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Lensfield Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lensfield Medical Practice on 2 August 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 been trained to provide them with 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.
  • 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 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.
  • 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 areas where the provider should make improvement are:

  • Ensure annual appraisals are completed in a timely way.
  • Ensure infection control audits are completed when due.
  • Ensure that on-going mandatory training is completed when due.
  • Ensure that children who fail to attend a hospital appointment are appropriately coded on the practice’s computer system.
  • Ensure repeat reviews of patient safety alerts searches are regularly conducted to ensure that medicines that are subject to safety alerts continue to be adequately monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 September 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 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 however the practice had recently undergone extensive building work and had not completed an infection control audit which was due end of April 2016. The practice manager advised a full audit would be completed in August 2016. We saw evidence of cleaning checks and all staff monitored the cleaning standards and reported any issues raised.
  • Patient safety alerts were logged, shared and initial searches were completed and the changes effected but the necessary subsequent repeat reviews were not regularly conducted to ensure that medicines that were subject to safety alerts continued to be adequately monitored.

  • 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 however the practice did not read code on their clinical system children who fail to attend a hospital appointment.

Effective

Good

Updated 6 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national averages.
  • 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 however, some were not completed within a 12 month period. The appraisals were planned for September 2016.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 September 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.
  • 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 6 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with NHS England and the Clinical Commissioning Group to secure improvements to services where these were identified. For example; the practice had an international expert in primary care management of diabetes leading their diabetic clinic.
  • 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 minor surgery on site. This included cryotherapy, coil and contraception implants.
  • The practice website included information on signs of stress, counselling services available to help students with stress and a depression questionnaire. The practice also had in house counsellors on site.

Well-led

Good

Updated 6 September 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.
  • 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.
Checks on specific services

People with long term conditions

Good

Updated 6 September 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 practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 90%, which was the same as the CCG average and the national average. The practice exception reporting for the clinical domain was 17% which was above the CCG average of 13% and the England average of 11%. The practice had an international expert in primary care management of diabetes leading their diabetic clinic.
  • Longer appointments and home visits were available when needed.
  • 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. The practice ran an annual review clinic which ensured patients were recalled in for review on their birthday month and served as a memorable prompt.

Families, children and young people

Good

Updated 6 September 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 however the practice did not read code children who fail to attend a hospital appointment on their clinical system. 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.
  • 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 6 September 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.
  • The practice had 49 patients on their palliative care register and the practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
  • The practice looked after patients living in local nursing homes. GPs undertook regular visits and visited patients as and when required.
  • The practice had in house phlebotomy appointments and a community phlebotomy team to attend patients in the community if necessary.

Working age people (including those recently retired and students)

Good

Updated 6 September 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.
  • The practice’s uptake for the cervical screening programme was 81% which compared to the CCG and England averages of 82%. The practice exception reporting for the clinical domain was 17% which was above the CCG average of 8% and the England average of 6%.
  • The practice website included information on signs of stress, counselling services available to help students with stress and a depression questionnaire. The practice also had in house counsellors on site.
  • The practice worked with the local colleges in order to a give a co-ordinated approach to care for their registered students.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 September 2016

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

  • 99% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG average by 14% and the England average by 15%. The exception reporting was 1% which was below the CCG average by 9% and the England average by 7%.
  • The practice achieved 97% for mental health related indicators in QOF, which was above with CCG averages and England averages by 4%. The rate of exception reporting for these indicators was generally lower than both the CCG and England averages.
  • 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.
  • The practice website had information on various services and charities available to patients with poor mental health and worked closely with the Psychological Wellbeing Service (Improving Access to Psychological Therapies (IAPT) is an NHS initiative designed to make psychological or talking therapies more accessible to people experiencing common mental health problems).

People whose circumstances may make them vulnerable

Good

Updated 6 September 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 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.
  • The practice worked closely with YMCA keyworkers and held meetings to offer proactive and educational assistance with contraceptive needs for vulnerable patients.