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St Clement's Surgery Good Also known as Village Health

Inspection Summary


Overall summary & rating

Good

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Clements Surgery on the 11 October 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 in place 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.
  • 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.
  • 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.

We saw one area of outstanding practice:

The practice had extended its opening hours on a Saturday morning to include not only bookable appointments but ten walk-in slots, plus the opportunity for patients to have their telephone calls returned on a Saturday morning which was especially useful for working age patients.  As a result of this the practice had reduced its accident and emergency admission rates by 15%. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 February 2017

  • There was an effective system in place for reporting and recording significant events. Significant event forms were available for completion by the staff, and a policy was available detailing how to record an event.

  • Lessons were shared to make sure action was taken to improve safety in the practice and quarterly whole team meetings took place during which significant events and complaints were discussed.

  • 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. Staff had received safeguarding training and contact telephone numbers were available in the reception identifying external organisations to be contacted should the lead GP not be available.

  • The practice had a new recruitment induction checklist which covered confidentiality and practice policies and procedures.

The practice had recently commenced a programme of risk assessments including health and safety and fire.

Effective

Good

Updated 6 February 2017

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 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.

  • 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 6 February 2017

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.

  • We received 41 comment cards which were all positive.

  • 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.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. During the inspection we witnessed reception staff handling complex situations with patience and understanding.

Responsive

Good

Updated 6 February 2017

The practice is rated as good for providing responsive services.

  • The GPs 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 Lead GP was a member of the Clinical Commissioning Group as Urgent Care Lead.

  • Patients said they found it easy to make an appointment with a named GP and urgent appointments were available the same day.

  • The practice had good facilities and were well equipped to treat patients and meet their needs.

  • The practice had a robust system for recording, discussing and sharing learning of all complaints. Information about how to make complaints was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning’s from complaints were shared with staff and other stakeholders.

  • Patients were invited to meet with the lead GP to discuss individual complaints either at the surgery or at the patient’s home.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, patients had commented that the reception area was close to the waiting area and therefore patients may be able to hear what was being said. The practice installed a television and re-arranged the waiting room so that the patient chairs faced away from the reception desk and towards the television screen.
  • Patients could access appointments and services in a way and at a time that suited them. Telephone consultations were available as well as same day, pre-bookable and urgent appointments. The practice was open Saturday mornings for pre-bookable and walk in appointments.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

Well-led

Good

Updated 6 February 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 notifiable safety incidents and ensured 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 practice had an active patient participation group.

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

Checks on specific services

People with long term conditions

Good

Updated 6 February 2017

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.

  • Pre-diabetic appointments were available and patients were seen by the diabetic nurse for lifestyle and dietary advice.

  • The practice had regular warfarin clinics (warfarin is an anticoagulant normally used in the prevention of thrombosis) and the lead GP checked that regular blood tests were carried out.101 patients attended this clinic.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 97%, which was above the local and national averages of 89%. Exception reporting for diabetes related indicators was 9% which was below the local and national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of the side effects).

  • Longer appointments and home visits were available when needed.

  • All 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.

  • The practice ran diabetic clinics, asthma and COPD clinics and spirometry clinics for patients with chronic conditions.

The practice health care assistant ran healthy living clinics and the smoking cessation clinic had recorded that 27 patients had stopped smoking in the last two quarters

Families, children and young people

Good

Updated 6 February 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Young children were automatically offered a same day appointment.

  • Pre-school health checks were offered at 3 years old, which allowed children to have their pre-school boosters. The health checks covered healthy eating, teeth-brushing and exercise.

  • Saturday morning clinics allowed children and working families to attend surgery outside of the normal hours.

  • Travel clinics were available.

  • The practice offered flexible vaccination appointments.

  • There was a policy for patients who had run out of medication to be offered same day repeat prescriptions.

  • Well-woman clinics were available most days for contraception, sexual health issues and cervical cytology.

  • The percentage of women aged 25 – 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 79%, which was below the local average of 84% and the national average of 82%.

  • 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, health visitors and school nurses.

Older people

Good

Updated 6 February 2017

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. These could be requested for the nurse or GP.

  • Flu clinics were available which were also used to check whether pneumococcal vaccinations were required.

  • The practice kept a variety of mobility aids and a wheelchair in order that patients with mobility problems were able to access the relevant areas of the surgery.

  • A call screen had been purchased as some elderly patients had commented that it was difficult to hear whose name was being called.The screen also showed educational information and details about support groups.

  • A monthly hearing aid clinic had been arranged in order that elderly patients did not have to travel to the local hospital for services.

  • A phlebotomy service had been set up to provide a local service for all patients.

Working age people (including those recently retired and students)

Good

Updated 6 February 2017

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

  • The practice recognised that its patient population consisted mainly of working age patients and therefore had extended Saturday morning clinics to include pre-bookable appointments, 10 walk-in-slots and the opportunity for patients to have telephone calls returned during these times. As a result of an audit carried out by the practice and the changes made around availability, A & E attendances had been reduced by 15%.

  • The practice were 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 dispensary was open on Saturday mornings.

  • Electronic prescribing had been introduced.

  • Cervical cytology appointments had been changed to early and late in the day to benefit working patients.

  • Telephone consultations with a GP or nurse practitioner were available throughout the day and patients were also able to speak to a doctor or a nurse about blood test results.

Temporary residents and students were offered same day appointments.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).The QOF indicators for 2014-2015 showed:

  • 94% of patients diagnosed with mental health problems had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 87% and the national average of 90%.

Since our inspection, the QOF indicators for 2015-2016 have now been published and the practice figure for patients diagnosed with dementia, who have had their care reviewed in a face to face meeting in the last 12 months, have increased to 100%, which is above the CCG average by 0.5% and above the national average by 3.4%.

  • Annual reviews of patients with dementia were carried out by a GP either at the surgery or at the patient’s home or their care home.Patients identified as at risk or needing further support were discussed at the practice multi-disciplinary team meetings which were held on a regular basis and included the GP’s, practice nurses,physiotherapy/occupational therapy, matron and integrated care liaison officer.The practice carried out advance care planning for patients with dementia. These patients were kept under monthly review until their level of need had been reduced.

  • 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.

  • The practice provided educational support to patients with dementia. This included an educational session run by the Contended Dementia Trust founder arranged by the Practice Participation Group.

  • Regular medication reviews and benchmarking of patients taking mental health medications and dementia medications were carried out every six months.

People whose circumstances may make them vulnerable

Good

Updated 6 February 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, travellers and those with a learning disability.

  • The practice offered longer appointments 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 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.

  • Vulnerable patients were flagged and coded on the practice computer system and patients were discussed at the monthly multidisciplinary team meetings. The lead GP met regularly with the health visitor to discuss vulnerable children and attended social services safeguarding meetings where necessary.

  • The Accessible Information Standard was used to ensure that patients who have a disability, impairment or sensory loss are provided with information that they can easily read or understand.(organisations that give NHS or adult social care have to comply with this standard which sets out the framework and provides clear direction for improvement in the ability of the NHS and adult social care system to meet the information and communication support needs of disabled people).

  • An interpreter service was available and all staff were aware of how to access this service.

  • A wellbeing service had been set up at the practice for patients with mild to moderate anxiety and depression. This service was supported by support workers, psychiatrist and counsellors. Referrals could be made by the patient or a GP.