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Dr Ian Allsebrook Good Also known as The Harrowby Lane Surgery

Inspection Summary


Overall summary & rating

Good

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ian Allsebrook practice on 14 January 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. There was a risk register in place with various health and safety risk assessments carried out and reviewed on a regular basis.

  • 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.

  • The practice employed a care coordinator to deliver care plans for older patients and those who were vulnerable.

  • All patients diagnosed with dementia had a care plan in place which was reviewed on a regular basis.

  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice offered an open access clinic for on the day, routine appointments on a daily basis.

  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 May 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.

  • There was a ‘safeguarding’ information board available for all practice staff to ensure they were provided with up to date safeguarding information on various safeguarding topics.

Effective

Good

Updated 5 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed some patient outcomes were at or above average for the locality and compared to the national average. Where the practice were outliers for outcomes such as Diabetes, evidence showed that improvements had already been made in comparison to 2014-15 performance.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. All staff groups were involved in clinical audit processes.

  • 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 multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.

  • GPs provided monthly in-house educational sessions to members of the nursing team.

  • Members of the nursing team received regular clinical supervision sessions.

Caring

Good

Updated 5 May 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.

  • Members of staff had received customer centred care training.

  • 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 provided a bereavement service to patients, relatives and carers who had suffered bereavement.

  • The practice held a register of patients who were carers.  The practice provided regular tea/coffee mornings for carers.

Responsive

Good

Updated 5 May 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.

  • 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 employed the services of locum GPs to ensure adequate access to appointments for patients.

  • The practice had recently employed an additional nurse practitioner which provided additional appointments for patients to improve access.

  • The practice employed a care coordinator to work specifically with older patients and ensured care plans were implemented and reviewed on a regular basis.

  • The practice provided an ‘open access’ appointment system for on the day appointments as well as pre-bookable routine appointments.

  • 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.

  • The practice had access to ‘Language Line’ interpreter services for patients whose first language was not English.

Well-led

Good

Updated 5 May 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 which was on display in areas of the practice. Staff were clear about the vision and their responsibilities in relation to this.

  • The practice had a five year business plan in place which included timeframes for completion of areas of improvement.

  • 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 staff and patients, which it acted on. The patient participation group was active and keen to develop their role.

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

Checks on specific services

People with long term conditions

Good

Updated 5 May 2016

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

  • 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 multi-disciplinary package of care.

  • The practice held regular palliative care meetings to review patient’s needs.

  • The GPs provided regular clinical support to patients who resided in a local hospice.

  • The practice participated in an admissions avoidance scheme and delivered personalised care plans and regular reviews for patients with a long term condition with a view to deliver more personalised care and to reduce emergency or unplanned hospital admissions.

Families, children and young people

Good

Updated 5 May 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.

  • The practice provided childhood immunisation clinics.

  • The practice’s uptake for the cervical screening programme was 80.2% which was comparable to the CCG average of 80.9%.

  • 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.

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

  • We saw positive examples of joint working and the practice held regular meetings with midwives, health visitors and school nurses.

  • The practice provided weekly midwifery led clinics.

  • The practice provided smoking cessation advice clinics.

Older people

Good

Updated 5 May 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 people in its population.

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

  • The practice employed a care coordinator to give additional support and ensured care plans were implemented and reviewed on a regular basis for older people. The care coordinator also visited patients who resided in care and nursing homes to review care plans.

  • All housebound patients had a care plan in place which was reviewed on a regular basis.

  • At the time of our inspection the practice were working towards the achievement of a carer’s award.

Working age people (including those recently retired and students)

Good

Updated 5 May 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 such as ordering repeat prescriptions appointment booking and viewing patient summary care records as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice participated in an electronic prescribing service.

  • The practice offered a text reminder service for booked appointments.

  • The practice offered telephone consultations for patients who were unable to attend for an appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 May 2016

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

  • 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 was a member of a local group ‘Dementia Action Alliance’ who promoted identification of dementia within the local area and attended regular meetings with this group.

  • The practice ensured care plans were in place for all patients who suffered poor mental health.

  • The practice worked closely with local mental health teams with a view to providing in-house clinics for patients suffering poor mental health in familiar surroundings.

  • The practice participated in a South West Lincolnshire Clinical Commissioning Group (SWLCCG) ‘dementia diagnosis care home project’ and employed a care coordinator to visit patients who resided in local care and nursing homes to improve diagnosis of 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 and had attended mental capacity awareness training.

  • All practice staff had received ‘Dementia Awareness’ training.

People whose circumstances may make them vulnerable

Good

Updated 5 May 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, those with a learning disability and those suffering domestic violence.

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

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

  • 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.