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Southview Medical Practice Good Also known as Southview Surgery

Inspection Summary


Overall summary & rating

Good

Updated 12 August 2016

We carried out an announced comprehensive inspection at Southview Medical Practice on 24 May 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.
  • Key members of the practice had collaborated with the clinical commissioning group and local community services to help in the development of a service designed to provide health, social care and community services in one place for older people.
  • The practice had developed links with other services supporting vulnerable people in the locality and provided medical care to these groups including the homeless.
  • 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 two surgery sites. One of these was purpose built and had good facilities for patients, the other site had limited space and there were plans to relocate this site. The practice 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 taken the initiative to improve healthcare access for people who historically had poor access. They provided holistic care to vulnerable people and took an approach beyond the traditional model. The practice had strong links with a local homeless shelter and other services for vulnerable people. They had worked closely with staff at the homeless shelter to improve the healthcare of people using their service, which had a positive impact on their health outcomes. The practice staff had received training from a manager at the homeless shelter to help them understand how to manage people who attended from the shelter, how to register them and deal with different behaviours. The impact of this approach was that patients with long term conditions had received specialist help which they had not been able to access previously.

The areas where the provider should make improvements are:

  • The practice should continue to review how to improve patient ratings on how they are involved in decisions about their care, as reported in the national patient survey
  • The practice should continue to review how to improve telephone access for patients

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 August 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 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 12 August 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 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 12 August 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.
  • The practice used a toolkit to assess the health impact on carers and prioritise carers in real need.

Responsive

Outstanding

Updated 12 August 2016

The practice is rated as outstanding 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.
  • One of the partners was the lead GP for the development of the new locality hub which provided health, social care and community services in one place for older people.
  • The practice piloted using electronic referrals into the new locality hub and were the second highest referrer when it first opened.
  • The practice had recruited a clinical pharmacist to manage medication reviews and they were undergoing training to carry out diabetic reviews.
  • 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 was the preferred provider for services for vulnerable people.
  • One of the GPs visited the local homeless shelter and encouraged homeless people to access health care, with positive effect.
  • The practice supported patients with learning difficulties in local residential homes. The practice supported five residential care homes for patients with learning disabilities and feedback from the homes was positive
  • 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 12 August 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 it.
  • The practice had developed plans to expand their branch surgery in preparation for the increasing number of patients moving into new homes in the area.
  • 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 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 12 August 2016

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.
  • A GP with a special interest in IT had developed templates to assist the GPs in giving information to patients with long term conditions. For example they had developed a pre diabetes information sheet.
  • 96% of patients on the diabetes register had a record of a foot examination and classification which was above the CCG average of 89% and national average of 88%.
  • 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.
  • One of the GPs had designed a self-management care plan for patients with chronic obstructive pulmonary disease (COPD). This was used in the surgery and shared with the local frailty hub for older people in need of medical care and social care. 

Families, children and young people

Good

Updated 12 August 2016

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. This included additional work with vulnerable families and those living in disadvantaged circumstances to ensure they understood the benefits of immunisation programmes.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • 80% of eligible female patients had a cervical screening test which was the same as the national average of 82%. This included multi-disciplinary work with vulnerable patients living in disadvantaged circumstances to ensure they understood the benefits of screening programmes
  • The practice offered a full contraceptive service including implants and coils.
  • 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 and health visitors. A joint 8 week baby clinic and first immunisation clinic was run on a Friday morning and a private room set aside for breast feeding at this time.

Older people

Good

Updated 12 August 2016

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.
  • The practice offered proactive, personalised care to meet the needs of the older people in its population. They created a care plan for those patients at risk of unplanned hospital admission. This provided a framework for the patient, their family, carers and health care professionals to work together to plan care. The care plan allowed care to be delivered in line with the patient’s wishes. Care plans were updated regularly and uploaded to a system so the ambulance teams were aware of patients’ needs.
  • The practice nurse contacted patients on the unplanned admissions register who had been discharged from hospital to ensure they had the medical support they needed.
  • Key members of the practice had been active in working with the clinical commissioning group and local community services to develop the new locality hub for older people in need of medical care and social care. Patients in need of extra support were referred to this hub and it was noted that this practice was the second highest referrer when it first opened.

Working age people (including those recently retired and students)

Good

Updated 12 August 2016

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, 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 that reflects the needs for this age group.
  • The practice offered electronic prescribing allowing patients to collect prescriptions closer to their place of work.
  • Registration forms were available on the practice website for patients.
  • Patients could opt to get appointment reminders sent to them by text.
  • Appointments were available on Wednesday mornings from 7.30am and Wednesday evenings between 6.30pm and 8.30pm for those who could not attend during normal surgery hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 August 2016

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

  • 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

  • The practice had a high rate of diagnosis for dementia (96%) which was in the top three practices in the clinical commissioning group. They produced personalised care plans for patients with dementia. The practice had taken part in a shared care protocol regarding prescribing for dementia with the local community mental health team for older people.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • 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.
  • 91% of patients experiencing poor mental health had an agreed care plan, which was better than the national average of 88%.
  • The practice provided health care services to mental health patients who were out of hospital on licence, staying in a residential home.
  • 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 very good understanding of how to support patients with mental health needs and dementia.
  • The practice had a high prevalence of patients with severe mental health problems (1.4% against 0.8% for the south east region).
  • The practice ran a service where patients who were at high risk of overdose or medicine abuse were given weekly or daily prescriptions with an alert on their records. This was managed by a specific prescription clerk under the guidance of the doctors. They were aware of the patients using this service and liaised closely with the local pharmacies. This ensured appropriate prescriptions were issued at the correct time thereby providing a safety net for these patients.
  • The practice was pro-active in using alerts on their clinical IT system. This ensured that staff were aware of potential issues for some patients. For example, symptoms for specific patients what could indicate a relapse, patients with violent tendencies. In addition the alerts showed those patients requiring a carer to accompany them. This enabled reception staff to remind patients and carers to attend together, where appropriate, which ensured appointments were not wasted.
  • The practice had established good communication with the staff at the supportive housing establishments and this has led to better care for their residents who were patients.

People whose circumstances may make them vulnerable

Good

Updated 12 August 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 homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • A practice nurse who was trained in learning disability assessments was able to communicate in Makaton. (Makaton is a language programme using signs and symbols to help people to communicate)
  • The practice had designed a bespoke health action plan for patients with learning disabilities which included pictures, large print and a note of what patients were upset by, as well as their health issues.
  • The practice supported five residential care homes for patients with learning disabilities and feedback from the homes was positive.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had proactively taken steps to help vulnerable groups and local support workers recognised this and chose to register patients with the practice for this reason. For example the practice were looking after a refugee family who had recently arrived in the country.
  • The practice supported a service for vulnerable people and feedback from this service was very positive. There was evidence of positive outcomes for patients who had not previously been able to access healthcare for their long term conditions.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice had strong links with a local homeless shelter and had worked closely with staff at the centre to improve the healthcare of homeless people. The project manager had recently attended a staff meeting at the surgery to give an insight into the homeless shelter and agree how best to support patients from the shelter.
  • 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.