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Inspection Summary


Overall summary & rating

Good

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Charnwood Surgery on 26 May 2016. Overall the practice is rated as good.

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

  • The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared with relevant staff.
  • Risks to patients were assessed and well managed. There were arrangements in place to review risks on an ongoing basis to ensure patients and staff were kept safe. However, the practice needed to ensure arrangements were in place to undertake regular fire drills.
  • Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
  • Regular clinical audits were undertaken within the practice to drive improvement.
  • Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
  • 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.
  • Patients said they generally found it easy to make an urgent appointment but that they sometimes had to wait to see a named GP.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Adjustments had been made to the premises to ensure these were suitable for patients with a disability.
  • There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the partners and 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.

There were some areas where the provider should make improvements:

  • Ensure that there are robust systems in place to record action taken in response to medicines and patient safety alerts received.
  • Ensure arrangements are in place to undertake regular fire drills within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 July 2016

The practice is rated as good for providing safe services.

  • The practice had systems in place to enable staff to report and record significant events. Staff understood the systems and were encouraged to report events and incidents.
  • Learning from significant events was identified and shared with staff to ensure action was taken to improve safety.
  • When things went wrong patients received support, information and apologies. They were told about actions to improve processes to prevent the same thing happening again.
  • Systems and processes were in place to ensure patients were kept safe and safeguarded from abuse. For example all clinical staff had been trained to child safeguarding level 3 and regular meetings were held with community staff to discuss children at risk.
  • However, the practice needed to strengthen its systems to document actions and responsibility for actions taken as a result of safety and medicines alerts received into the practice.
  • Risks to patients were assessed and generally well managed across the practice; however, the practice needed to ensure arrangements were in place to have regular fire drills.

Effective

Good

Updated 28 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with local and national averages. For example the most recently published results for 2014/15 showed the practice had achieved 96.6% of the total number of points available. This was 0.4% below the clinical commissioning group (CCG) average and 1.9% above the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • There were systems in place to ensure staff were up to date with relevant guidelines including regular training and clinical meetings. Templates on the patient record system which were used to support the delivery of patient care were updated annually to ensure any changes to guidelines were embedded.
  • Clinical audits were undertaken within the practice to support improvement. Seven clinical audits had been undertaken in the last 12 months.
  • 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.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. The practice worked closely with the community care coordinator who was positive about the engagement demonstrated by the practice.

Caring

Good

Updated 28 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for several aspects of care. For example, 100% of patients said they had confidence and trust in the last nurse they saw compared to the CCG average of 98% and the national average of 97%.
  • The national GP patient survey identified several areas where the practice was rated below others for aspects of care. We saw evidence that the practice and the patient participation group were aware of areas for improvement and the recent practice survey showed the vast majority of patients responded positively to questions about 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.
  • During the inspection we observed that staff treated patients with kindness and respect, and maintained confidentiality.
  • The practice had identified 390 patients as carers which equated to 2.9% of their practice list.

Responsive

Good

Updated 28 July 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of the local population and delivered services to meet their needs.
  • Extended hours appointments were offered three times per week including on Saturday mornings.
  • A range of services were offered by the practice to avoid patients having to travel including minor surgery and joint injections.
  • Patients said they generally found it easy to make an urgent appointment but some patients said there could be a wait to see a named GP. The practice was aware of issues related to accessing appointments with some GPs and was reviewing their appointment system on an ongoing basis.
  • 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 the patient participation group (PPG).

Well-led

Good

Updated 28 July 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 providing a safe, high quality service.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice had a range of policies and procedures to govern activity and held regular governance meetings. Policies were regularly reviewed and updated.
  • 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 patient participation group (PPG) was active and met regularly; they worked closely with the practice to identify areas for improvement and supported them to make improvements. For example, the PPG had worked with the practice to review the letter sent to patients who missed appointments. In addition, the PPG supported the practice by reviewing and refreshing noticeboards within the practice and arranging themed displays.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 28 July 2016

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

  • Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of admission to hospital were identified as a priority.
  • Performance for diabetes related indicators was 96% which was 3% above the CCG average and 7% above the national average. The exception reporting rate for diabetes indicators was 16% which was slightly above the CCG average of 13% and the national average of 11%.
  • Longer appointments and home visits were available when needed to facilitate access for these patients.
  • All these patients had a named GP and were offered regular reviews to check their health and medicines needs were being met.
  • For patients with more complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice worked closely with their attached care coordinator to ensure support was in place for patients who required it.

Families, children and young people

Good

Updated 28 July 2016

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

  • Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and a deputy lead and staff were aware of who these were.
  • We saw positive examples of joint working with midwives, health visitors and school nurses with regular meetings being held to discuss children at risk.
  • Extended hours appointments were offered three days per week, including Saturdays, to ensure appointments were available outside of school hours.
  • Vaccination rates for childhood immunisations were in line with local averages.

Older people

Good

Updated 28 July 2016

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

  • Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Longer appointments were provided for older people as required.
  • The practice had worked with a national charity to offer free hearing aid checks to patients. This was set up during the flu season to maximise impact.
  • Following feedback received from patients the practice reversed their decision to cease providing phlebotomy services from their branch practice. This followed concerns expressed by elderly patients that it could be difficult for them to access alternative services.
  • Older people at risk of admission to hospital were flagged to the care coordinator who worked with the practice who reviewed support arrangements in place with the aim of preventing admissions.

Working age people (including those recently retired and students)

Good

Updated 28 July 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 offered services which were accessible and flexible. For example extended hours appointments were offered most days from 7am to 8am to facilitate access for working patients.
  • The practice was proactive in offering online services including appointment booking and online prescription services.
  • A range of health promotion and screening services were offered and promoted that reflected the needs of this age group.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 84% and the national average of 82%.
  • A range of services were offered at the practice to facilitate patient access including minor surgery and joint injections.
  • Text messaging was used to confirm appointments and issue reminders.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 July 2016

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

  • Performance for mental health related indicators was 91% which was 6% below the CCG average and 2% below the national average. The exception reporting rate for mental health related indicators was 10% which was below the CCG average of 17% and above the national average of 11%.
  • 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 8% below the CCG average and 6% below the national average. This exception reporting rate for this indicator was 7% which was below the CCG average of 9% and the national average of 8%.
  • Monthly multidisciplinary meetings were held within the practice to ensure the needs of these patients were being met.
  • The practice had a system in place to follow up patients who had attended A&E who may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and training was planned to enable staff to become dementia friends.

People whose circumstances may make them vulnerable

Good

Updated 28 July 2016

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

  • Homeless people and those living in the vulnerable circumstances were registered with the practice. For example, the practice would use the address of a local hotel or the practice address to register homeless patient.
  • The practice offered longer appointments for patients with a learning disability where required.
  • The practice had undertaken work with a local alcohol support organisation to identify potential patients with possible alcohol problems and was planning regular support sessions at the practice for patients who had alcohol dependency issues.
  • Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.
  • Translation services were provided where these were required and various pieces of information and signage were available in more than one language.
  • In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • 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.
  • The practice held a register of carers; there were 390 patients identified as carers, this represented 2.9% of the total practice list.