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Inspection Summary


Overall summary & rating

Good

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at George Clare Surgery on 15 November 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Feedback from patients about their care was generally positive. Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
  • Data from the National GP Patient Survey published in July 2016 showed patients rated the practice in line with local and national averages for most aspects of care.
  • 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 sometimes found it difficult to get an appointment at a time convenient for them. The practice had identified that this was an area to be improved upon and proactively sought patient feedback to gain a better understanding of the issue.
  • 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 well supported by management. Monthly whole team meetings were held to ensure effective communication throughout the practice.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice had identified a high proportion of obesity within the patient population compared to the local and national averages. We were told that lifestyle issuescreated an increased prevalence of diabetes. As a consequence of this the practice had commenced weekly diabetes specific multidisciplinary team meetings, which were attended by practice nurses, healthcare assistants, specialist community diabetic liaison nurses and the local diabetologist. The practice had seen an increasing improvement in patient involvement and attendance to health reviews.

The areas where the provider should make improvements are :

  • Ensure that patient feedback continues to be monitored to identify further areas for improvement.
  • Improve the recording of minutes of clinical meetings to evidence learning from discussion.
  • Monitor near-miss dispensing errors to detect trends and ensure appropriate actions are taken to minimise the chance of similar errors occurring again.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 January 2017

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 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 6 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement and the practice participated in research which demonstrated improved outcomes for patients.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 January 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed patients rated the practice in line with local and national averages for most aspects of care.
  • Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • The practice was proactive in identifying patients with caring responsibilities. The practice had identified 211 patients as carers (2% of the practice list). There was a notice board in the practice which was specifically aimed at identifying carers and providing advice, information and support to them.
  • 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.

Responsive

Good

Updated 6 January 2017

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. For example, two GPs at the practice had been involved in the procurement of the local older people’s service.
  • Feedback from patients reported that access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually available on 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 6 January 2017

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.
  • Staff at the practice were engaged with local healthcare services and worked within the wider health community. For example, the practice manager was involved with the Cambridgeshire and Peterborough CCG. Furthermore, practice nurses were involved in national training for diabetes care.
  • 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 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 virtual 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 6 January 2017

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

  • Both GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 97%, which was above the local and national average of 90%. Exception reporting for diabetes related indicators was 13%, which was in line with the local average of 13% and national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • The practice had identified a high proportion of obesity within the patient population compared to the local and national averages. We were told this was a local issue which created an increased prevalence of diabetes. As a consequence of this the practice had commenced weekly diabetes specific multidisciplinary team meetings, which were attended by practice nurses, healthcare assistants, specialist community diabetic liaison nurses and the local diabetologist. The practice had seen an increasing improvement in patient involvement and attendance to health reviews.
  • Patients taking disease-modifying antirheumatic drugs (DMARDs) were regularly monitored by an in house rheumatology specialist nurse, ensuring optimum medication safety for these patients.
  • Longer appointments and home visits were available when needed.
  • Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
  • 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 6 January 2017

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 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 percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 84%, which was in line with the local and national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered a full range of contraception services and chlamydia screening.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 6 January 2017

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

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
  • The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
  • Clinical staff provided regular home visits to patients living in the three care homes covered by the practice. Each home had a named doctor to ensure continuity of care. We received positive feedback about the practice from the local care homes.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Working age people (including those recently retired and students)

Good

Updated 6 January 2017

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 where possible.
  • 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.
  • Extended hours appointments were available between 6.30pm and 8pm on Mondays and Thursdays.
  • Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes.
  • The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 January 2017

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

  • 88% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local and national average of 84%.
  • 97% of patients experiencing poor mental health had a comprehensive care plan, which was above the local average of 87% and the national average of 88%.
  • 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.
  • The practice had provided training on dementia awareness and the Mental Capacity Act 2005 to all members of staff to ensure that mental health and psychological wellbeing was considered at every contact.

People whose circumstances may make them vulnerable

Good

Updated 6 January 2017

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 travellers and those with a learning disability.
  • The practice had 43 patients on the learning disabilities register. Last year 37 out of the invited 43 patients had received a care review. 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, and held regular multidisciplinary team meetings.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice was engaged with the local carers support group, which provided guidance, support and respite for carers. Written information was available to direct carers to the various avenues of support available to them.
  • 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.