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Dr KS Upton's Practice Good Also known as Tardis Surgery

Inspection Summary


Overall summary & rating

Good

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr KS Upton’s Practice on 16 December 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 a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • 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.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Results from the national GP patient survey 2016 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Patients said they did not find it easy to get through to the practice to make an appointment. There was continuity of care, with urgent appointments available the same day.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.
  • 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 was aware of and complied with the requirements of the duty of candour.

There were areas of practice where the provider should make improvements:

  • Consider pro-actively identifying carers and establishing what support they need.
  • Consider ways to improve patient telephone access to the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found 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 were informed as soon as practicable, received reasonable support, relevant information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 17 March 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 aware of current evidence based guidance.
  • Clinical audits demonstrated improvement.
  • Staff had the skills and knowledge 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.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 17 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice similar to others for most 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.
  • The practice had identified 59 carers on its register. This represented 0.9% of the practice population, which was just below the expected one percent.

Responsive

Good

Updated 17 March 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.
  • The practice took account of the needs and preferences of patients with life-limiting conditions
  • The practice offered extended opening mornings and two evenings two day per week which enabled appointments to be made outside of traditional working hours. There was continuity of care, with urgent appointments available the same day.
  • Patients we spoke with said they did not find it easy to get through to the practice by phone to make an appointment. This was also reflected in the National GP patient survey survey responses which showed that only 49% of patients said they could get through easily to the practice by phone compared to the CCG) average of 72% and the national average of 73%.
  • 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.
  • Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 March 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 policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • 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 for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • 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.
Checks on specific services

People with long term conditions

Good

Updated 17 March 2017

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

  • The GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The GPs and nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.

  • The practice Quality and Outcomes Framework (QOF) score for the care of patients with long-term conditions was similar in some areas compared to the local and national average. For example the practice performance for diabetes related clinical indicators overall was higher than the local Clinical Commissioning Group and England average (77% compared to the local average and England average of 78%.

Families, children and young people

Good

Updated 17 March 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 higher overall for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice’s uptake for the cervical screening programme was 82% which was higher than the local Clinical Commissioning Group (CCG) average of 78% and the same as the England average.
  • The practice offered a confidential sexual health and relationships service to young patients and were part of a scheme which provided patients under the age of 24 years access to free condoms at a range of places across Stoke on Trent and North Staffordshire.

Older people

Good

Updated 17 March 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 patients in its population.
  • 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. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • The practice carried out weekly visits to a care home where some of its elderly patients lived.

Working age people (including those recently retired and students)

Good

Updated 17 March 2017

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

  • The practice offered telephone consultations.
  • The practice offered extended clinic appointments two days per week for working patients who could not attend during the normal opening hours.
  • The practice was proactive in offering online services which included making online prescription and appointment requests.
  • Patients were signposted to 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 17 March 2017

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

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
  • The practice carried out advance care planning for patients living with dementia.
  • 89% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice held a register of patients who experienced poor mental health. Data for the year 2015/16 showed that 94% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Patients at risk of dementia were identified and offered an assessment.

People whose circumstances may make them vulnerable

Good

Updated 17 March 2017

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

  • The practice supported patients who abused substances that could harm their health and wellbeing and provided health, social and professional support.

  • The practice held a register of 24 patients with a learning disability and offered this group of patients longer appointments.

  • The practice had told vulnerable patients about how to access various support groups and voluntary organisations.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.