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Old Coulsdon Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Coulsdon Medical Practice on 26 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 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.
  • 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.
  • 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 two areas of outstanding practice:

  • The practice Patient Participation Group (PPG) regularly invited specialist speakers and provided educational events for patients on topics including dementia, cardiology, prostate cancer, breast cancer, arthritis and gastric reflux; about 30 to 80 patients attended these talks; these talks were followed by a question and answer session. Following these events the PPG obtained feedback from these patients and found that these educational events were very useful for patients as they provided exercise and lifestyle advice.
  • The practice hosted a dementia carers support group through their Patient Participation Group (PPG) and had a held carers week. The practice also ran monthly carer support group afternoons. The PPG invited guest speakers during these support group meetings and provided talks and live demonstrations on topics such as manual handling, incontinence pads, eating and dressing.

There were areas of practice where the provider should make improvements:

  • Ensure that the business continuity plan is up-to date.
  • Ensure that all staff have annual basic life support training.
  • Review the complaints procedure to ensure it contains all the relevant information for patients.
  • Consider documenting discussions from staff meetings.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 July 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.

Effective

Good

Updated 4 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 4 July 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice above average 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. There was a wide range of information leaflets available for patients which provided information on health and wellbeing and local support information.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 4 July 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 had good facilities and was well equipped to treat patients and meet their needs.
  • Learning from complaints was shared with staff and other stakeholders; evidence showed the practice responded quickly to issues raised.
  • The practice provided a phlebotomy service at the practice to encourage older patients who may have difficulty in getting to the hospital and to improve monitoring of patients with long term conditions.
  • The practice provided minor surgical procedures including dermatological procedures, joint injections and coil fitting which reduced the need for referrals to hospital.

Well-led

Good

Updated 4 July 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 this.
  • 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 GP 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.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 4 July 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.
  • The national Quality and Outcomes Framework (QOF) data showed that 77% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 94% which was above the CCG average of 86% and national average of 88%.
  • The national Quality and Outcomes Framework (QOF) data showed that 78% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 75%.
  • Longer appointments and home visits were available for people with complex long term conditions when needed.
  • The practice provided a phlebotomy service, electrocardiography, spirometry and ambulatory blood pressure monitoring to improve monitoring of patients with long term conditions.
  • All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice also had personalised care plans for these patients.
  • The practice GPs had personal patient lists which facilitated continuity of care of these patients. The practice used a risk stratification tool that analysed medicine interactions and blood result anomalies on a weekly basis.
  • The practice Patient Participation Group (PPG) regularly invited specialist speakers and provided educational events for patients on topics including dementia, cardiology, prostate cancer, breast cancer, arthritis and gastric reflux; about 30 to 80 patients attended these talks; these talks were followed by a question and answer session. Following these events the PPG obtained feedback from these patients and found that these educational events were very useful for patients as they provided exercise and lifestyle advice.

Families, children and young people

Good

Updated 4 July 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 urgent care and Accident and Emergency (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’s uptake for the cervical screening programme was 89%, which was above the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice nurses ran daily minor illness clinics to manage patients with simple issues; the lead practice nurse was a nurse prescriber.

Older people

Good

Updated 4 July 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 checked their list of house-bound patients every six months to ascertain if these patients had their problems and medicines reviewed.
  • The practice ran an open surgery every day from 8am to 11:30am to enable patients to be seen on the same day; this enabled improved access for older people.
  • The practice GPs provided care for a local warden assisted property and a local care home for highly dependent neurologically impaired patients supporting the needs of the residents.

Working age people (including those recently retired and students)

Good

Updated 4 July 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 early morning appointments and telephone consultations to enable access to working age people.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 July 2016

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

  • The number of patients with dementia who had received annual reviews was 86% which was above the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
  • 92% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 85% and 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 GPs provided care for a local home for patients with mental health issues.
  • The practice carried out advance care planning for patients with dementia. The practice hosted a support group for patients with dementia and their carers.
  • 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. The practice had also trained many non-clinical staff in care for the patients with dementia.
  • The practice used books and online resources to educate patients with mental health problems.
  • The practice also used local re-enablement services to reduce social isolation and to ensure that the patients remain stimulated.
  • To enable improved access to cognitive and behavioural therapy the practice had arranged a training session for clinical staff from the local NHS psychological therapies service.  This particularly helped patients with anxiety who were reluctant to travel to access this service.

People whose circumstances may make them vulnerable

Good

Updated 4 July 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 and extended annual reviews for patients with a learning disability; 76% (37 patients) of patients with learning disability had received a health check in the last year.
  • 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. The practice hosted a dementia carers support group through their Patient Participation Group (PPG) and had a held carers week. The practice also ran monthly carer support group afternoons.
  • The practice had a system in place to ensure appointments were monitored for patients who were unable to chase up appointments.
  • 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.