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Inspection Summary


Overall summary & rating

Good

Updated 2 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Station Road Surgery on 14 June 2017. The overall rating for the practice was Good. However we rated the practice as Requires Improvement for providing safe services. The full comprehensive inspection report can be found by selecting the ‘all reports’ link for Station Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation which we identified at our previous inspection on 14 June 2017. The report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

The practice is now rated as Good for providing safe services.

Our key findings were follows:

  • Processes for receiving and acting upon patient safety alerts had been improved. Systems had been streamlined. Searches were made in patient records to identify patients affected by any such alerts, and appropriate action was taken when necessary.
  • Vaccine stock levels were logged and monitored.
  • Communication with locums had been improved to encourage attendance at meetings, or disseminating of minutes from meetings where attendance was not possible.
  • The practice was continuing to engage with patients to review satisfaction with access to appointments. The practice was participating in a CCG wide audit of patient satisfaction with access to appointments with GPs, which was due to end on 6 November 2017.

However we found one area where the provider should make an improvement:

The provider should:

  • Deliver on their plan to carry out any remaining staff appraisals by December 2017.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 November 2017

This inspection was conducted to review issues that we found during our comprehensive inspection carried out on 14 June 2017. The issues identified at that inspection included:

  • Medicines and Health Regulatory Agency (MHRA) and other patient safety alerts were not always acted upon in a timely way.

  • There were systems in place to record vaccine refrigerator temperatures. At the time of our visit full vaccine fridge logs were not available and were provided following the inspection. In addition, vaccine stock levels were not monitored to ensure stock levels were accounted for and accurate.
  • Regular staff meetings were held. At the time of our visit locum staff were not always able to access such meetings.
  • The practice had received a number of patient complaints in relation to access to appointments. The practice had developed systems to continually monitor and assess the level of appointment availability.

Our inspection on 24 October 2017 found:

  • Processes for receiving and acting upon patient safety alerts had been improved. Systems had been streamlined. Searches were made in patient records to identify patients affected by any such alerts, and appropriate action was taken when necessary.
  • Vaccine stock levels were logged and monitored. Vaccine refrigerator temperature logs were available, and were complete.
  • Staff were aware of the process for reporting significant events. We saw that these were discussed and reviewed at staff meetings, and that learning from incidents was shared.
  • Communication with locums had been improved to encourage attendance at meetings. Minutes from meetings were disseminated where attendance was not possible.
  • The practice was continuing to engage with patients to review satisfaction with access to appointments. The practice was participating in a CCG wide audit of patient satisfaction with access to appointments with GPs, which was due to end on 6 November 2017.
  • The provider showed us their plan to carry out any remaining staff appraisals by December 2017.

Effective

Good

Updated 27 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • Staff were able to demonstrate their awareness of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment. We reviewed details of staff training, and saw that opportunities for all staff to maintain mandatory and role specific training were provided.

  • We saw that a timetable for staff appraisals had been developed, which would ensure all staff had received an appropriate appraisal and personal development plan by September 2017. We reviewed examples of appraisals which had been completed; and saw there was a comprehensive and thorough process in place.

  • The practice held regular multidisciplinary meetings in house, and worked closely with the Primary Care Team to understand and meet the range and complexity of patients’ needs.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 27 July 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for several aspects of care.

  • Patient comment cards we reviewed reflected patients’ views and showed that patients felt 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 accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice maintained a register of people undertaking an unpaid caring role for friends, neighbours or family. We saw that 2% of the practice population (185 people) had been identified as carrying out this role.

Responsive

Good

Updated 27 July 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example a men’s health ‘drop in’ open day had been held; and a number of unmet health issues had been identified, which the practice were acting on and providing appropriate follow up and treatment.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Patient comment cards we reviewed demonstrated that access to appointments had improved in recent months. We were told that urgent appointments were made available when needed.

  • The practice had some limitations in relation to premises. However we saw that good use had been made of the space available. Premises were accessible to patients with limited mobility, or those who used a wheelchair.

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

  • The practice had responded to a number of complaints which they had received in relation to accessing the practice by telephone, and availability of appointments. A new telephone system had been introduced, with additional staff deployed to answer incoming calls during busy times. Appointment availability was closely monitored; with telephone triage, telephone appointments, same day and routine appointments available. In addition the practice was taking part in the ‘practice assist’ pilot which enabled patients to receive telephone consultations offered by qualified GPs off site.

Well-led

Good

Updated 27 July 2017

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

  • The practice had undergone a period of significant disruption and staffing changes in the preceding 18 months. The practice had experienced two floods; one in December 2015 during high levels of rain; and another one in May 2017 when they experienced an internal water leak. In this period a number of key staff personnel had left the practice, including two GP partners, practice nurses and practice manager. At the time of our visit a locum practice manager had recently been appointed, with a view to a long term position. Additional clinical and non-clinical staff posts had been filled. The leadership team told us they were developing and nurturing a cohesive staff team. Staff we spoke with confirmed that the shared vision of continuing to improve and provide the best possible care for patients was understood and embraced by all members of the team.

  • There had been recent disruptions to the leadership structure in the practice. Staff spoke positively about support they received from the GP partners and newly appointed locum practice manager. Staff told us they felt able to make suggestions and give feedback, and action was taken in response to this when appropriate

  • The practice had policies and procedures to govern activity and held regular governance meetings. 

  • The practice had engaged an external company to develop and carry out health and safety risk assessments. We looked at these, and saw they were appropriate, and in date.

  • We saw evidence of a clear induction process. Appraisal dates were planned for all staff. We saw evidence of a plan which would ensure all staff had received an appraisal by September 2017.

  • Staff meetings were held regularly. Staff had access to training and learning appropriate to their role. We saw minutes from meetings which demonstrated that information from matters such as medicine or drug alerts was discussed at clinical meetings. However, locum staff did not always have access to these discussions.

  • The partners encouraged a culture of openness and honesty. The provider was aware of the requirements of the duty of candour. In three examples we reviewed we saw evidence the practice complied with these requirements.

  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.

  • The practice provided opportunities for apprenticeships within the staff team. Staff at all levels were able to access training and development appropriate to their role.

Checks on specific services

People with long term conditions

Good

Updated 27 July 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • 79% of patients with diabetes, on the register, had a cholesterol reading which was within normal limits recorded in the preceding 12 months, compared to the CCG average of 81% and the national average of 80%.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • The practice had recently carried out searches on patient records. As a result 343 patients had been added to a number of disease registers.

  • The practice had developed in-house chronic disease management templates.

  • One of the practice nurses had received enhanced training in diabetes care and treatment. The nurse was qualified, with GP support, to initiate insulin treatment for diabetic patients where appropriate.

  • We saw that patient information leaflets had been developed, to provide patients with diabetes with additional information to help them with managing their condition.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with the wider multidisciplinary team to deliver appropriate care packages.

Families, children and young people

Good

Updated 27 July 2017

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

  • The practice held monthly meeting with the health visitor. This allowed them the opportunity 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 accident and emergency (A&E) attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Staff told us that children under five years of age were prioritised for same day appointments.

  • The practice had employed a nurse who provided a full range of contraceptive and sexual health services to patients. They told us they were considering introducing a ‘drop in’ element to the service to broaden the appeal for younger people.

  • The practice liaised with appropriate agencies, such as midwives and the local neonatal unit, to provide support for premature babies and their families following discharge from hospital.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 27 July 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. We saw that 93% of patients over 75 years taking multiple medicines had a review of their medicines completed in the preceding year. 57% of patients over 75 years had a care plan in place.

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

  • The practice identified at an early stage older patients who may need palliative care. as they were approaching the end of life. The practice held quarterly palliative (end of life) care meetings with specialist nurses and the community matron. Weekly meetings with district nurses were also held. Older patients were involved in planning and making decisions about their care.

  • The practice had identified over 2% of their population who were at risk of unplanned hospital admission; and followed up on these, and other older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services, such as out of hours (OOH) services.

  • Before the inspection we sought feedback from a residential home for older people who were registered with the practice. They told us the practice provided a responsive and caring service to their residents.

Working age people (including those recently retired and students)

Good

Updated 27 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations 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 offered online services. In February 2017 the practice had changed their clinical system, which had resulted in the loss of 3000 patients who had previously registered for online services from the online access database. At the time of our visit the practice was actively promoting this service, and encouraging patients to re-register. When we visited, we saw that 896 patients (9% of the practice population) were registered for the service.

  • The practice offered a full range of health promotion and screening appropriate to this age group.

  • An ‘E-Consult’ service was available on the practice website, which enabled patients to complete details of their symptoms for minor illnesses; and the practice made contact to provide additional advice and support if needed.

  • Students were encouraged to register with the practice as temporary patients during holiday periods.

  • The practice was participating in a ‘Practice Assist’ pilot which gave patients contacting the surgery for an appointment the opportunity to receive a telephone consultation from a GP situated remotely, not attached to the practice.

  • A men’s health event had recently been held in the practice. Out of 45 attendees, 35 had been found to have unmet health needs which required further follow up. 100% of attendees said they had found the event beneficial; and that they felt better informed about their health as a result.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 July 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 82% and the national average of 84%.

  • 100% of patients with dementia had a care plan in place at the time of our visit.

  • The practice made use of pharmacists employed by the practice to monitor repeat prescribing for patients receiving medicines for mental health needs.

  • 84% of patients with schizophrenia or other psychoses had their blood pressure recording completed in the preceding 12 months, which was lower than the CCG average of 90% and the national average of 89%.

  • The practice worked with other professionals, such as mental health teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients with mental health problems, who were experiencing a crisis, were offered same day GP assessment.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 27 July 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.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered longer appointments for patients with a learning disability.
  • We saw evidence that 45 out of 60 (75%) of annual reviews for patients with learning disability had been completed in the previous year.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff we spoke with demonstrated their awareness of how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
  • Before the inspection we sought feedback from a care home for younger physically disabled people who were registered with the practice. They told us that overall they were satisfied with the service; however they had experienced some difficulties in accessing the practice by telephone, and in relation to medicines requests. We fed this back to the practice who told us they would make contact with the home and develop improved systems of communication.