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Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirkgate Surgery on 11 November 2015. 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 a 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 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 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:

  • In the recording, monitoring, action planning and identification of any themes and trends relating to significant events.
  • To have a process to check that staff have appropriate and current registration with a professional regulator and medical indemnity.
  • Use of the functionality of the computer record system should be improved by further IT training by clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events, however this needed some improvement in the monitoring and reflection on action plans.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had systems, processes and practices in place to keep people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 4 February 2016

The practice is rated as good for providing effective services.

  • Data showed many 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 improvements.
  • 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 people’s needs.

Caring

Good

Updated 4 February 2016

The practice is rated as good for providing caring services.

  • Data showed that 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 4 February 2016

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, a care co-ordinator worked at the practice one day a week to help join up health and social care services for older patients and those with long term conditions.
  • 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.
  • 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 4 February 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.
  • 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 was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 4 February 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 quality and outcomes framework (QOF) indicators for diabetes were better than the national averages.
  • 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 medicines 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.
  • A GP in the practice was the palliative care lead for the local Clinical Commissioning Group.

Families, children and young people

Good

Updated 4 February 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.
  • The percentage of women having cervical screening was comparable to the national average.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • A midwife provided weekly antenatal clinics, post natal checks were done jointly by the practice nurse and GP.
  • Information was readily available about family support services and sexual health.

Older people

Good

Updated 4 February 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.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Additional services such as hearing clinics were provided at the practice to avoid patients needing to travel to hospital.
  • The practice was a pilot site for a local clinical co-ordinator scheme one day per week

Working age people (including those recently retired and students)

Good

Updated 4 February 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. For example, by employing advanced nurse practitioners to increase access for patients.
  • 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 4 February 2016

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

  • 93% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. The practice acted as a safe haven for patients with dementia and members of the reception staff had attended dementia awareness courses.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 4 February 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.
  • It offered longer appointments 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.

The practice had arranged for another agency to provide counselling and support to individuals with alcohol dependency problems. This service was also available to patients registered with other GP practices.