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Inspection Summary


Overall summary & rating

Good

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harptree Surgery on 15 March 2016. Overall the practice is rated as good.

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

  • 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 the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice scored highly on the GP patient survey.
  • 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • The practice provided pharmaceutical services to almost all those patients who used the practice.

The areas where the provider should make improvements are:

  • The practice should engage more effectively with the patient participation group to improve collaborative working with service users.

  • The practice should review procedures for monitoring temperatures within the dispensary where medicines were stored.

  • Review the practice of cutting of blister packs and placing them in weekly compliance aids.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 May 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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.

  • The practice provided pharmaceutical services to almost all those patients who used the practice. The arrangements for the management of medicines was safe. However the practice should monitor temperatures more effectively within the dispensary where medicines were stored and review the practice of cutting of blister packs and placing them in weekly compliance aids.

Effective

Good

Updated 18 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance. GPs and nurses all took personal accountability for ensuring they were up to date with current guidelines and cascading new information to the team.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice worked closely with local consultants and invited them to the practice to deliver educational sessions on a regular basis, to continually update knowledge and skills.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 May 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 all aspects of care. For example, 96% said the GP was good at listening to them compared to the clinical commissioning group (CCG) average of 92% and national average of 87%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. For example, 95% said the last nurse they spoke to was good at treating them with care and concern compared to a national average of 90%.

  • 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 18 May 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. For example, the practice had worked with other local practices on a forward weekend planning initiative. If GPs had concerns regarding a patients health over the weekend, appointments could be made for them at the local hospital with the Bath emergency medical service, or for the patient to be visited, so that their health to be reviewed. This had meant that patients who otherwise would have needed admission to hospital could remain at home.

  • 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.

  • Following results from a patient survey the practice recognised that waiting time was an issue for a number of patients. The practice responded to this by tailoring the length of appointments for each individual GP depending on their working styles.

  • 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 18 May 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.

  • There was a strong focus on continuous learning and improvement at all levels.

However

  • The practice had an online patient participation group (PPG) which had not been effectively engaged or communicated with. The three members we met with recognised that the group was not meeting the objectives of an effective PPG.

Checks on specific services

People with long term conditions

Good

Updated 18 May 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.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 96% compared to a national average of 88%.

  • The percentage of patients with chronic obstructive disease (COPD) who had a review undertaken in the preceding 12 months (04/2014 to (03/2015) was 94% compared to a national average of 90%.

  • Longer appointments and home visits were available when needed.

  • A nurse visited housebound patients with a long term condition to carry out an annual review.

  • Virtual clinics were held on a regular basis to review diabetic patients with complex needs with the local diabetic specialist nurse.

  • 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 18 May 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.

  • The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control (04/2014 to 03/2015) was 81% compared to a national average of 75%.

  • 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (04/2014 to 03/2015) was 89% compared to a national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 18 May 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. Individualised care plans were in place for older patients who were at risk of admission. Care plans were shared with other services, to ensure patient wishes were adhered to.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs and this was acknowledged positively in feedback from patients.

  • Patients who were carers had been identified by the practice and offered annual health checks.

  • The practice had no nursing homes within the practice boundary. However the practice continued to provide medical services to patients who had transferred to a nursing home but wished to continue being registered at the practice.

Working age people (including those recently retired and students)

Good

Updated 18 May 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.

  • Extended hours surgeries were held, one morning and one evening each week and alternate Saturday mornings.

  • Bookable telephone appointments were available, with a preferred GP, for those unable to attend the practice in person.

  • The practice offered full sexual health services for those who required them.

  • 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 18 May 2016

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

  • The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (04/2014 to 03/2015) was 83% compared to a national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.

People whose circumstances may make them vulnerable

Good

Updated 18 May 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 provided medical services to a local learning disabilities home and worked closely with the local learning disabilities consultant to ensure standards of care remained high.

  • 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.