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Dr Fisher & Partners Good Also known as Camberley Health Centre

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 Dr Fisher & Partners on 7 July 2016. Overall the practice is rated as good.

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

  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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.
  • 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.
  • 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 practice had a strong ethos for training. Clinical staff were able to access a number of different training elements. This included a monthly dedicated practice educational meeting, protected learning time, talks from external professionals and daily shared learning with other staff members.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had reviewed patient access and was able to offer evening appointments every week day until 8pm. This service was jointly run with another local practice.


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.
  • 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.
  • 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.
  • The practice was clean and tidy and there were arrangements in place to ensure appropriate hygiene standards were maintained.
  • Risks to patients were assessed and managed. Blank prescription forms and pads were securely stored and there were systems in place to monitor their use.
  • The practice had policies and procedures in place to help with continued running of the service in the event of an emergency.

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 average when 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.
  • The practice had a strong ethos for training. Clinical staff were able to access a number of different training elements. This included a monthly dedicated practice educational meeting, protected learning time, talks from external professionals and daily shared learning with other staff members.
  • 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 12 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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 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 12 August 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.
  • 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.
  • The practice was open from 7.30am to 6.30pm every weekday and had reviewed patient access to the service. Evening appointments were available from 6.30pm to 8pm every day. This service was jointly offered with another practice. Every other Saturday morning appointments were available from 8am to 11.30am.
  • The practice website had information in relation to different long terms condition including information for diabetes during Ramadan or fasting.

Well-led

Good

Updated 12 August 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 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 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 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 12 August 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 either on par or slightly lower than the clinical commissioning group (CCG) and national average. For example, 81% of patients on the diabetes register, had a record of a foot examination taking place within the last 12 months. The local CCG average was 84% and the national average was 88%.
  • For patients with more complex diabetic needs the practice could refer to the local community diabetes nurse specialist.
  • 90% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was the same as the national average of 90%

  • Patients were supported to self manage their long term condition by using agreed plans of care and were encouraged to attend self-help groups.
  • 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.
  • The practice website had information in relation to different long terms condition including information for diabetes during Ramadan or fasting.

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.

  • The practice GPs had a personalised list based system keeping families registered together with one GP.
  • 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.
  • Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
  • The practice ensured that children needing emergency appointments would be seen on the same day.
  • Immunisation rates were average 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered Saturday flu clinic appointments for children to fit in around working parent’s commitments.
  • The number of women aged between 25 and 64 who attended cervical screening in 2014/2015 was 78% compared to the clinical commissioning group (CCG) and national average of 82%
  • We saw positive examples of joint working with midwives and health visitors.
  • The practice offered family planning and routine contraception services including implant/coil insertion.
  • The practice had a variety of self-help leaflets and information. This included information targeted to young patients – a leaflet providing information about how to access services at the practice and the local area.

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 had patients registered who resided in several local care homes.
  • Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were appropriately shared with local organisations to facilitate the continuity of care.
  • The practice was working to the Gold Standards Framework for those patients with end of life care needs. (The Gold Standards Framework is a framework to enable a standard of care for all people nearing the end of their lives. The aim of the Gold Standards Framework is to develop a locally-based system to improve and optimise the organisation and quality of care for patients and their carers in the last year of life).
  • The practice telephoned patients upon their discharge from hospital to offer support, and to enquire whether a visit or other assistance was required.
  • The practice worked with the integrated care team to improve communication between different services, for patients who were vulnerable or had complex needs

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 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 was open from 7.30am to 6.30pm every weekday. The practice had extended opening and offered evening appointments every week day until 8pm. This service was jointly run with another local practice. Every other Saturday morning appointments were available.
  • The practice offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
  • Patients were able to access their repeat prescription online and were able to have this collected by a pharmacy of their choice, which could be closer to their place of work if required.

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).

  • 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to 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 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 homeless people, travellers and 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.
  • The practice could accommodate those patients with limited mobility or who used wheelchairs.
  • Carers and those patients, who had carers, were flagged on the practice computer system and were signposted to the local carers support team.
  • The practice worked with the integrated care team in order to improve support and communication between different services for patients.