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Inspection Summary


Overall summary & rating

Good

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spilsby Surgery on 10 November 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.
  • The practice was responsive to the needs of patients and tailored its services to meet those needs.
  • 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 there was continuity of care, access to GPs and clinicians through the telephone triage system was effective and same day appointments were available.
  • 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:

  • The practice should ensure that the process that enabled practice staff to identify children who may be subject to safeguarding concerns is consistent and that the records of clinical meetings where safeguarding issues were discussed reflected what had taken place. The practice should also consider identifyingand monitoring children who did not attend appointments in secondary care.

  • Ensure that most recent NICE guidance is disseminated and followed by GPs and staff.

  • Review the process used to check dispensary stock is within expiry date and maintain appropriate records.

  • Improve arrangements for dispensary ’near-miss’ recording.

  • Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 December 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.

  • Medicines were effectively and safely managed.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse, however we found there was some inconsistency in how the patient records of children subject to safeguarding concerns were flagged to heighten awareness with staff.

  • Risks to patients were assessed and well managed.

  • There were effective systems in place to ensure the practice could continue to function in the event of foreseeable events such as fire, flood or loss of utilities.

Effective

Good

Updated 14 December 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 CCG 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.

  • 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 14 December 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 14 December 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 through the older persons service.

  • Patients with a medical need were able to see or have a telephone consultation with a GP or clinician on the day. Clinical assessments were all made by GPs or an appropriately trained and qualified clinician.

  • 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 14 December 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.

  • GPs and staff were engaged with the wider healthcare community. For example they held key posts at the local medical committee , CCG and a community healthcare trust.

  • 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 meetings for all staff groups.

  • 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 reference 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 14 December 2016

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Data from the Quality and Outcomes framework showed that the clinical indicators for diabetes care were 100%, which was 7% above the CCG and 10% above the national average.

  • The practice worked with other healthcare providers to deliver the ‘Healthier You’ diabetes prevention programme.

  • Home visits to patients with long term conditions who were unable to attend the surgery were undertaken by the advanced nurse practitioner.

  • 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 14 December 2016

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

  • The practice offered a full range of long-acting reversible contraception, and free condoms to C-Card holders.

  • Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • Rates of cervical screening were in line with both CCG and national figures.

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

  • The practice provided a full range of immunisations for babies, children and young people. Immunisation rates were relatively high for all standard childhood immunisations.

  • We positive examples of working with health visitors in ensuring that parents brought their child to the practice for childhood immunisations.

Older people

Good

Updated 14 December 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 Advanced Nurse Practitioner conducted weekly visits to the three residential homes where patients of the practice lived.

  • In collaboration with East Midlands Ambulance Service the practice had developed and implemented a practice conveyance programme to give paramedics the opportunity to transport appropriate patients to the surgery instead of the hospital Emergency Department where this had been agreed with the duty clinician.

  • The practice participated in the clinical commissioning group initiated Older Adults Service and provided additional care to meet the needs of this group of patients. The service was managed by a part time care co-ordinator, who was a nurse.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 14 December 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 reflected the needs for this age group.

  • The practice offered extended hours appointments on two evenings a week and on Saturday mornings to help meet the needs of patients in this group.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 December 2016

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

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented in the record in the preceding 12 months was 74%, which was comparable to other practices.

  • 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 identified 70 patients experiencing poor mental health and told them how to access various support groups and voluntary organisations.

  • There was a good understanding of how to support patients with mental health needs and dementia. Staff had received specific training in dementia awareness.

People whose circumstances may make them vulnerable

Good

Updated 14 December 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 those with a learning disability.

  • The practice had 86 patients on its learning disability register and offered longer appointments for patients in this group.

  • 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.