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Inspection Summary


Overall summary & rating

Good

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Linden Hall Surgery on 14 July 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, with the exception of the completion of risk assessments of the building and an up to date fire risk assessment.
  • 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.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • The majority of patients told us on the day of the inspection they could get appointments. However, two patients told us it was difficult to get at an appointment at Muxton so they attended the main practice instead.
  • 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 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.

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

  • Introduce a system to record the action taken in response to Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
  • Carry out risk assessments to monitor the safety of the premises and update the fire risk assessment.
  • Carry out a risk assessment to ensure that medicines are being stored in line with manufacturers’ guidance.
  • Ensure that staff are offered an annual appraisal.
  • Make patients aware that translation services are available.
  • Adopt a more proactive approach to identifying and meeting the needs of carers.
  • Include contact details for the Parliamentary and Health Service Ombudsman in the complaints procedure.
  • Introduce a more structured programme for administration / reception staff meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 August 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.
  • The practice did have a clear system to record the actions they had taken in response to Medicines and Healthcare products Regulatory Agency alerts.
  • 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 the risk of abuse.
  • Risks to patients were assessed and well managed, with the exception of the completion of risk assessments of the building and an up to date fire risk assessment.

Effective

Good

Updated 12 August 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.
  • The GP partners supported the practice nurses with the management of patients with long term conditions and patients could be referred internally to a GP colleague for condition specific advice.
  • 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, although not all staff had had an appraisal within the last 12 months.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice in line with or above other practices.
  • 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Although the practice promoted the role of carers and provided information on the service available, the practice needed to adopt a more proactive approach to identifying carers and recording the information on the electronic patient record.

Responsive

Good

Updated 12 August 2016

The practice is rated as good for providing responsive services.

  • The practice 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. One of the GP partners worked with the CCG as an advisor for Information Technology. Another of the GP partners was the local federation lead.
  • The practice offered a range of enhanced services including minor surgery, joint injections and spirometry (a test to see how well a patient can breathe).
  • The practice co-hosted a number of services including diabetic eye screening and podiatry.
  • The majority of patients told us on the day of the inspection they could get appointments. However, two patients told us it was difficult to get at an appointment at the Muxton branch so they attended the main practice instead.
  • 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. However the practice did not make patients aware that they raise their complaint with the
  • The practice did not make patients aware that translation services were available.

Well-led

Good

Updated 12 August 2016

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

  • The practice had a clear vision to provide the highest quality healthcare for the local population in an open and welcoming environment and treat patients with respect, dignity and honesty.
  • 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 clinical staff meetings. However, administration / reception staff meetings were organised on a more adhoc basis.
  • 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 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. This included the development of the staff team skills and knowledge.
Checks on specific services

People with long term conditions

Good

Updated 12 August 2016

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

  • The practice nurses had lead roles in chronic disease management and worked with the GPs to support patients with long term conditions.
  • The practice maintained registers of patients with long term conditions. Patients were offered a structured annual review to check their health and medicines needs were being met.
  • Performance in the five diabetes related indicators were comparable to or better than the national average. For example: The percentage of patients with diabetes, on the register, in whom a specific blood test was recorded was 83% compared with the national average of 77%.
  • Longer appointments and home visits were available when needed.
  • 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 12 August 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 who were at risk, for example families with children in need or on children protection plans. The safeguarding lead held quarterly meetings with the health visitor and school nurse to discuss at risk children and families.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children.
  • There were screening and vaccination programmes in place and the practice’s immunisation rates
  • Data from the Quality and Outcomes Framework (QOF) for 2014/15 showed that 84% of women aged 25-64 had received a cervical screening test in the preceding five years. This was above the national average of 82%.
  • The practice offered family planning and routine contraception services.

Older people

Good

Updated 12 August 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 visited patients who lived in the local care homes on a weekly basis. Each care home had a named GP who visited to provide continuity of care.
  • Patients who lived in care homes with long term conditions and / or dementia were offered regular reviews.
  • The practice worked closely with the Age Concern Care Navigator who held drop in sessions bi-weekly at the practice. Care Navigators assist patients who may feel lonely or isolated, have little local support, have been recently bereaved or who wish to find out about services which may be available to them. They can help put in place support or find activities provided by voluntary and statutory services.

Working age people (including those recently retired and students)

Good

Updated 12 August 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 offered routine pre-bookable appointments up to four weeks in advance, on the day appointments and appointments that were released 48 hours in advance. Telephone consultations were also available with all of the GPs.
  • Extended consultation hours were offered on Tuesdays and Wednesdays between 6.30pm and 8.20pm.
  • 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 12 August 2016

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

  • Ninety-two per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
  • The practice carried out advance care planning for patients with dementia.
  • Performance for the mental health related indicators was above the national average.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 12 August 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 or identified as vulnerable.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice provided medical services for seasonal workers at local salad producer and temporary patients receiving care provided by a national veterans’ mental health charity.
  • The staff knew how to recognise signs of abuse in vulnerable adults and children. The 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.