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Archived: Lockfield Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 16 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lockfield Surgery, with a visit to the branch site, Raynor Road Surgery on 12 May 2015. Overall the practice is rated as Good.

Specifically, we found the practice to require improvement for providing safe services. It was good for providing an effective, caring, responsive and well led service. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings across all the areas we inspected were as follows:

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients’ needs were assessed and the practice planned and delivered care following best practice guidance.
  • The practice had a well-established and well trained team with expertise and experience in a range of health conditions. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Lockfield Surgery was clean and hygienic and had arrangements for reducing the risks from healthcare associated infections. The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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, the practice did not have a process in place for the testing of fire alarms and fire drills and fire risk was not assessed in the practice.
  • The practice had identified that the branch site was no longer a suitable premises at which to deliver care and treatment and had plans in place to relocate during July 2015.
  • Data showed patient outcomes were average for the locality.
  • Information about services and how to complain was available and easy to understand.
  • The practice had recognised that internal communication processes was an area which they needed to develop and improve.

The areas where the provider must make improvements are:

  • Ensure fire risk is assessed and document fire risk assessments within the practice.

In addition the provider should:

  • Ensure a consistent process is applied to recording fridge temperatures.
  • Improve internal communication and consider introducing regular meetings involving the whole practice team, ensuring there are mechanisms in place to seek feedback from staff . This would provide opportunities to share information learning from significant events and complaints.
  • Routinely document attendance and input at internal and external meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 January 2017

The practice is rated as good for providing safe services.

  • During our responsive inspection on 28 April 2016 we identified significant concerns with regards to the premises used for the branch surgery at Raynor Road. Furthermore, we found that the branch surgery was unsuitable for people with mobility problems. Additionally, we found that patients were not being protected against the risk of unsafe care and treatment as a result of insufficient infection control at the branch.

  • During our follow up inspection in December 2016 we received assurance that the provider continued to comply with the urgent condition imposed by the Care Quality Commission in relation to preventing the delivery of regulated activities from the branch surgery. Therefore, risks associated with the branch premises were mitigated.

  • Staff were aware of their responsibilities to raise and report concerns, incidents and near misses. Significant events, incidents and complaints were regularly discussed with staff during practice meetings. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • We observed the premises to be visibly clean and tidy. There was a health and safety policy and the practice had risk assessments in place to monitor safety of the premises.
  • During our responsive inspection in April 2016 we identified gaps in the arrangements for managing emergency medicines and vaccinations. We noted improvements had been made during our most recent inspection. For example, the practices emergency medicines included medicine associated with the procedure of fitting birth control devices. Vaccinations were stored within the recommended temperatures and during our inspection we saw that temperatures were logged in line with national guidance. 

Effective

Good

Updated 16 July 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from National Institute for Health and Care Excellence (NICE) and used it routinely. Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 16 July 2015

The practice is rated as good for providing caring services. Data showed that 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 to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 16 July 2015

The practice is rated as good for providing responsive services. It 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. 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 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 that the practice responded quickly to issues raised. Learning from complaints with staff and other stakeholders.

Well-led

Good

Updated 16 January 2017

The practice is rated as good for providing well led services.

  • During our responsive inspection in April 2016 we found that governance arrangements were not effective. This was heavily influenced by a lack of risk management in relation to the practices previous unsuitable branch premises. During our most recent inspection we noted that the branch was no longer operational and as a result, the risks associated with the branch premises had been mitigated.

  • During our most recent inspection we noted effective governance arrangements in place such as well embedded practice policies for areas such as safeguarding and management of the cold chain. We also saw a range of comprehensive risk assessments in place where risks associated with health, safety, fire and infection control were well monitored and mitigated.
  • Staff said they were confident in raising concerns and suggesting improvements openly with the management team. Staff also spoke positively about working at the practice and said that they felt supported and part of a close team. Monthly practice meetings were governed by agendas which staff could contribute to.
Checks on specific services

People with long term conditions

Good

Updated 16 July 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people 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 16 July 2015

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. Childhood Immunisation rates were in line with regional immunisations rates. 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 also available outside of school hours.

Older people

Good

Updated 16 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 16 July 2015

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 offered a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 July 2015

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Most staff had received training on how to care for people with mental health needs.

People whose circumstances may make them vulnerable

Good

Updated 16 July 2015

The practice staff told us that they regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.