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Staunton and Corse Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Staunton and Corse Surgery on 3 February 2016. We found that the practice had breached a regulation relating to the safe delivery of services.

The practice required improvement for the provision of safe services to ensure that the risks associated with prescription security had been appropriately assessed. The practice also needed to implement a system to identify, assess and mitigate risks arising from cross infection this included the requirement to complete an infection control risk assessment required by the relevant code of practice. Overall the practice was rated as good.

Following the inspection the provider sent us an action plan detailing how they would improve the prescription security and infection control management systems ensuring they reflect national guidelines.

We carried out a desktop review of Staunton and Corse Surgery on 16 May 2016 to ensure these changes had been implemented and that the service was meeting the regulations previously breached. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report from 3 February 2016.

We found the practice had made improvements since our last inspection on 3 February 2016 and they were meeting the regulations that had previously been breached.

Specifically the practice was operating safe systems in relation to prescription security and infection control management. This included:

  • The practice reviewed prescription security and had implemented new processes supported by a policy amendment.

  • The practice improved infection control management by completing a robust infection control audit.

During our previous inspection we also highlighted areas where the practice should consider improvement and these have been improved as follows:

  • The practice has established and operates a robust fire evacuation plan to include named fire marshals.

  • All Standard Operating Procedures have been signed.

  • The practice has ensured that there is a robust and consistent system in place for the dissemination of learning from prescribing and, or dispensary incidents.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 June 2016

The provider was rated as good for providing safe services.

Since our last inspection in February 2016 systems had been put in place and embedded to ensure the prescription security and infection control management reflected national guidelines.

  • The practice reviewed prescription security and had implemented new processes supported by a policy amendment which all staff had signed. All staff now ensured that that treatment rooms and consultation rooms were locked when not occupied.

  • The practice completed a robust infection control audit, detailing and undertaking any relevant actions as required.

During our previous inspection we also highlighted areas where the practice should consider improvement and these have been improved as follows:

  • The practice has established and operates a robust fire evacuation plan to include named fire marshals. In line with the practices fire risk assessment the practice carried out a fire drill on 21 April 2016 and analysed the results.

  • All Standard Operating Procedures have been signed by the lead dispenser and practice manager.

The practice has ensured that there is a robust and consistent system in place for the dissemination of learning from prescribing and dispensary incidents. A new policy has been introduced to ensure that all dispensing errors are logged and reviewed at bi-monthly dispensary meetings. They are then raised as significant events with the rest of the practice where appropriate.

Effective

Good

Updated 19 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average for the locality and compared to the 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.

  • The practice could demonstrate how they ensured role-specific training and updating for relevant staff. For example, for those staff reviewing patients with long-term conditions. Speakers were invited to bi-monthly education meetings at the practice, two of the most recent topics covered were diabetes and dermatology.

  • 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 patients’ needs.

Caring

Good

Updated 19 April 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • Patients with a hearing loss or vision problems were flagged on the practice’s computer system and all patients were collected from the waiting room by the GPs and nurses.

Responsive

Good

Updated 19 April 2016

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. For example, the practice took part in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit. Patients said they found it easy to make an appointment with a named GP and 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.

  • 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 19 April 2016

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 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 had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 19 April 2016

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

  • The practice had specialist nurses for diabetes and respiratory disease who provided both chronic and acute management of patients with the conditions of their expertise. Support from a GP was available if needed, and patients at risk of hospital admission were identified as a priority.

  • Performance for overall diabetes related indicators was 97% which was above the CCG average of 95% and national average of 89%.

  • Longer appointments and home visits were available when needed.

  • All these 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.

Families, children and young people

Good

Updated 19 April 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • 73% of patients with asthma on the register had a review in the last 12 months which was below both the CCG and national averages of 75%. The practice send patients a letter inviting them for a review on their birthday month, also in February and finally call patients who still have not attended.

  • The practice QOF Lead also advised that they were planning to discuss collaborative working with local college nurses to try to identify ways of improving compliance from students with asthma, who historically have been difficult to get to attend the surgery.

  • Patients told us children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 83% which was above the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • A weekly clinic for children under the age of five, which was staffed by a GP, Health Visitor or Nursery Nurse and Practice Nurse was available on Mondays.

We saw positive examples of joint working with midwives, health visitors and school nurses through multi-disciplinary meeting minutes.

Older people

Good

Updated 19 April 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 and

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

  • The practice took part in a “Village Agent” system which was run by the local County Council to facilitate access to benefits and services to patients over the age of 55.

Working age people (including those recently retired and students)

Good

Updated 19 April 2016

The practice is rated as good for the care of working-age patients (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 was proactive in offering online services as well as a full range of health promotion and screening reflects the needs for this age group.

  • Clinics available included in house phlebotomy, minor surgery, anticoagulant clinics, spirometry, 24 hour electrocardiogram (ECG) monitoring, international normalised ratio (INR) monitoring and NHS health checks.

  • The needs of approximately 1000 patients from a local college were met as the practice worked closely with the college nurses and acted as the first point of contact for students when they were unwell or need health care. The practice had dedicated safeguarding, women’s health and sexual health leads to support all patients including local students.

  • The Student Services department at the College have dedicated appointments each day with GPs and Practice Nurses, which are bookable by them. The students are brought to the practice by College transport. Quarterly meetings with between the practice GPs and College nurses are held to discuss any issues.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 April 2016

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

  • 83% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

    Staff had a good understanding of how to support patients with mental health needs and dementia. Performance for mental health related indicators was 100% compared to the CCG average of 97% and national average of 82%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and an intermediate mental health nurse visited once a week.

  • The practice 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.

  • The practice had a system in place to follow up patients who had attended accident and emergency 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 19 April 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 homeless patients, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • The practice informed 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.

  • The practice took part in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit.