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Lisson Grove and Woolwell Medical Centres Good

Inspection Summary


Overall summary & rating

Good

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lisson Grove Surgery on 23 June 2015.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for the population groups of older people; people with long term conditions; families, young people and children; people experiencing poor mental health; people in vulnerable circumstances; working age people and those recently retired.

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.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • 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.

However there were areas of practice where the provider needs to make improvements

Importantly the provider should

  • Ensure that staff undertaking chaperone duties should receive training in this role.

Ensure that patients are aware of the chaperone service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 August 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. Medicines were stored, managed in line with national guidance. There were safeguards in place to identify children and adults in vulnerable circumstances. There was enough staff to keep people safe. Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Good

Updated 6 August 2015

The practice is rated as good for providing effective services. Supporting data obtained both prior to and during the inspection showed the practice had systems in place to make sure the practice was effectively run. The practice had a clinical audit system in place and audits had been completed. Care and treatment was delivered in line with national best practice guidance. The practice worked closely with other services to achieve the best outcome for patients who used the practice. Staff employed at the practice had received appropriate support, training and appraisal. GP appraisals and revalidation of professional qualifications had been completed. The practice had extensive health promotion material available within the practice and on the practice website.

Caring

Good

Updated 6 August 2015

The practice is rated as good for providing caring services. Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.

Accessible information was provided to help patients understand the care available to them. We also saw that staff treated patients with kindness and respect ensuring confidentiality was maintained.

Responsive

Good

Updated 6 August 2015

The practice is rated as good for providing responsive services. The practice reviewed and understood the needs of their local population. The practice identified and took action to make improvements. Patients reported that they could access the practice when they needed. Patients reported that their care was good. The practice was well equipped to treat patients and meet their needs.

There was an accessible complaints system with evidence demonstrating that the practice responded appropriately and in a timely way to issues raised. There was evidence that learning from complaints was shared with staff.

Well-led

Good

Updated 6 August 2015

The practice is rated as good for being well-led. The practice had a clear vision and strategy to deliver quality care and treatment and they were looking for ways to improve. Staff reported an open culture and said they could communicate with senior staff. The practice had a number of policies and procedures to govern activity and regular governance meetings took place. There were systems in place to monitor and improve quality and identify risks. There were systems to manage the safety and maintenance of the premises and to review the quality of patient care.

The practice had an active patient liaison group (PLG) which was involved in the core decision making processes of the practice.

Checks on specific services

People with long term conditions

Good

Updated 6 August 2015

The practice is rated as good for providing care to people with long term conditions.

The practice managed the care and treatment for patients with long term conditions in line with best practice and national guidance. Health promotion and health checks were offered to patient with specific conditions, such as diabetes and asthma. Practice nurses did not have separate clinics for patients with long-term conditions but run mixed clinics with varying appointment times, allowing greater flexibility.

The practice had a carers' register and all carers were offered an appointment for a carers' check with nursing staff. The practice worked with other health professionals to help patients stay within their own homes and avoid hospital admission where possible.

Families, children and young people

Good

Updated 6 August 2015

The practice is rated as good for families, children and young people.

Staff worked well with the midwife to provide antenatal and postnatal care. The practice provided baby and child immunisation programmes to ensure babies and children could access a full range of vaccinations and health screening. Patients could book appointments online and these were available before and after school hours. Patients were sent a text reminding them of their appointment.

Information relevant to young patients was displayed and health checks and advice on sexual health for men, women and young people included a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. The GPs training in safeguarding children from abuse was at the required level three.

Older people

Good

Updated 6 August 2015

The practice is rated as good for providing care to older people.

All patients over 75 years had a named GP. Health checks and promotion were offered to this group of patients. There were safeguards in place to identify adults in vulnerable circumstances. Each of the 11 local care homes had a named GP.

The practice worked well with external professionals in delivering care to older patients, including end of life care. The practice worked with other community staff to help patients stay within their own homes and avoid hospital admission where possible.

Pneumococcal vaccination and shingles vaccinations were provided at the practice for older people on set days as well as during routine appointments. A nurse visited a local care home to administer flu and shingles vaccinations. Patients could obtain their medicines from a local pharmacy.

Working age people (including those recently retired and students)

Good

Updated 6 August 2015

The practice is rated as good for providing care to working age people.

The practice provided appointments or telephone consultation on the same day. Emergency appointments were available. The practice operated early opening and extended hours each day.

Smoking cessation and lifestyle consultations and appointments were available. The practice website invited all patients aged between 40 years to 75 years to arrange to have a health check with a nurse if they wanted. A cervical screening service was available. Patients could order repeat prescriptions on line.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 August 2015

The practice is rated as good for people experiencing poor mental health, including people with dementia.

The practice was aware of their ageing patient population group, particularly in relation to those with dementia. Staff were aware of the safeguarding principles and GPs and nurses had access to safeguarding policies. All staff had received training in the Mental Capacity Act (MCA) 2005 and were aware of the principles and used them when gaining consent. The practice worked closely with the primary care dementia support practitioner and district nurses to help patients retain enough independence to remain at home. There was signposting and information available to patients.

The practice referred patients who needed mental health services and community psychiatric nurses visited the practice. Support services for patients with depression were provided at the practice, such as counselling. Patients suffering poor mental health were offered annual health checks as recommended by national guidelines.

People whose circumstances may make them vulnerable

Good

Updated 6 August 2015

The practice is rated as good for people whose circumstances may make them vulnerable.

The practice had a vulnerable patient register to identify these patients. Vulnerable patients had their cases reviewed at team meetings. Referral to a counselling service was available. The practice did not provide primary care services for patients who were homeless as none were known, however, staff said they would not turn away a patient if they needed primary care and could not access it.

Patients with language interpretation requirements were known to the practice and staff knew how to access translation services. A portable computer device was available at reception for interpreter purposes.

Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with them and their carer if appropriate. Reception staff were able to identify vulnerable patients and offer longer appointment times where needed.

The practice provided services for patients on the violent patient register; this ensured that there were sufficient arrangements in place to provide primary medical services to patients who have been subject to immediate removal from a patient list of a primary medical services contractor because of an act or threat of violence.