anonymous test collection point. 

Older people

Good

Updated 14 April 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.

  • The practice kept a palliative care and a hospital admission avoidance register, which included older people with complex needs, at risk of harm or vulnerable. The practice worked closely with other services, and held monthly multidisciplinary meetings to discuss and review patients care and support needs.
  • All palliative care patients had a 1st and 2nd named GP for continuity of care.

    An in-house audiology clinic was held at the practice, which enabled older people to attend locally.

  • Patients over 75 years had access to a health check on request.

  • Patients had access to a chemist collection service which delivered their medicines to their home.

  • As part of the care home initiative a named GP carried out regular structured visits and telephone consultations to care homes to review patients’ needs.
  • The 2013-2014 flu vaccination rates for the over 65s was 81.4%, compared to the national average of 72.5% and the local average of 75.4%.
  • The practice had a large number of older people, including isolated and vulnerable patients. The practice planned to hold an over 75 years open day twice a year, involving the Patient Participation Group and various external agencies such as Age UK, Carers Association, Derbyshire fire and police, continence, hearing and mobility services. The first health day was due to be held on 18 May 2016.

Working age people (including those recently retired and students)

Outstanding

Updated 14 April 2016

The practice is rated as outstanding 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 and flexible.

  • Patients were able to book to book appointments around their working day by telephone, on line or by text.

  • Patients were able to access appointments throughout the day including lunchtime, usually from 8am to 5.50pm daily. They also had access to telephone consultations for advice, test results, treatment, health reviews and to request a medical fit note.

  • Extended opening hours were available on Tuesday and Thursday evenings for those unable to attend in the day.

    A prescription collection service was available with all local pharmacies, which enabled patients to collect their prescription around their working day.

  • Patients had access to a wide range of medical advice, health material and useful contacts on the practice website, including a symptom checker on mobile and desktop sites.

    The practice was proactive in offering online services as well as health checks and screening that reflects the needs for this age group. There was a high uptake for both health screening and checks. For example, 85% of women aged 25 to 64 years had received a cervical screening test in the last 5 years, compared to a national average of 74.3% and a local average of 77.7%.

     

People experiencing poor mental health (including people with dementia)

Good

Updated 14 April 2016

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

  • The practice held registers of patients experiencing poor mental health and with dementia. Patients were offered longer appointments or home visits where needed.
  • Patients were invited to attend an annual health check. Out of 40 eligible patients on the mental health register 29 had received a health check in the last 12 months and 12 had declined.
  • The practice worked with multi-disciplinary teams in the case management of people with poor mental health.
  • The practice had a system in place to follow up patients who had attended the accident and emergency department, where they may have been experiencing poor mental health.
  • Patients had access to counselling and psychological therapies. The alcohol and crisis teams also saw patients at the practice.
  • The practice actively screened appropriate patients for dementia, to support early referral and diagnosis where dementia was indicated.
  • The practice carried out advanced care planning for patients with dementia. Out of 52 eligible patients 35 had received a health check in the last 12 months, one  had declined and seven had not responded to invites. A further seven had an appointment to attend, and the remaining patients were due to be sent an invite before 31 March 2016.

People whose circumstances may make them vulnerable

Good

Updated 14 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice was responsive to the needs of people whose circumstances may make them vulnerable. Patients were offered longer appointments or home visits where needed.

  • The practice held a register of patients whose circumstances may make them vulnerable.
  • The practice worked with multi-disciplinary teams to meet the needs of vulnerable people, and to safeguard children and adults from abuse or harm.
  • All staff had received relevant training on safeguarding vulnerable children and adults. Staff knew how to recognise and respond to signs of abuse in vulnerable adults and children, and how to contact relevant agencies.
  • Patients were informed about how to access support groups and voluntary organisations.
  • Patients with a learning disability were invited to attend an annual health check. Out of 56 eligible patients 33 had received a health check  in the last 12 months, two had declined and two had not attended the appointment. The remaining patients were due to be sent an invite to attend before 31 March 2016.

  • The practice had produced various information and letters in a picture and easy to read form, that patients could understand.