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Archived: GP at Hand Good Also known as Dr Jefferies & Partners, Lillie Road

Inspection Summary


Overall summary & rating

Good

Updated 26 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jefferies & Partners, Lillie Road on 21 April 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.

  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, all actions identified as part of a recent fire risk assessment had not been completed.

  • The practice had not risk assessed their decision not to provide a defibrillator as part of their medical emergency equipment.

  • The seating facilities in the practice waiting area required improvement.

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

  • The majority of patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment and all of the comment cards we received aligned with these views.

  • 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.

  • 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.

The areas where the provider must make improvement are:

  • Ensure all recommendations made as a result of the fire risk assessment are completed and a fire alarm system is installed within the practice.

  • Ensure the availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.

  • Ensure waiting area seating is clean and the scuffed and broken wooden panels under the seating and the tears in the fabric of the seating are addressed.

The areas where the provider should make improvement are:

  • Ensure all staff understand their responsibilities when acting as chaperones, including where to stand to be able to observe the examination.

  • Consider improving communication with patients who have a hearing impairment.

  • Advertise the interpreting service within the practice to inform patients this service was available to them.

  • Consider ways to actively identify carers and provide appropriate support for them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 26 May 2016

The practice is rated as requires improvement 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.

  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.

  • There was no automated external defibrillator (AED) available on the premises and the practice had not undertaken a formal risk assessment for the decision to not have an AED on site.

  • The practice waiting area seating facilities required improvement.
  • The practice had an up to date fire risk assessment carried however, the recommendations from this assessment had not been completed and there was no fire alarm system within the practice.

Effective

Good

Updated 26 May 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.

  • Clinical staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of regular appraisals for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 26 May 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care however, the practice had been proactively working to improve the patient experience and the latest results from the Friends and Family Test s

  • The majority of patients we spoke with said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment and all of the comment cards we received aligned with these views.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect.

Responsive

Good

Updated 26 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.

  • The practice had registered as a foodbank voucher holder to issue foodbank vouchers for patients who needed them which provided

  • There were longer appointments available for patients with a learning disability.

  • Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

  • Same day appointments were available for children and those patients with medical problems that require same day consultation.

  • 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.

Well-led

Good

Updated 26 May 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision to be committed to the continued development and growth of a quality clinical primary care service, maximising efficiency and being patient focused. 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 meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners and management team 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 26 May 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 diabetes related indicators was better than the national averages. For example, the percentage of patients on the diabetes register with a record of a foot examination was 92% in comparison to the national average of 88%; the percentage of patients with diabetes, on the register, who had received an influenza immunisation, was 100% in comparison to the national average of 94%.

  • 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 26 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.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice’s uptake for the cervical screening programme was 63%, which was below the national average of 74%.

  • Appointments were available outside of school hours.

Older people

Good

Updated 26 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.

Working age people (including those recently retired and students)

Good

Updated 26 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 May 2016

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

  • Performance for mental health related indicators was better than the national averages. For example, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had received a comprehensive, agreed care plan which was above the national average of 84%.

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face consultation was 100% which was above the national average of 84%.

  • 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.

  • 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 26 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 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.