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Inspection Summary


Overall summary & rating

Good

Updated 12 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Station Road Surgery on 16 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • The practice had an open and transparent approach to safety and an effective system in place for reporting and recording significant events, although it was not always clear how this information was shared across the practice.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff had 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.
  • Patients generally 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.
  • 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 improvement are:

  • Continue to review patient feedback and work to improve patient experience with long waiting times.

  • Continue to develop the patient participation group.

  • Review how learning is shared across the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events, although it was not clear how this information was shared within the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information and a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed and the practice had suitable arrangements to deal with emergencies.

Effective

Good

Updated 12 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were generally at the average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits were used to ensure 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 December 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than 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.

Responsive

Good

Updated 12 December 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. For example early morning and Saturday appointments were started in response to patient feedback.

  • Patients sometimes 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.

  • 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 12 December 2016

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

  • The practice had a clear vision and strategy to deliver high quality patient centred 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 partners had different areas of responsibility within the practice to share the non-clinical workload. The practice had a number of policies and procedures to govern activity which were reviewed regularly. The partners 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 sought feedback from staff and patients, which it acted on. The patient participation group had recently reformed with 17 members partially representing the patient population. This group had not met but were being involved in reviewing services provided and supporting the practice to make improvements.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 12 December 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 practice had registers of patients with the various long term conditions and had systems in place to recall patients for regular reviews. Nursing staff received regular training updates to monitor these patients appropriately.

  • Performance for diabetes related indicators was generally comparable to other practices, with numbers for some indicators above and others below the CCG and national averages. For example: 80% of patients had the flu immunisation between April 2014 and March 2015. The practice had developed an action plan and had increased the number to 88% between March 2105 and February 2016; 80% had records of their cholesterol between April 2014 and March 2015 was 80%, same as the national figures. Clinical staff had completed updated training in care of patients with diabetes.

  • 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.

Families, children and young people

Good

Updated 12 December 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.

  • The practice sent new parents a congratulations letter which included an information pack with the immunisation schedule, a new baby registration form for the practice and information about breast feeding. Immunisation rates were in line or above national averages for all standard childhood immunisations.

  • 75% of patients diagnosed with asthma had a review of their condition between April 2014 and March 2015 was 75%, the same as the national average.

  • 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.

  • 86% of female patients aged 25-64 had cervical screening test in the last five years which was above the local and national average.

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

  • We saw positive examples of joint working with health visitors and midwives, families with children under five were routinely discussed.

Older people

Good

Updated 12 December 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 named doctor.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They maintained a list of patients who needed home visits and carried out at least annual reviews for all these patients.

  • The practice had an arrangement with a local practice for patients to attend blood tests rather than travelling to the hospital for this service.

  • The practice provided a weekly service to a local nursing home and fortnightly visits to a local care home and carried out home visits to patients in their own homes when they were required.

Working age people (including those recently retired and students)

Good

Updated 12 December 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. It provided early morning appointments three mornings a week and appointments on alternate Saturdays.

  • The practice was proactive in offering online services including an electronic prescriptions service. There was a system for clinical staff to return patients telephone calls.

  • The practice provided 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 12 December 2016

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

  • 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting between April 2014 and March 2015, which was below the national average of 84%. The practice had developed an action plan to improve this number by training the health care assistant to complete them.
  • 95% of patients with schizophrenia, bipolar affected disorder and other psychoses had a review of their care plan (above the national average of 88%) and 87% had a record of their alcohol consumption which was in line with the national average.

  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 12 December 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, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability. They had 15 patients on the learning disability register and all had received an annual health care review.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • 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.