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Inspection Summary


Overall summary & rating

Good

Updated 29 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burbage Surgery on 29 September 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 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.
  • The patient participation group (PPG) were well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services.
  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 100%, which was better than the national average of 88%.
  • 99% of patients said they could get through easily to the practice by phone (national average 73%).
  • The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
  • 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.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
  • The practice hosts a talking therapy service on one afternoon per week, for patients who have experienced a bereavement, were carers, or were experiencing mental health issues. The service is funded by the local clinical commissioning group (CCG) and available on referral.
  • The practice offers a ‘community clinic’ run by a nurse and GP, for patients with complex medical needs. Patients are allotted one hour, during which time their medical condition is reviewed and managed, and they are screened for dementia.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 November 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 29 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework for April 2015 to March 2016 showed patient outcomes were above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • We saw a programme of clinical audits that included improvements for patient care.
  • 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 patients’ needs.

Caring

Good

Updated 29 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (July 2016) showed patients rated the practice as either comparable with or better than other local practices 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 had identified patients who were carers and alerted them whenever a local carers group met. This provided an opportunity for carers to gain support and raised awareness of carer’s services locally.
  • Vulnerable patients who did not attend their scheduled appointments were contacted by a practice nurse, to check their welfare.
  • A carer’s co-ordinator, based at the practice, telephoned patients on discharge from hospital to offer support, and to enquire whether a GP visit or other assistance was required. The carer’s co-ordinator also visited patients in their homes.
  • The practice provides an unpaid out of hours service for terminal care patients. We saw evidence that the GP was available at all times by telephone and carried out home visits as necessary.
  • The practice worked with the CCG to purchase urgent nursing home beds and had commissioned a taxi service for late afternoon urgent blood samples, measures taken in order to prevent unnecessary hospital admissions. We saw evidence that this measure had contributed to the practice’s low patient referral and unplanned hospital admissions rates in Wiltshire. Figures available between June 2015 and August 2016 indicated that the practice had admitted five patients to nursing home beds as a result of the fund.

Responsive

Good

Updated 29 November 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 (CCG) to secure improvements to services where these were identified. For example, the practice worked with the CCG to purchase urgent nursing home beds, and commissioned a taxi service for late afternoon urgent blood samples, measures taken in order to prevent unnecessary hospital admissions.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with regular appointments available the same day.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of patient feedback.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice worked with other health professionals to minimise unnecessary hospital admissions.
  • The practice provided a cholesterol testing machine for patients.
  • Patients were able to access the practice by telephone, and face to face.
  • The practice sent text reminders for appointments.
  • The practice increased the length of individual appointment times for patients with complex medical conditions.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
  • The practice offered International Normalised Testing (INR). INR tests monitor the use of a drug used to reduce the risks of heart attacks and strokes.
  • The practice offered cryotherapy treatment for benign skin lesions and some pre-malignant conditions such as sun damage.
  • The practice hosted a talking therapy service for patients who have experienced a bereavement, were carers, or were experiencing mental health issues. The service is funded by the local clinical commissioning group (CCG) and is available on referral.
  • The practice provides mobile 24 hour electrocardiogram (ECG) testing. An ECG is a test to determine whether the heart it is working normally.

Well-led

Good

Updated 29 November 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.
  • 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 provider 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 staff and patients, which it acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 29 November 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.
  • Performance for patients with long-term conditions was better than national averages. For example, 83% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
  • 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.
  • The practice routinely offered longer appointments for patients with complex medical needs and a ‘community clinic’ run by a nurse and GP.
  • The practice provides an unpaid out of hours service for terminal care patients. We saw evidence that the GP was available at all times by telephone and carried out home visits as necessary.
  • The practice worked with the CCG to purchase urgent nursing home beds and had commissioned a taxi service for late afternoon urgent blood samples, measures taken in order to prevent unnecessary hospital admissions.

Families, children and young people

Good

Updated 29 November 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.
  • 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. The practice assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in a target period of three-and-a-half or five-and-a-half years was 88%, which was better than 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 29 November 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • A care co-ordinator based at the practice worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
  • The practice referred patients to local community health improvement schemes.
  • The practice offered cryotherapy treatment for benign and malignant tissue damage.

Working age people (including those recently retired and students)

Good

Updated 29 November 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 extended hours appointments with a GP on two evenings a week.
  • Patients were able to order repeat prescriptions on-line.
  • The practice offered text reminders for appointments.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 November 2016

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

  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than both the clinical commissioning group (CCG) average of 86% and national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 100%, which was better than the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • 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 29 November 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 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.
  • The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.