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Inspection Summary


Overall summary & rating

Good

Updated 10 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on May 2015 and a focused inspection in January 2016. During both inspections we found the same breach of legal requirement and the provider was rated as requires improvement under the safe domain. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

  • Ensuring that all recruitment checks are carried out and recorded as part of the staff recruitment process, including a risk assessment as to which staff required a criminal records check with the disclosure and barring service (DBS).

We undertook this announced focused inspection on 8 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the safe domain.

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

  • The practice had reviewed their processes for the employment of staff and ensured that recruitment checks were carried out and all required information was recorded. This included, proof of identification including photo identification, references, full works history, signed confidentially forms and where required disclosure and barring checks (DBS). We saw that risk assessment had also taken place to review whether a DBS check was required for individual staff members.

We also received concerns raised by patients in relation to access to GPs. We spoke with the two GP partners about this. They were able to explain they had difficulties in recruiting and retaining GPs, this was partly due to many GPs not wishing to work full time. In response to this the GPs had come up with several initiatives to ensure that extra GPs had been recruited and that patients had timely access to emergency appointments and GP appointments.

Initiatives included:-

  • Creating an on the day urgent care centre at Giggs Hill. Patients who required an on the day emergency appointment were given a two hour sit and wait time slot either in the morning or afternoon to see the Advanced Nurse Practitioners (who had support from the duty GP). The practice had plans to ensure that urgent care would also be provided from Glenlyn each morning, Monday to Friday after acting on comments from the patient participation group (PPG).
  • Having a daily Administration GP assigned, which covered both Glenlyn and Giggs Hill. This role meant that all prescriptions, test results, calling patients for reviews etc. and administrative duties for all GPs were covered by a single GP. This ensured that any administration duties for GPs would not be delayed and the practice had been able to employ more GPs including those who wished to work part time. Patient prescription requests were completed in a timely fashion and the Administration GP had more time to review test results and decide on next actions to take for patients.
  • Having a Duty GP which covered both Glenlyn and Giggs Hill. The duty GP had a slightly lighter patient list for the day to be able to support the advanced nurse practitioners and to take urgent phone appointments and could be called upon to help with enquiries from staff or other GPs.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Glenlyn medical Centre on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 January 2017

Previously the practice had been rated as requires improvement for providing safe services as the provider had failed to ensure that recruitment files contain the required information. For example, files did not contain proof of identification including photo identification, references, reasons for leaving their last employment or if gaps in employment had been investigated.

At this inspection in December 2016, we found the processes for recruitment had been reviewed and a new system put in place. Files we reviewed all contained the required information. Staff we spoke with told us that staff at the main site and branch location merged at the beginning of 2016. This had given the practice the opportunity to review all recruitment files and to ensure the required information was retained and recorded in individual files. Check lists had been put in a place and a new recruitment policy written.

Effective

Good

Updated 21 March 2016

The practice is rated as good for providing effective services.

We were able to review the computer system to review test results and saw that these were reviewed in a timely manner and where necessary patients were contacted either the day the results were reviewed or the day after if further investigation was needed.

We found that no staff had the sole role as phlebotomist and instead were employed as Health Care Assistants (HCA). Staff we spoke with and evidence we saw showed that staff had been trained to take on all the duties they performed.

At our previous comprehensive inspection in May 2015 we found:-

  • Data showed patient outcomes were at or above average for the locality.
  • Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely.
  • Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health.
  • Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with local multidisciplinary teams to provide patient centred care.

Caring

Good

Updated 23 July 2015

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality. During the inspection we witnessed staff interacting with patients in a way that was respectful and friendly. The practice advertised local support groups so that patients could access additional support if required.

Responsive

Good

Updated 21 March 2016

The practice is rated as good for providing responsive services.

The branch surgery and main practice were acting as one. Therefore patients were able to access appointments at both locations. The practice had recently merged the two patients lists and the computer system. The phone lines were due to be transferred to one number in the next few weeks so calls would be taken from one location.

We reviewed the clinics listed for the INR clinics going back three months from October to December 2015 and found that during that time only one clinic had been cancelled.

At our previous comprehensive inspection in May 2015 we found:-

  • 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.
  • Patients told us they did not always find it easy to make an appointment with a named GP. However, they had been able to access urgent appointments on 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.

Well-led

Good

Updated 21 March 2016

The practice is rated as good for being well-led.

At our previous comprehensive inspection in May 2015 we found:-

  • It had a clear vision and strategy. 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 meetings.
  • There were systems in place to monitor and improve quality and identify risk.
  • The practice proactively sought feedback from staff and patients.
  • The patient participation group (PPG) was in the process of being re-organised due to a recent merger with another practice.
  • Staff had received inductions, regular performance reviews and attended staff meetings and events.
Checks on specific services

People with long term conditions

Good

Updated 23 July 2015

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. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medicine needs were being met. The GPs followed national guidance for reviewing all aspects of a patient’s long term health. 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. The practice nurses were trained and experienced to support patients with managing their conditions and preventing deterioration in their health. The local clinical commissioning group had funded a specialist diabetic nurse to offer support and training to the practice to increase clinician’s knowledge. Diabetic patients were supported by the practice in managing their condition and were encouraged to monitor their own condition and set health goals. The practice had a specialist respiratory nurse who managed all asthma and chronic obstructive pulmonary disease (COPD) patients. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness.

Families, children and young people

Good

Updated 23 July 2015

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. Monthly meeting were held with health visitors to discuss any children of concern. Immunisation rates were average for the local clinical commissioning group (CCG) area. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff. The practice ensured that children needing emergency appointments would be seen on the day.

Older people

Good

Updated 23 July 2015

The practice is rated as good for the care of older people. Patients had a named GP which allowed for continuity of care. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care. Elderly patients with complex care needs all had personalised care plans that were shared with local organisations to facilitate the continuity of care. The practice was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs. Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues. The practice had a safeguarding lead for vulnerable adults. The practice had good relationships with a range of support groups for older patients. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. Clinics included diabetic reviews and blood tests. Blood pressure monitoring was also available.

Working age people (including those recently retired and students)

Good

Updated 23 July 2015

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 and flexible. For example, the practice was open Monday to Friday 8am to 8pm and offered Saturday morning appointments. 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. The practice offered advice on diet and weight reduction. Nurses were trained to offer smoking cessation advice and patients could request routine travel immunisations.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with severe and enduring mental health needs had care plans and received annual physical health check. New cases had rapid access to community mental health teams. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice participated in the Dementia Direct Enhanced Service which ensures early diagnosis of Dementia. Patients were referred to a dementia nurse for consultation following a blood test and could then be referred to the local elderly mental health team. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 23 July 2015

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 for example those who were housebound or with complex health needs. The practice ensured that patients classed as vulnerable had annual health checks. It offered longer appointments for patients when required. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. 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. Translation services were available for patients who did not use English as a first language. The practice could accommodate those patients with limited mobility or who used wheelchairs. Carers and those patients who had carers were flagged on the practice computer system. A member of staff was a carer’s support link worker who worked closely with Surrey Carer Support Programme and could provide information or signpost carers to local support teams and networks.