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Inspection Summary


Overall summary & rating

Good

Updated 29 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spa Medical Centre on 12 April 2016. The overall rating for this service is good.

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

  • The practice provided patients with care which was planned and delivered following best practice guidance. Staff told us and records showed that training appropriate to their roles had been carried out. Staff training needs had been identified and planned for the following year.

  • There was a system in place to raise concerns and report significant events. Staff understood their responsibilities to raise concerns, and to report significant events. These were discussed regularly at meetings and were a standing agenda item. Learning was shared with practice staff regularly and with other practices in the locality.

  • Information was provided to help patients understand the care available to them. Patients told us they were treated kindly and respectfully by staff at the practice. Their treatment options were explained to them so they were involved in their care and decisions about their treatment.
  • The practice was well equipped and had good facilities to treat patients and meet their needs.

  • Information about services and how to complain was available in the reception area and patients told us that they knew how to complain if they needed to.
  • There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from patients, which it acted on. Staff appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice.

However there are areas where improvements are needed.

The areas where the provider should make improvements are:

  • Take action to ensure that the infection control measures in place are followed and applied consistently by all staff.
  • Take action to ensure that all policies and procedures are dated and kept under regular review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 June 2016

The practice is rated as good for providing safe services.

  • The practice had a system in place for reporting and recording significant events. Staff were actively encouraged to report all incidents and near misses. Staff recognised this was part of their role and responsibilities.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • There were safeguarding measures in place to help protect children and vulnerable adults from the risk of abuse. Staff had received training to the appropriate level which had equipped them to protect vulnerable patients.
  • Risks to patients were assessed and well managed. There were robust systems in place to manage patient safety alerts, including medicines alerts which were acted upon. Action should be taken to ensure that the infection control measures in place are followed and applied consistently by all staff.

Effective

Good

Updated 29 June 2016

The practice is rated as good for providing effective services.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice had carried out clinical audits to ensure best practice was followed in providing quality services for patients.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. NICE is the organisation responsible for promoting clinical excellence and cost-effectiveness. NICE produced and issued clinical guidelines to ensure that every NHS patient gets fair access to quality treatment.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Annual appraisals and personal development plans were completed for all staff. Staff confirmed these were carried out annually.

Caring

Good

Updated 29 June 2016

The practice is rated as good for providing caring services.

  • Results from the National GP Patient Survey published in January 2016 showed that the practice scored average or below average for results in relation to patients’ experience and satisfaction scores on consultations with the GPs and the nurses. The practice had responded to the results and action was taken. Patients were encouraged to book appointments online and telephone triage was introduced.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.
  • Patients were very complimentary about the practice and commented that staff were very friendly, that they received excellent care from the GPs and the nurses, and could always get an appointment when they needed one.
  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 29 June 2016

The practice is rated as good for providing responsive services.

  • The practice was responsive to patients’ needs and had systems in place to maintain the level of service provided. Services were planned and delivered to take into account the needs of different patient groups to ensure flexibility, choice and continuity of care.
  • The practice offered a dual appointment system. One GP offered traditional appointments where patients contacted the practice for an appointment. The other GP offered triage telephone appointments with follow up appointments arranged when a patient needed to be seen by the GP.
  • Extended hours were available for the benefit of patients unable to attend during the main part of the working day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Translation services were available to patients should they need this. Information about this facility was available on the information board in the reception area. An in-house interpreter was also available.
  • Results from the National GP Patient Survey published in January 2016 showed that patients’ satisfaction with how they could access care and treatment was generally in line with or below local and national averages. For example, 94% of patients said the last appointment they got was convenient which was in line with the CCG and the national averages. 70% of patients described their experience of making an appointment as good which was below the CCG average of 79% and a national average of 73%. The practice had taken action in response to these results.
  • 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 practices within the local Clinical Commissioning Group (CCG) group and the GP Federation.

Well-led

Good

Updated 29 June 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 understood the values of the practice and worked to provide a service which was patient-centred.
  • 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 were processes in place to monitor and improve quality and identify risk, although improvements were needed to evidence that learning was shared.
  • The practice had a range of policies and procedures in place to guide staff, however we found that not all of the policies and procedures were up to date or had been dated.
  • Staff had received inductions and attended staff meetings. Staff told us they were supported to develop their skills to improve services for patients.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active Patient Participation Group (PPG) which was positive about their role in working with the practice to respond to patients feedback and make improvements where needed.
Checks on specific services

People with long term conditions

Good

Updated 29 June 2016

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

  • The quality monitoring data (QOF) for 2014/2015 showed that the percentage of patients with diabetes who had received a foot examination and risk classification for monitoring their conditions was 86% which was 6% below the CCG average and 3% below the national average. The practice had recruited nursing staff and restructured the nursing team to provide continuity of care and improve patient reviews.
  • The practice nurses 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.
  • Longer appointments and home visits were available when needed for patients diagnosed with a long term condition. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 29 June 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 who were at risk of abuse. For example, children and young patients who had a high number of accident and emergency (A&E) attendances. Staff had received safeguarding training. They were aware of their responsibilities in protecting children who were at risk of harm.
  • Childhood immunisation rates were higher than the local Clinical Commissioning Group (CCG) averages.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence that confirmed this.
  • Appointments were available outside of school hours and the premises were suitable and accessible for children.
  • We saw good examples of joint working with midwives, health visitors, and district nurses.
  • Appointments were available outside school hours. A number of online services including booking appointments and requesting repeat medicines were also available.

Older people

Good

Updated 29 June 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • It was responsive to the needs of older patients, and offered home visits and urgent appointments for those patients unable to access the practice.
  • There was a dedicated nurse who worked with Age UK to provide holistic reviews of patients over the age of 75 years, and worked proactively with the practice to help patients maintain good health.
  • The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs.

Working age people (including those recently retired and students)

Good

Updated 29 June 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 offered weekly evening extended hours so that patients could access appointments around their working hours.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 June 2016

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

  • The practice held a register of patients experiencing poor mental health including those patients with dementia. Advanced care planning and annual health checks were carried out which took into account patients’ circumstances and support networks in addition to their physical health. Longer appointments were arranged for this and patients were seen by the GP they preferred. Patients were given information about how to access various support groups and voluntary organisations.
  • The percentage of patients diagnosed with dementia whose care has been reviewed for 2014/2015 was 84% which was 14% lower than the CCG average and 11% lower than the national average. The practice had recruited nursing staff, restructured the nursing team, and developed more effective recall systems to improve on these rates.
  • The GPs and the practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
  • The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations. Staff had received training on how to care for patients with mental health needs and dementia.
  • There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 29 June 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those patients with a learning disability.
  • The practice offered longer appointments for patients with a learning disability, and had completed annual health checks for all 12 patients on their register. Communication aids such as easy read and picture formats were available to ensure communication opportunities were enhanced.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments or offered longer appointments.
  • Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. Staff were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.
  • The practice told us they were in the process of reviewing carers asinformation about carers had not always been collected from patients. Forms were now available for reception staff to ask patients for this information. The GPs and the nurses were to review their care plans in order to ascertain whether any carers had been missed.A poster was displayed in the waiting room advertising support for carers.