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Inspection Summary


Overall summary & rating

Good

Updated 13 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St. Luke’s Surgery on 23 March 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, including those relating to recruitment checks.
  • Feedback from patients about their care was consistently and strongly positive.
  • 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.
  • 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.
  • The practice implemented suggestions for improvements and made changes to the way they delivered services as a result of feedback from patients.
  • 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.

The areas where the provider should make improvement are:

  • The practice should review the complaints process to ensure patients are given information on how they can escalate the complaint if they remain dissatisfied.

  • Review the opening times in line with patient feedback in respect of access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 June 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.
  • The practice was clean and tidy and there were arrangements in place to ensure appropriate hygiene standards were maintained.
  • The practice had policies and procedures in place to help with continued running of the service in the event of an emergency.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 13 June 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.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The GPs within the practice peer reviewed hospital referrals to ensure that the best care pathway had been chosen for the patient.
  • Two GPs had received awards from the CCG in recognition of their work. One GP received an award for Clinical excellence in primary care whilst another GP received recognition in the area of Transformational change in primary care.

Caring

Good

Updated 13 June 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.
  • We observed a strong patient-centred culture.
  • The practice employed a care co-ordinator to ensure that support could be delivered to people at the level that they required it.
  • The practice had identified 310 patients as carers (approximately 3% of the practice list).

Responsive

Good

Updated 13 June 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. However, the practice did not inform patients how they could escalate the complaint should they still remain dissatisfied following the final response letter.

Well-led

Good

Updated 13 June 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 focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 13 June 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.
  • Data from 2014/15 showed the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 93% compared to the national average of 81%.
  • Two GPs and the lead practice nurse all hold the Warwick certificate in diabetes care (The Certificate in Diabetes Care (CIDC) course is the UK's leading foundation course in diabetes care).

  • Patients diagnosed with diabetes had access to a podiatrist every quarter to enable high quality foot care and there was a diabetes care clinic every two weeks.
  • 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.

Families, children and young people

Good

Updated 13 June 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 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.
  • 82% of eligible patients had received cervical screening which was the same as the national average.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There was a youth counsellor available at the practice for children and young adults.
  • We saw positive examples of joint working with midwives and health visitors.
  • The practice ensured that children needing emergency appointments were seen on the day.

Older people

Good

Updated 13 June 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 supported a number of patients in local care homes and ran regular weekly rounds to meet their needs.
  • The practice had identified elderly patients that were the most vulnerable and created advanced care plans which were patient held but also available for ambulance staff to view via a computerised system.
  • The practice contacted all patients that had been discharged from hospital within three days to discuss their care needs.

Working age people (including those recently retired and students)

Good

Updated 13 June 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.
  • Telephone appointments were available for patients who could not attend the practice due to work commitments or where they could not attend the surgery.
  • The practice offered text reminders for appointments to prevent patients not attending.
  • Electronic prescribing was available which removed the need for working people to attend the surgery to collect their prescriptions.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 June 2016

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

  • 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
  • Data from 2014/15 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 86% which was comparable to the national average of 88%.
  • The practice assisted patients in accessing the Surrey Independent Living Council funding to enable breaks for carers.
  • 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 developed a carer’s pack which contained information regarding the help available.
  • The practice was part of the Improving Access to Psychological Therapies (IAPT) programme which enabled patients to access support for conditions such as stress and depression.
  • 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 13 June 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 was the sole GP care provider for patients living at a refuge where women, often with young children, were placed after fleeing domestic violence.
  • The practice had a lead GP for patients diagnosed with learning disabilities and co-ordinated care with the local learning disability specialist nurse and team.
  • The practice provided medical services for two local homes which catered for people with learning difficulties. The GPs conducted annual health checks for these residents.