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Inspection Summary


Overall summary & rating

Good

Updated 15 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cross Road Surgery on 10 March 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 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.
  • Patients said they found it easy to make an appointment with a named GP and that 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.

We saw one area of outstanding practice:

The practice is part of the Weymouth Elderly Care Service (WECS) which supports patients who are resident in nursing homes plus any other housebound patients. The practice funds this service along with four other local GP practices. WECS consists of a dedicated GP and nurse practitioner who ensure that every patient has a weekly review plus a care plan in place. Feedback collated from the nursing homes involved shows an improvement in the quality of care since WECS started in April 2015. 88% of nursing homes find it significantly easier to get queries answered and patients reviewed compared to 37% prior to WECS. 88% of nursing homes feel their patient receive significantly better care, compared to 69% prior to WECS.

The areas where the provider should make improvement are:

  • Ensure that procedures for the storage of emergency medicines are consistent and well publicised to staff.
  • Review the process for involving the whole staff in meetings and decisions about the practice.
  • Review the procedure for proactively offering health checks to vulnerable groups, such as carers, people with learning disabilities and patients with mental health problems.

The practice should review its processes for proactively identifying patients who may also be carers and ensure they receive appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 April 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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, with the exception of emergency medicines.

Effective

Good

Updated 15 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 15 April 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 15 April 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.
  • 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.

Well-led

Good

Updated 15 April 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 this.
  • 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 knowing about 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 upon. The virtual 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 15 April 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 percentage of patients with diabetes with an acceptable average blood sugar reading was 81% which is similar to the national average of 78%.
  • The practice regularly met with specialist diabetes and heart failure nurses to ensure patients with these conditions had the most appropriate care.
  • Longer appointments and home visits were available when needed.
  • 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 15 April 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 accident and emergency attendances. Immunisation rates were high for all standard childhood immunisations.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in children were better than average. For example, 82% of patients with asthma had an asthma review in the preceding 12 months which is better than the national average of 75%
  • 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.
  • 83% of eligible women attended for a cervical screen examination compared to a national average of 74% and a CCG average of 77%.
  • The practice offered free in-house chlamydia testing kits to patients. They had also provided a link on their website to enable patients to access kits without having to come into the surgery.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Patients told us they could always get same day appointments for children.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 15 April 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 patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice is part of the Weymouth Elderly Care Service (WECS) which supports patients who are resident in nursing homes plus other housebound patients. WECS provides weekly ward rounds for patients who are housebound or resident in nursing homes.
  • Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were similar or better than the national average. For example, the percentage of patients with atrial fibrillation (an irregular heart beat) who were treated with an appropriate medication was 100%, which is better than the national average of 98%.

Working age people (including those recently retired and students)

Good

Updated 15 April 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 offered extended hours on Tuesday mornings and Friday evenings aimed at people unable to attend in usual hours.
  • The practice offered telephone advice for patients unable to attend the surgery in the usual opening hours.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 April 2016

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

  • A total of 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
  • 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in the preceding 12 months. This was better than the national average of 88%.
  • 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 15 April 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 patients and those with a learning disability.
  • The practice offered longer appointments and annual health checks for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams 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.