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Inspection Summary


Overall summary & rating

Good

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stockbridge Surgery on 26 July 2016. At this inspection the overall rating for the practice was requires improvement. The full comprehensive report on the 26 July 2016 inspection can be found by selecting the ‘all reports’ link for Stockbridge Surgery on our website at www.cqc.org.uk .

This inspection was an announced focused follow up inspection carried out on 20 July 2017 to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At the inspection in July 2016 we found there were areas of practice where the provider needed to make improvements. This included:

  • The practice must ensure that clinical waste is managed in line with its policy and protocol. In particular all clinical waste bags and sharps bins must be marked with the postcode of the practice and the date on which the packages were sealed.

  • The provider must ensure all appropriate recruitment checks are undertaken and recorded prior to the employment of new staff including obtaining satisfactory evidence of conduct in previous employment.

At the inspection in July 2016 we said the provider should:

  • Ensure that they identify and support carers appropriately.

  • Encourage and support the formation of the new patient participation group.

  • Improve their performance with regards to the management of patients who have diabetes.

  • Ensure that all policies and procedures clearly state the date when those were written. It should also be clear when a review date is include whether that is a ‘due date’ or the date when a review was completed. This includes the practice’s written dispensary standard operating procedures.

At this inspection in July 2017 we found:

  • All waste was securely stored and labelled in line with the practice policy and national guidance. The waste management policy had been updated.

  • A recruitment pack had been introduced which included a mandatory checklist for employment. An inspection of four files demonstrated that this checklist was being used. A welcome pack for staff had been introduced which included the above checklist, job description, contract of employment, training information, induction documentation, information on emergency procedures and contact numbers for the team and local safeguarding teams.

  • Changes to the identification of carers had resulted in the numbers of carers increasing from 0.5% of the patient population to 2%.

  • A new patient participation group had been formed.

  • Significant steps had been taken to improve the service being offered to patients with diabetes.

  • Policies and standard operation procedures had been reviewed and amended to make the review dates clearer on the document.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 August 2017

At our previous inspection in July 2016, we rated the practice as requires improvement for providing safe services as the arrangements in respect of recruitment, waste management and management of policies were not adequate.

These arrangements had significantly improved when we undertook a follow up inspection on 20 July 2017. The practice is now rated as good for providing safe services.

At this inspection on 20 July 2017 we found that:

  • Waste management processes at the practice had improved.

  • Policies had been amended and a clear system introduced to ensure that policies were all kept under regular review.

  • Recruitment processes had been improved to ensure that all pre-employment checks were performed.

Effective

Good

Updated 18 August 2017

At our inspection in July 2016 we rated the effective domain as good. However we said the provider should improve the performance for diabetes indicators.

At this inspection in July 2017 we found the practice had made significant steps in the provision of diabetic services to patients.

Caring

Good

Updated 18 August 2017

At our inspection in July 2016 we rated the caring domain as good. However we said the provider should identify carers more effectively and ensure they receive the information needed.

At this inspection in July 2017 we found the identification of carers had increased from 0.5% to 2% of the practice population.

Responsive

Good

Updated 18 August 2017

At our inspection in July 2016 we rated the responsive domain good. We did not inspect this domain at this inspection.

Well-led

Good

Updated 18 August 2017

At our inspection in July 2016 we rated the well led domain as good. However we said the provider should encourage and support the formation of the new patient participation group (PPG).

At this inspection in July 2017 we found the provider had invited patients to join the new PPG resulting in twenty patients signing up. A launch event for the PPG had been booked and staff links had been highlighted to improve communication.

Checks on specific services

Older people

Good

Updated 9 November 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. For vulnerable and often elderly patients the practice provided service of assessment and support planning, signposting and unplanned hospital admission prevention.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Patients aged over 75 years had a named GP and a medicines delivery service was available.
  • Meetings took place with other health care professionals on a monthly basis when care plans were routinely reviewed and updated for patients with complex needs.

People with long term conditions

Good

Updated 9 November 2016

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

  • 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.
  • 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 experienced good engagement and uptake of their diabetes education programme.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 9 November 2016

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

  • The practice’s GPs had special interests which included safeguarding children, paediatrics, family planning, obstetrics and gynaecology.
  • 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.
  • Young patients told us they were treated in way that was appropriate to their age and were recognised as individuals.
  • The practice’s uptake for the cervical screening programme was 92%, which was better than the CCG average of 82% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Working age people (including those recently retired and students)

Good

Updated 9 November 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. Evening and weekend clinics were available.
  • University and boarding school students were accommodated when required during vacations and home leaves.
  • 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.
  • E-mail advice and same day telephone advice was available from the patients usual GP or from the duty GP.

People whose circumstances may make them vulnerable

Good

Updated 9 November 2016

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

  • The practice held a register of vulnerable children and adults and had regular meetings to discuss their cases. The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice funded a proactive care team though the Transformation Fund. This included funding nursing and clinician time for preventative work with vulnerable patients, particularly the elderly at risk of hospital admission.
  • The practice hosted multi-disciplinary meetings which helped to coordinate the care of some of the most vulnerable patients, and allowed exchange of ideas and information about how to best manage the patients with skills and resources which they may have not been aware of.
  • The practice offered longer appointments for patients with a learning disability.
  • 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 was 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 November 2016

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

  • 94% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was better than the clinical commissioning group (CCG) average of 89% and the national average of 88%.
  • 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 84% and 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 made use of the Child and Adolescent Mental Health Services’ consultation line and patients had access to same day appointments.