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Inspection Summary


Overall summary & rating

Good

Updated 6 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens Walk Practice on 16 February 2016. The overall rating for the practice was good. However, within the key question safe some areas were identified as ‘requires improvement’, as the practice was not meeting the legislation for Safe care and treatment; Good governance; Staffing & Fit and proper persons employed.

The practice was issued requirement notices under Regulation 12, Safe care and treatment; Regulation 17 Good governance; Regulation 18 Staffing; and Regulation 19 Fit and proper persons employed. The full comprehensive inspection on 16 February 2016 can be found by selecting the ‘all reports’ link for the Queens Walk Practice on our website at www.cqc.org.uk.

This inspection was a focused desk based review carried out on l June  2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 16 February 2016. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall, the practice is rated as good.

Our key findings were as follows:

  • The practice had implemented and was following a system to ensure all MHRA and medicines alerts were acted on.

  • All staff acting as a chaperones had the appropriate Disclosure and Barring Service check (DBS check) completed.

  • Locum staff at the practice had all the necessary employment checks.

  • A cleaning schedule was in place and was being monitored.

  • Staff had received appropriate infection control training and they were infection control audits in place.

  • Health care assistants were working in accordance to Patient Specific Directions to ensure they delivered care safely.

  • A risk assessment had been completed for the safe keeping of a large liquid nitrogen container used for surgical procedures to ensure it was stored safely.

In addition improvements had been made in the following areas we had recommended :

  • Improvements had been made to the recording of patients care plans.

  • The practice was ensuring that palliative care meetings were held.

  • The recording of team meetings was consistent to ensure staff had access to them if they had been absent on the day of the meeting.

  • The practice had developed and was following a formalised system of identifying carers.

We reviewed this information and made an assessment of this against the regulations.

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation. Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment; Regulation 17 HSCA (RA) Regulations 2014 Good governance; Regulation 18 HSCA (RA) Regulations 2014 Staffing; and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 July 2017

The practice is rated as good for providing safe services.

  • The practice had implemented and was following a system to ensure all MHRA and medicines alerts were acted on.

  • All staff acting as a chaperones had the appropriate Disclosure and Barring Service checks (DBS check) completed.

  • Locum staff at the practice had all the necessary employment checks.

  • A cleaning schedule was in place and was being monitored.

  • Staff had received appropriate infection control training and they were infection control audits in place.

  • Health care assistants were working in accordance to Patient Specific Directions to ensure they delivered care safely.

  • A risk assessment had been completed for the safe keeping of a large liquid nitrogen container used for surgical procedures to ensure it was stored safely.

Effective

Good

Updated 13 April 2016

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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.

  • Although the practice had written care plans for 5. 2% of patients with a high risk of admission most patients with long term conditions did not have written care plans nor did they have written escalation or de-escalation plans for patients with COPD or asthma.

  • The practice held multi- disciplinary meetings but these did not include palliative care patients.

Caring

Good

Updated 13 April 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 13 April 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.

Well-led

Good

Updated 13 April 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 this.

  • 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 knowing about 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 13 April 2016

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


  • GP had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, who have a record of an albumin: creatinine ratio test (The urine albumin test or albumin/creatinine ratio ACR is used to screen people with chronic conditions, such as diabetes) in the preceding 12 months was comparable to the CCG and national average (practice 85%; national 77 %).

  • Longer appointments and home visits were available when needed. However, not all these patients had a personalised care plan.

Families, children and young people

Good

Updated 13 April 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.

  • 80% of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was comparable to the national average.

  • 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.

  • The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 78% 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.

Older people

Good

Updated 13 April 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.

Working age people (including those recently retired and students)

Good

Updated 13 April 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 April 2016

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

  • 80% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

  • 97% of patients diagnosed with schizophrenia, bipolar and other mental health conditions had a care plan reviewed in the last 12 months, which was higher than the national average.

  • 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 13 April 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 multi-disciplinary teams in the case management of vulnerable people.

  • 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.