You are here

St Lawrence Surgery Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 13 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Lawrence surgery on 02 August 2016. Overall the practice is rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example they regularly shared the learning from significant events with other local practices.

  • Feedback from patients about their care was consistently positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example they supported their local GP provider company to submit a bid for funding from the Prime Ministers challenge fund to provide this service across Worthing and Adur.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example they installed a new telephone system in response to patient feedback.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been developed with the patient participation group and was regularly reviewed and discussed with staff.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

  • The practice employed a practice care co-ordinator who had a pivotal role as a liaison between the practice, patients and external agencies. This meant that members of the multi-disciplinary team (MDT), safeguarding teams, palliative care teams, pro-active care teams and carers all had a single contact point within the practice which ensured that patients had seamless care.

  • The practice worked very closely with the patient participation group (PPG) and considered them an integral part of the practice team. For example the practice ran walking, singing and weight management groups in conjunction with the PPG in order to promote patient well-being. They formed a self-care forum that led their self-help initiative producing a variety of self-care leaflets and devoting an area in the waiting room to self-care advice. The PPG chair was involved in the recruitment and selection of new GPs and sat on the interview panel. The PPG also helped organise an annual health promotion day for patients and regular evening educational events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 October 2016

The practice is rated as Good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • 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 used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on a thorough analysis and investigation. The practice shared learning through significant events with other practices.

  • Information about safety was highly valued and was used to promote learning and improvement.

  • There were comprehensive systems to keep people safe and safeguarded from abuse which took account of current best practice. The whole team were engaged in reviewing and improving safety and safeguarding systems.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 13 October 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices nationally. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 94% (national average 88%). The practice contracted an independent data analyst every six months to review their Quality and Outcomes Framework (QOF) registers, risk registers and prevalence searches to ensure that they were maximising the usefulness and quality of their data.

  • 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.

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example they had employed a care co-ordinator who acted as a liaison between the practice, patients and external agencies ensuring that patients, members of the multi-disciplinary team (MDT) teams, palliative care teams and pro-active care teams all had a single contact point which helped ensure that patients had seamless care.

Caring

Good

Updated 13 October 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.

  • Patients who had difficulties with communication had their preferred form of communication flagged on their notes.

  • Information for patients about the services available was easy to understand and accessible.

  • There was a care co-ordinator who amongst other roles liaised with carers

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 13 October 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. They were involved in the formation of the local ‘MIAMI’ (Minor Injury Assessment & Minor Illnesses) clinics throughout Worthing and Adur.

  • They used innovative approaches to providing integrated patient-centred care. For example they worked with parent carers to help children with additional needs and developed a ‘medical passport’ which contained important clinical and social information about them including such things as likes and dislikes. This provided other providers of health and social care with key information about their needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example they put a new updated telephone system in response to patient satisfaction surveys on telephone access.
  • Patients could access appointments and services in a way and at a time that suited them.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff, and other practices via the practice managers’ forum.

Well-led

Outstanding

Updated 13 October 2016

The practice is rated as outstanding for being well-led.

  • The practice had a clear vision to give their patients the care that they themselves would like to receive. The strategy to deliver this vision was developed with the patient participation group (PPG) and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles. Staff took great pride in their roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients using new technology and it had a very engaged PPG which influenced practice development. The PPG were integral to the running of the practice. The chair was involved in the interviewing of prospective GPs and the practice newsletter was jointly signed by the chair and practice manager. The PPG was also involved in the promotion and planning of the practice self-care initiative.

Checks on specific services

People with long term conditions

Outstanding

Updated 13 October 2016

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

  • The practice produced personal care plans for patients with diabetes, asthma, chronic obstructive pulmonary disease (COPD) and dementia.

  • The practice held dedicated weekly diabetes clinics and a hospital diabetes specialist nurse joined a practice nurse for the clinic once a month. The diabetes lead GP and other practice staff were working with the National Association of Primary Care on a pilot scheme to assess how patients could be empowered and motivated to self manage their condition.

  • The practice also held respiratory clinics. The lead GP, who also worked at the local hospital respiratory clinic once a week, saw complex cases to try to avoid hospital referral. The clinic was held in conjunction with the practice nurse. The practice’s respiratory referral rate was the lowest in the CCG as a result.

  • The practice also held also held clinics for patients with more than one long term illness, so that all of the reviews could be dealt with in one stop to save return visits.

  • They produced admission avoidance care plans agreed with the patient, family and/or carer. Patients with an admission avoidance care plan were contacted and if necessary visited within 48 hours of a hospital discharge.

  • Patients were encouraged and reminded to attend for reviews as well as flu, pneumococcal and shingles vaccines. This was done opportunistically, by email, personalised letters and as well as via the website, newsletters and posters.

  • The practice held patient educational events throughout the year. Examples included monthly group patient education sessions for newly diagnosed diabetics and an autumn ‘Keep Warm in Winter’ event. There were eight such events booked for 2016.

Families, children and young people

Outstanding

Updated 13 October 2016

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

  • The practice had both clinical and administrative child safeguarding leads. 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 child safeguarding register was updated monthly and the practice held monthly meetings with health visitors to discuss children and families at risk. They communicated regularly with school nurses and health visitors.

  • The practice ran weekly baby immunisations clinics and provided six week postnatal checks. They also provided parents with ‘when should I worry’ educational leaflets.

  • There were baby changing facilities and the practice provided a separate waiting area or room for mothers to breast feed.

  • Family planning clinics were run weekly and chlamydia testing was offered to patients.

  • Flu vaccines were offered for children, young people in the ‘at risk’ category and pregnant women.

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

  • The PPG held annual events for the children to encourage them to feel comfortable about attending the doctors’ surgery such as Easter egg hunts, health promotion days and Father Christmas.

  • The practice had a special interest in children with additional needs. They held a register of such children and hosted a bi-monthly Parent Carer support group. Emails containing useful information were sent to patients and their carers via a distinctive mail group and there was a social media page run by and for patients and carers in the group.

  • Each child with additional needs was issued with a ‘Medical Passport’ which had been devised in partnership with parent carers and which contained important clinical and social information about the children including their likes and dislikes. Newly diagnosed patients and their carers were issued with an ‘after diagnosis’ information pack and the parents ran a website specifically for this group of parents and children.

  • The practice had won an award for their work with and for children with additional needs.

  • Immunisation rates were average 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.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% (CCG 83%, national average 82%).

Older people

Outstanding

Updated 13 October 2016

The practice is rated as outstanding for the care of older people.

  • The practice looked after patients in a number of residential and nursing care homes with two nominated GPs who attended ward rounds on alternate weeks.

  • The practice nurse manager communicated with the residential and nursing care home staff nurses with regards to dressings and creams and the practice held regular meetings with staff of the largest nursing home that they served.

  • The practice clinical pharmacist undertook medicines reviews with elderly patients and answered nursing home queries.

  • Home visits were offered to the housebound patients by GPs and paramedic practitioners. Practice nurses would visit to carry out reviews of patients with diabetes and/or lung problems.

  • Flu vaccines were offered to the over 60s and those considered at risk. Clinics were held on weekdays and Saturdays. They also offered a housebound flu vaccine service.

  • Wheelchairs were available in the practice for patients with mobility problems.

  • There was a carers register as well as register of patients who were cared for. Flexible appointments were provided for patients who were or had a carer.

  • The practice held minuted monthly multi-disciplinary team (MDT) meetings to discuss the needs of patients on the palliative care register. The meeting was attended by the palliative care nurses and community nurses.

  • The practice worked alongside the local proactive care team which consisted of a proactive care co-ordinator, mental health professionals, community nurses, an occupational therapist, a physiotherapist, social workers, a clinical pharmacist and the prevention and assessment team. GPs and nurses met weekly with the team to discuss patients with complex health and social care needs to ensure they had a plan of care in place that prevented unnecessary admission to hospital.

  • The practice had a register of patients who were housebound. At Christmas (2015) they sent Christmas cards with the latest patient participation group (PPG) newsletter and invited housebound patients to weekly social activities and support group. The group was run in partnership with the PPG and a local nursing home provider who provided transport.

  • The practice ran walking, singing and weight management groups in conjunction with the PPG to promote the physical and wellbeing of patients.

  • There was an in house podiatry service which meant older patients could receive a local service.

Working age people (including those recently retired and students)

Outstanding

Updated 13 October 2016

The practice is rated as outstanding 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, evening and Saturday morning appointments for working people and commuters this included nurse and health care assistant appointments.

  • Health checks were available on a Saturday morning in addition to the GP appointments.

  • The practice held evening health education sessions.

  • The practice ran a GP, nurse and paramedic practitioner triage service with flexible telephone triage, telephone consultations and follow ups.

  • Patients could access GP appointments (book or cancel), request medication and view their medical records online.

  • The practice had produced a large variety of “self-care” leaflets available in the surgery and on their website.

  • 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. Patients could email the practice directly.

  • The practice used a text messaging system that worked with their practice software to send appointment and review reminders, cancellations and general messages to their patients.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 13 October 2016

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

  • 87% of patients diagnosed with dementia 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 (82%) and the national average (84%).

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 94% (CCG average 92%, national average 90%).

  • 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. Patients’ care was personalised and the practice understood the needs of individual patients. For example staff knew to collect some patients from their cars at the time of their appointments. The practice was also flexible with appointment times and lengths for patients experiencing poor mental health.

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

  • Several counselling services and the mental health link worker provided services on site.

  • The practice had a system in place to follow up patients who had attended accident and emergency when they may have been experiencing poor mental health.

  • The practice had a lead GP with a special interest in mental health and dementia. All staff had a good understanding of how to support patients with mental health needs and dementia. Many staff had had ‘dementia friendly’ training and the practice had been identified as a dementia friendly practice. Additionally all staff members had attended training on the Mental Capacity Act 2005.

  • There were registers of patients with mental health concerns and dementia.

  • The practice worked closely with the mental health trust consultants who were available for email advice and education.

People whose circumstances may make them vulnerable

Outstanding

Updated 13 October 2016

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

  • The practice kept registers of patients living in vulnerable circumstances including homeless people, housebound patients, vulnerable adults, carers and cared for patients, those with mental health concerns and those with a learning disability.

  • The practice encouraged and reminded patients with a learning disability to attend their annual reviews. GPs visited patients at home where appropriate.

  • The practice had a clinical adult safeguarding lead as well as an administrative adult safeguarding lead. 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.

  • There was a carers lead who was in contact with the local carers support services for updates, training and patient events.

  • Flexible appointments and urgent prescriptions were available for carers.

  • The practice offered longer appointments for patients with a learning disability and those that required an interpreter.

  • 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.

  • The practice had regular meetings with the staff of local nursing homes.

  • They worked with the proactive care team to support patients who were being cared for at home.