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Inspection Summary


Overall summary & rating

Good

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stanwell Road Surgery on 28 April 2016. Overall the practice is rated as good.

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

  • The practice provided safe and effective clinical care.
  • 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.
  • 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.
  • The nurse practitioner was a nurse mentor and worked with the local university to train practice nurses.
  • 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.
  • The practice had reasonable facilities and was well equipped to treat patients and meet their needs.
  • The practice ran a walk in teenage sexual health clinic for the local area. This was a unique service which was well used by teenagers in the practice population.
  • The practice was a yellow fever centre and provided travel health services to people from outside the practice.
  • 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 practice had a charter, written with the patient participation group, committed to giving patients the best service by the practice staff working together.
  • The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 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.
  • Risks to patients were assessed and well managed.


Effective

Good

Updated 15 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.

  • The practice had invested heavily in training the practice nurse team by supporting an experienced nurse to become a nurse practitioner and training two new practice nurses. The nurse practitioner was a nurse mentor and worked with the local university to train practice nurses.

  • 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.

Caring

Good

Updated 15 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.


Responsive

Good

Updated 15 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 (CCG) to secure improvements to services where these were identified. The practice had recently set up a blood testing anticoagulation clinic to monitor patients on blood thinning medicines following work with the CCG to commission this service locally.
  • Most 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.
  • The practice offered early morning appointments from 7.30am every weekday for GP appointments and for blood tests.
  • The practice was a yellow fever centre and provided travel health services to people from outside the practice.

Well-led

Good

Updated 15 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.
  • The practice had a charter, written with the patient participation group, committing to give patients the best service by working together.
  • 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 strong focus on continuous learning and improvement at all levels. One of the partners and the practice manager were actively involved in the clinical commissioning group and were open to piloting new ideas to improve patient care and practice efficiency.

Checks on specific services

People with long term conditions

Good

Updated 15 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.
  • 87% of patients on the diabetes register had a record of a foot examination and classification which was in line with the CCG average of 89% and national average of 88%.
  • 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 15 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.
  • 81% of eligible female patients had a cervical screening test which was in line with the clinical commissioning group average of 80% and 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. At the time of the inspection there was no named health visitor for the practice due to issues with the provider of this service. The practice had to work with a rotation of different health visitors who were providing a cover service.
  • The practice ran a walk in teenage sexual health clinic for the local area. This was a unique service which was well used. A practice survey run between October 2015 and January 2016 showed that 93% of respondents rated the service as good.
  • Youth counsellors held a weekly clinic on site which patients could self-refer to or be referred to by a GP.
  • The practice provided implant and intrauterine device fitting contraceptive services, as well as sexual health advice and counselling and testing for sexually transmitted infections.

Older people

Good

Updated 15 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. This included carrying out urgent home blood tests to avoid long delays for patients due to low district nursing capacity.
  • Practice nurses carried out health checks for patients over 75.
  • The practice identified those patients most at risk of hospital admissions. A care coordinator contacted these patients after a discharge from hospital to offer assistance and check medication.
  • A representative from an older person’s national charity attended the surgery every two weeks and held an open advice clinic for patients.

Working age people (including those recently retired and students)

Good

Updated 15 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 offered early morning appointments from 7.30am for blood tests and GP consultations.
  • 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.
  • The practice had recently started an email service for patient queries with a 48 hour response time.
  • The practice offered electronic prescribing allowing patients to collect prescriptions closer to their place of work.
  • Registration forms, travel forms and self-certification certificates were available on the practice website for patients.
  • The practice ran a travel clinic and was a yellow fever centre for patients from other local surgeries.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 June 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 had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • 91% of patients experiencing poor mental health had an agreed care plan, which is the same as clinical commissioning group average of 91% and better than the national average of 88%.
  • 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 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. For example they sent on the day appointment reminders to patients.

People whose circumstances may make them vulnerable

Good

Updated 15 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 those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and arranged appointments at suitable times and places for those patients who became agitated or scared by noise.
  • The practice provided support for a care home for people with a learning disability which gave very positive feedback on the care the practice provided. The practice had agreed to look after these residents even though the home was outside the practice boundary, as other more local practices had not been willing to take on the care of the people in the care home.
  • 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.