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Inspection Summary


Overall summary & rating

Good

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Surgery on 28 October 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 within the practice. Effective systems were in place to report, record and learn from significant events. Learning was shared with staff and external stakeholders where appropriate.

  • Risks to patients were assessed and well managed. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • GPs worked collaboratively with neighbouring practices in their locality area in planning services to suit their population in order to achieve better health outcomes for patients across the locality.

  • The practice demonstrated a caring approach by hosting a monthly carer’s clinic offered by a local carer’s organisation. There were three members of staff who were trained as carer’s champions including a dementia champion.

  • The practice provided anticoagulation clinics which were run flexibly to accommodate all patients and home visits were offered to housebound patients. Patient feedback was sought on the service which indicated positive outcomes for the patients.

  • Training was provided for staff which equipped 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.

  • Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

  • 99% of patients stated they had confidence in the last GP they saw or spoke to.

  • 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 and learning from complaints was shared with staff and stakeholders.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. Services were designed to meet the needs of patients.

  • 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 partners held an annual business review meetings where all staff were involved, with a half yearly review.

  • There was evidence of close partnership working with the patient participation group (PPG) who undertook annual patient surveys to gather feedback from at least 500 patients each year to obtain a wide range of views on the quality of services provided.

We saw an outstanding feature:

  • The practice was proactive in identifying and supporting patients with long term conditions such as chronic kidney disease and atrial fibrillation. For example, they purchased their own device which was used to screen patients opportunistically at flu clinics. As a result, 129 patients were screened and 14 of these were found to have symptoms which instigated further investigation. One patient received a confirmed diagnosis whilst the others were waiting for their reviews to be completed. The practice produced an in-house information leaflet on the management of chronic kidney disease. On the back of the leaflet was a log of checks which was personalised to help both the patient and the GP to monitor kidney function

The areas where the provider should make improvements are:

  • Take steps to identify more carers in order to support them where appropriate.

  • Take more proactive steps to ensure patients with a learning disability have an annual health check.

  • Explore the reasons for higher exception reporting in some areas and consider actions which could be taken to improve this to ensure patients health and wellbeing

  • Continue to take steps to improve access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 January 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place to ensure significant events were reported and recorded.

  • Lessons were shared internally and externally when appropriate to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received support, information and apologies where appropriate. 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 well assessed and managed within the practice.

  • Appropriate recruitment checks had been carried out on recently recruited staff.

Effective

Good

Updated 17 January 2017

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 national average. The most recently published results showed the practice had achieved 99% of the total number of points available, 2% above the clinical commissioning group (CCG) average and 4% above the national average. The overall exception reporting rate was 16.5%, compared to the CCG average of 12% and the national average of 10%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.) GPs were aware of the high exception reporting rate and steps were taken to carry out more opportunistic checks for patients to ensure they were not removed for failing to attend review appointments.

  • Staff used current evidence based guidance and local guidelines to assess the needs of patients and deliver appropriate care.

  • There was an ongoing programme of clinical audit within the practice. The audits undertaken demonstrated improvements in quality.

  • 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 was proactive in early identification and management of patients with atrial fibrillation to prevent strokes and associated problems. They purchased their own device which was used to screen patients opportunistically at flu clinics. As a result, 129 patients were screened and 14 of these were found to have symptoms which instigated further investigation.

Caring

Good

Updated 17 January 2017

The practice is rated as good for providing caring services.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Results from the national GP patient survey showed there were a number of areas where patients rated the practice higher than others locally and nationally. For example, 99% had confidence and trust in the last GP they saw or spoke to, compared to the CCG average of 96% and the national average of 95%.

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

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

  • Views of external stakeholders were positive about the practice and aligned with our findings.

Responsive

Good

Updated 17 January 2017

The practice is rated as good for providing responsive services.

  • Patients told us urgent appointments were generally available the same day with the GP of their choice and that reception staff were accommodating to patients’ needs.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice offered a range of services within its premises. Patients were encouraged to self-refer to services such as counselling and physiotherapy services.

  • 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 17 January 2017

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. This was underpinned by clear business development plans and regular monitoring of areas for improvement and development.

  • There was a clear leadership structure and staff felt supported by management. The practice had a wide range of policies and procedures to govern activity and held regular partnership/business meetings to ensure oversight and governance was effective within the practice.

  • 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 practice proactively sought feedback from staff and patients, which it acted on. There was engagement with the patient participation group which looked at ways to improve patient experience.

  • There was evidence of continuous improvement through shared learning from the collaboration with neighbouring practices.

Checks on specific services

People with long term conditions

Good

Updated 17 January 2017

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

  • Nurses held regular meetings with the lead GP to discuss the provision and monitoring of patients who take anticoagulation medicines, to improve safety of these patients. Clinics were run flexibly to accommodate all patients and home visits were offered to housebound patients. There were 27 questionnaires completed by patients to review the service, all of which contained positive feedback including efficiency of the service and choice of appointments.

  • Opportunistic screening for atrial fibrillation (an irregular or often very fast heart rate) was carried out during flu vaccination clinics. There 129 patients screened and 14 of them were suspected to have the condition and referred for further assessment, with one patient receiving a confirmed diagnosis.

  • Performance on heart failure and stroke indicators were above local and national averages. For example, the practice achieved 100% for stroke and transient ischaemic attack, compared to the CCG average of 98% and national average of 97%. The exception reporting for patients with a history of a stroke who had their blood pressure monitored in the preceding 12 months was 9%, compared to the CCG national average of 4%.

  • The practice produced an in-house information leaflet on the management of chronic kidney disease. On the back of the leaflet was a log of checks which was personalised to help both the patient and the GP to monitor kidney function. Performance on chronic kidney disease for QOF was 100%, the same as the CCG and national average of 100%.

  • Longer appointments and home visits were available when needed.

  • For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. Regular multidisciplinary meetings were held at the practice. The practice worked closely with the community trust employed care coordinator.

  • Patients identified as having pre-diabetes were offered dietary and symptom management advice to improve outcomes for the patients. Staff worked closely with diabetes specialist nurses to manage more complex patients.

  • Telehealth services were offered, allowing patients to monitor their blood pressure readings at home and feedback their results to a clinician at their review appointments.

Families, children and young people

Good

Updated 17 January 2017

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 child safeguarding lead and staff were aware of who they were.

  • 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 GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

  • Immunisation rates were relatively high for all standard childhood immunisations and the practice worked with health visitors to follow up children who did not attend for immunisations.

  • Postnatal baby checks and maternal assessments were provided to new mothers.

  • The practice offered a range of contraception services including implants and coil fittings.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Urgent appointments were available on a daily basis to accommodate children who were unwell.

Older people

Good

Updated 17 January 2017

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 their population. Regular multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

  • The practice was responsive to the needs of older people, and offered GP and nurse home visits and urgent appointments for those with enhanced needs. Weekly ward rounds were offered to two care homes aligned to the practice resulting in improved communication, care planning and continuity of care for the patients. Feedback from these care homes was entirely positive.

  • Data from 2015/16 showed 71% of eligible patients aged over 65 years were given flu vaccinations, in line with the CCG average of 73%. Pneumonia and shingles vaccinations were offered to eligible patients.

  • All patients aged over 75 years old had a named GP for continuity of care.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages.

  • A hearing loop system was available for patients with a hearing impairment, including a hand-held portable hearing loop.

Working age people (including those recently retired and students)

Good

Updated 17 January 2017

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.

  • Late night appointments were available on alternate Monday and Thursday evenings with appointments available up to 8.45pm on a pre-bookable and same day access basis. Telephone appointments were available throughout the day. Two patients who completed the CQC comment cards told us the evening appointments were convenient for them because of work commitments during normal surgery opening hours.

  • Appointments could be made and cancelled online as well as management of repeat prescriptions. Patients were able to access their medical records and make administration enquiries online.

  • 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. For example, NHS health checks were offered to patients aged 40 to 74 years old to help identify early indicators of disease.

  • Uptake rates for health screening were similar or better than the national average. For example, the uptake rate for cervical cancer screening in 2015/16 was 80%, which was broadly in line with the CCG average of 83% and the national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 January 2017

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

  • Data from 2015/16 showed the number of people with a complex mental health condition that had received a comprehensive care plan in the preceding 12 months was 93%, compared to the CCG average of 93% and the national average of 89%. This was with an exception rate of 31%, which was 10% above the local average and 18% above the national average. Staff told us reminders had been added to patients’ records so that clinical staff were prompted to carry out opportunistic checks when patients attended the practice in order to increase the number of reviews undertaken and reduce exceptions.

  • The proportion of patients with a diagnosis of dementia who had their care reviewed in a face-to-face review in the last 12 months was 96% which was 10% above the local average and 12% above the national average. This was achieved with an exception reporting rate of 8% in line with local average of 8% and national average of 7%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. There were close links with emergency mental health services for patients in crisis. GPs had recently changed their procedure for repeat prescriptions of anti-depressant medicines to include recording of suicide ideation, ensuring patients are provided with immediate support where appropriate. The practice prevalence for mental health was 1.16%, compared to CCG average of 0.79% and national average of 0.9%

  • Two GP partners provided substance misuse services as part of a local shared care service with drug and alcohol services, alongside a substance misuse nurse.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Leaflets were available on how to access local counselling, psychological therapy and dementia services.

People whose circumstances may make them vulnerable

Good

Updated 17 January 2017

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 and used alerts on the computer system to highlight the patients’ specific needs. There were 156 patients identified as vulnerable with complex or mental health needs at risk of hospital admission.

  • In addition, staff had identified 54 patients who may require longer appointments or additional help. These included patients who were deaf, had learning disabilities and those whose first language was not English.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. Regular multidisciplinary meetings were hosted by the practice. In addition the practice held regular meetings to discuss patients on their palliative care register.

  • There were 33 patients identified on the learning disabilities register in 2015/16; 14 of them had attended a face to face review appointment. GPs worked closely with a local learning disabilities specialist to ensure their patient lists were up to date.

  • 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. In addition, all staff had undertaken training in domestic violence.

  • The practice had identified 85 patients as carers which was equivalent to 1% of the practice list. There were plans to hold an event to identify more carers registered with the practice. A carer’s clinic was hosted monthly by a local carer’s organisation, offering one hour appointments for assessment and support to carers.

  • Additionally, there were links with Citizens Advice who attended the practice weekly to collect referral information for patients in need of their services.