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Inspection Summary


Overall summary & rating

Good

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at London Lane Clinic on 2 November 2016. 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 an effective system 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 been trained to provide them with 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.
  • Improvements were made to the quality of care as a result of complaints and concerns.
  • Urgent consultations were available the same day for patients who needed them. However patients said they found it difficult to book a routine appointment less than two weeks in advance.
  • 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 practice had identified only 37 patients as carers (0.2% of the practice list). However, in an attempt to increase the identification and support for carers the Health Care Assistant had been nominated a Carer’s Champion for the surgery and had undergone a carers support induction programme provided by the local carers support service.

There was one area where the provider should make improvements:

  • The provider should continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.

Professor Steve Field  CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 January 2017

The practice is rated as good for providing safe services.

  • There was an effective system for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 11 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that patient outcomes were above or comparable to the local and national averages. Exception reporting for most indicators was comparable to the local and national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 11 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as comparable to 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 to them was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect and maintained confidentiality of patient information.

Responsive

Good

Updated 11 January 2017

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.
  • Patients said they sometimes found it difficult to make a routine appointment with a GP but urgent consultations were available via the daily open access clinic. The provider was aware of the current difficulties experienced by patients when booking appointments and was making efforts to address this.
  • 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 11 January 2017

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. Staff were clear about the vision and their responsibilities in relation to it.
  • 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 the reporting and investigation of incidents and this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The patient participation group was active and contributed to the development of the practice improvement programme.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 11 January 2017

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

  • Nursing staff worked closely with GPs and community specialist nurses in the management of patients with long-term conditions.
  • Patients at risk of hospital admission were identified as a priority.
  • The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
  • Longer appointments and home visits were available when needed.
  • 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. These patients were discussed at the multi-disciplinary team meetings held every two months.

Families, children and young people

Good

Updated 11 January 2017

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, 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.
  • Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.
  • The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, who held an antenatal clinic at the surgery every week. Health visitors were based in the clinic and attended safeguarding meetings at the practice as required.

Older people

Good

Updated 11 January 2017

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.
  • Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local and national averages.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had Visiting Medical Officer (VMO) agreements with several local nursing and residential care homes. Partners held lead responsibility for one location each.

Working age people (including those recently retired and students)

Good

Updated 11 January 2017

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.
  • Extended hours evening and Saturday appointments were available at the surgery for patients who could not attend during normal working hours.
  • The practice was proactive in offering online services. The practice Patient & Data Support Worker held promotional sessions in reception to encourage uptake of the service. 
  • A full range of health promotion and screening services were provided that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 January 2017

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

  • 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local average of 83% and national average of 84%.
  • 97% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was higher than the local average of 84% and national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health including those with dementia. The practice carried out advance care planning for patients with dementia.
  • The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations.
  • A counsellor provided a weekly clinic at the surgery.
  • The practice had a system in place to follow up patients who had attended A&E 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 11 January 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 homeless people and those with a learning disability.
  • The practice offered longer appointments and annual reviews for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients 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.