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Inspection Summary


Overall summary & rating

Good

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nagle and Partners on 18 December 2015. Overall the practice is rated as good.

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

  • The practice ensured that when things went wrong that these were investigated and learning was shared with staff. Risks to patients were assessed and well managed. There were systems for assessing risks including those associated with medicines, premises, equipment and infection control.
  • There was a detailed business continuity plan to deal with untoward incidents that may affect the day to day running of the practice.
  • Staff were recruited robustly with all of the appropriate checks carried out to determine each person’s suitability and fitness to work at the practice. Where locum GPs were employed verbal references had been sought and this was not recorded.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.

  • Staff were supported and received role specific training to meet the needs of patients and there was a system for staff appraisal.
  • 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. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or their experienced poor care or services.
  • The majority of 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 reviewed its appointments system and upgraded the telephone systems to address patients comments about the lack of accessible appointments and difficulties
  • 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 to make improvements to the services provided.

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

Importantly the provider should:

  • Review the arrangements for storing temperature sensitive medicines and keep records of actual fridge temperatures.

  • Ensure that recruitment files for locum GPs contain a record of all of the checks carried out including references.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 February 2016

The practice is rated as good for providing safe services. There were systems in place to monitor safety and to act when things went wrong. Lessons were learned and communicated with staff to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed.

There were policies, procedures and risks assessments to identify risks to patients and staff. These included safeguarding adults and children, infection prevention and control and health and safety. Staff were recruited with all of the appropriate checks carried out including proof of identify, employment references and Disclosure and Barring Services (DBS) checks. Staff were trained and had access to appropriate policies and guidance for their roles. However references were not recorded for locum GPs who were employed at the practice.

Medicines were managed safely. However fridge temperatures were not recorded consistently and there were no procedures in place for staff to follow in respect of monitoring these temperatures.

The practice had appropriate premises and equipment and these were well maintained to help keep patients and staff safe.

Effective

Good

Updated 11 February 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality for the management of the majority of long term conditions and disease management such as heart disease, dementia and diabetes. Where areas for improvements were identified the practice acted promptly to address these. Staff referred to guidance from the National Institute for Health and Care Excellence local and national initiatives and used it routinely.

Patients’ needs were assessed and care was planned and delivered in line with current legislation and guidance. Staff regularly reviewed current guidance to ensure that patients were receiving treatments in line with any changes for improvement. A system of audits and reviews were in place to monitor and improve outcomes for patients.

Staff were supported and received training relevant to their roles and the needs of patients.

Caring

Good

Updated 11 February 2016

The practice is rated as good for providing caring services. The results from the 2014/14 national GP survey showed that patients generally satisfied with how staff at the practice treated them and the practice performance was similar to other GP practices both locally and nationally for several aspects of care. Where areas for improvement were identified the practice had acted on these to improve patients’ experience.

Patients who completed comment cards and those we spoke with during the inspection also told us that staff at the practice were respectful and caring. Patients said they were treated kindly with dignity and respect. Patients’ privacy was maintained during consultations and treatment and information in respect of patients was treated confidentially. The practice had a dedicated room where patients could speak in private should they wish to.

Patients told us that they received information about their treatment in a way which they could understand and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. The practice recognised the needs of patients who were carers and provided support and information about the range of agencies and organisations available.

Responsive

Good

Updated 11 February 2016

The practice is rated as good for providing responsive services. It 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.

Appointment times and availability were flexible to meet the needs of patients. Same and next day appointments were available. Home visits and telephone consultations were provided as needed. The practice had responded to patients comments about access to appointments and getting through to the surgery on the telephone. They had upgraded the telephone system and amended the appointments system to offer more same day appointments.

The practice had good facilities and was well equipped to treat patients and meet their needs. Accessible toilets and baby changing facilities were available. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. The practice offered apologies to patients when things went wrong or the service they received failed to meet their expectations. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 11 February 2016

The practice is rated as good for being well-led. It had a clear vision and strategy to provide a personalised high quality care for all its patients. Patients had access to GPs throughout the day via face to face appointments or for advice and telephone consultations. The strategy included planning for the future. Staff were clear about the vision and their responsibilities in relation to this. Information about the practice was available to staff and patients.

There was a clear leadership structure within the practice and staff felt supported by management. The practice had a number of policies and procedures to govern activity and these were regularly reviewed and updated so that they reflected current legislation and guidance. There were systems in place to monitor and improve quality and identify risk.

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and met every four to eight weeks with practice staff to discuss any issues and how these could be improved upon. The patient participation group was working proactively to attract new members. Staff told us that they felt supported and that they could raise comments and suggestions, which were acted upon.

Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

The practice is rated as good for the care of people with long-term conditions. GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally.

Patients at risk of unplanned hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice had a dedicated member of staff to coordinate reviews for the management of long term conditions and work was being done to streamline reviews so as to minimise the number of visits for patients with one or more long term condition.

Families, children and young people

Good

Updated 11 February 2016

The practice is rated as good for the care of families, children and young people. The practice offered same day appointments for children. Appointments were available outside of school hours. Post-natal and baby checks were available to monitor the development of babies and the health of new mothers. The practice contacted all new mothers to remind them to register babies to help promote continuity of care.

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. The practice held monthly safeguarding meetings with relevant health professionals including health visitors to review children who were identified as being at risk.

Immunisation rates were similar to other GP practices 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.

Information and a range of sexual health and family planning clinics were available.

Older people

Good

Updated 11 February 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people, and offered home visits and rapid access to telephone advice and appointments for those with enhanced needs.

GPs worked with local multidisciplinary teams to reduce the number of unplanned hospital admissions for at risk patients including those with dementia and those receiving end of life palliative care.

The patient participation group had organised a recent event to promote awareness about dementia. This event was attended by patients and carers. Information and advice was provided by the Alzheimer’s society, Dementia Friends and Age Concern. The practice also hosted the Alzheimer's Society twice monthly who met with patients and/or carers to offer support and advice. The practice was also working towards becoming a Dementia Friendly Practice.

Working age people (including those recently retired and students)

Good

Updated 11 February 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. Pre-booked appointments were available each morning between 7am and 8am.

The practice was proactive in offering online services including on-line appointment booking and electronic prescribing (where patients can arrange for their repeat prescriptions to be collected at a pharmacy of their choice).

The practice offered a full range of health promotion and screening that reflected the needs for this age group including NHS Health Checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice reviewed and monitored patients with dementia and carried out face-to-face reviews. Staff at the practice were proactive in carrying out dementia screening and liaised with the dementia community nurses to ensure that care was coordinated and effective to meet patient’s needs.

Patients with mental health conditions were reviewed and had an annual assessment of their physical health needs. Longer appointments and home visits were provided as required.

The patient participation group had organised a recent event to promote awareness about dementia. This event was attended by patients and carers. Information and advice was provided by the Alzheimer’s society, Dementia Friends and Age Concern. The practice also hosted the Alzheimer's Society twice monthly who met with patients and/or carers.  The practice was also working towards becoming a Dementia Friendly Practice.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 11 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Staff undertook safeguarding training and the practice had a dedicated safeguarding leads for overseeing adult and child safeguarding procedures.

The practice held a register of patients living in vulnerable circumstances including patients with a terminal illness and those with a learning disability. The practice proactively promoted annual health checks for patients with learning disabilities and nurses had received specific training to support these patients.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This helped to ensure that patients whose circumstances made them vulnerable were supported holistically and that patients who were at a higher risk of unplanned hospital admissions were supported to and treated in their home.

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.