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Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Street Surgery on 4 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 an effective system in place for reporting and recording significant events. All significant events and incidents were discussed at practice meetings so that learning could be shared.

• Most risks to patients were assessed and well managed, although we found a risk relating to the maintenance of the building had not been resolved.

• 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.

• Recruitment checks had been carried out prior to employment.

• 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.

• Most 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.

In addition the provider should:

  • Ensure environmental risks relating to the practice environment are resolved promptly.
  • If a decision is made to not have an automated external defibrillator (AED) on-site, undertake a formal risk assessment of not having access to an AED during practice opening hours.
  • Review national guidance relating to annual basic life support training for non-clinical staff.
  • Advertise that translation services are available to patients on request.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there are unintended or unexpected safety incidents, people received reasonable support, truthful information, an apology and 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 people safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed. For example, those relating to infection prevention and control, medicines management, and dealing with emergencies. However, we found that an environmental risk relating to the maintenance of the building had not been resolved.
  • Recruitment checks had been carried out for new starters prior to employment.
  • Arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs.
  • We found that some non-clinical staff required training or updated training for basic life support. During our visit the practice made arrangements for staff to undergo this training.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services.

  • Data showed 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 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 people’s needs.

Caring

Good

Updated 21 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice similar to or 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 21 January 2016

The practice is rated as good for providing responsive services.

  • It reviewed the needs of its local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified.
  • Most patients said they found it easy to access the service and make an appointment. Patients confirmed that they could usually see a doctor on the same day and were aware that this might not be with the GP of their choice.
  • 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.

Well-led

Good

Updated 21 January 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 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 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
Checks on specific services

People with long term conditions

Good

Updated 21 January 2016

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

  • The percentage of patients at the practice with a long standing health condition (48.8%) was lower than the national average of 54%, and those with health related problems in daily life (53.9%) was higher than the national average of 48.8%.

  • Nationally reported data showed that outcomes for patients with long term conditions was good.
  • 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.
  • GPs and nurses had lead roles in chronic disease management. Some clinicians had additional diplomas in diabetes and asthma.
  • Patients could attend the practice to have a blood test which measured how well their anticoagulation medication was working.
  • Patients at risk of hospital admission were identified as a priority and discussed at weekly clinical meetings and monthly multidisciplinary team meetings.
  • Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 21 January 2016

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

  • Children aged zero to four represented 7.2% of the practice population (national average 6.0%); children aged five to 14 represented 12.4% (national average 11.4%); and those aged under 18 years represented 15.1% (national average 14.8%). The income deprivation level affecting children was 40 compared to the national average of 22.5.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, there was joint working with the health visitors to discuss children on the child protection register, and the practice had procedures to follow when children and young people did not attend appointments.
  • Urgent access appointments were available for children who were unwell.
  • Immunisation rates for standard childhood immunisations were in line with the CCG averages.
  • The practice ran a weekly paediatric phlebotomy clinic for children under 16.
  • Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered antenatal and postnatal services.

Older people

Good

Updated 21 January 2016

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

  • The practice had a similar percentage of patients over the age of 75 (5.6%) when compared to the national average (7.6%), and patients over the age of 85 (1.9% compared to the national average of 2.2%). The income deprivation level affecting older people was 32 compared to the national average of 22.5.

  • 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 GP and were informed of this.
  • The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, which included offering the shingles vaccination and avoiding unplanned admissions to hospital.
  • Monthly multidisciplinary team meetings were used to review care plans and discuss those with enhanced needs. The practice targeted 2% of the most at risk patients, the majority of whom were elderly, to ensure their needs were met.
  • The practice were responsive to the needs of older people, and offered longer appointments, home visits and rapid access appointments for those with enhanced care needs.
  • Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions.
  • The practice looked after patients from three residential care homes and the GPs carried out six monthly reviews or more frequent visits when required.

Working age people (including those recently retired and students)

Good

Updated 21 January 2016

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

  • The number of patients in paid work or full-time education was above the national average, 66% compared to 60.2%.
  • 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 had a website which offered facilities to book appointments and order repeat prescriptions online. Text messaging was used for confirming appointments and health promotion.
  • ‘Commuter Clinics’ were available on Thursday morning from 07:30 to 08:00, and on Tuesday and Thursday evening until 19.30. These appointments were prioritised for working patients who could not attend the practice during normal opening hours.
  • There was a full range of health promotion and screening that reflected the needs for this age group, including NHS health checks for patients aged 40 to 74.
  • The practice’s uptake for the cervical screening programme was 77.9%, which was similar to the CCG average of 78.3% and below the national average of 81.8%.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 January 2016

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

  • In 2014/15 performance for mental health related indicators was above the CCG and national averages (practice 100%; CCG 94.9%; national 92.8%).
  • Nationally reported data showed that outcomes for patients with dementia were good. For example, the practice’s performance for dementia related indicators in 2014/15 was above the CCG and national averages (practice 100%; CCG 96.3%; national 94.5%).
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
  • Patients could be referred to a primary care mental health nurse who attended the practice each week.
  • 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.
  • 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 21 January 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 housebound patients, carers, those with a learning disability, patients receiving end of life care, and homeless patients.
  • It offered longer appointments for vulnerable patients who may need it. Housebound patients and those who could not access the practice were supported via home visits or a community bus service which would bring patients to the practice.
  • 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.