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Dr Cotterell and Partners Good

Inspection Summary


Overall summary & rating

Good

Updated 3 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nene Valley Surgery on 16 February 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 a 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 expressed high levels of satisfaction and 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care and reported that they could see a GP on 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 to:

  • Consider introducing a recording template for significant events which allows reflection and identification of themes and clearly shows actions taken.

  • Consider a more robust recording of actions from safety alerts.

  • Consider a more robust system for recording communications with out of hours providers.

  • Introduce a system for recording written consent for invasive procedures.

  • Ensure that the DBS check is completed for the member of the nursing team employed prior to 2002 and confirm this has been done.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 May 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • Patients received reasonable support, truthful information, a verbal and written apology when things went wrong. 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.

Effective

Good

Updated 3 May 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 for the locality and 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 staff.
  • Staff worked with multidisciplinary teams such as the diabetes specialist nurse and respiratory team to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 3 May 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 most aspects of care. Patients expressed satisfaction with the GPs and gave examples of high standards of caring.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Patients spoke very positively about all staff and the way they delivered care.
  • 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 3 May 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 at the reception and on the practice website. It was easy to understand and evidence showed the practice responded quickly to issues raised, although complaints were few. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 3 May 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 meetings where governance was discussed.
  • 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 on. The patient participation group was active and reported good engagement with the practice.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 3 May 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.
  • Patients with two or more long term conditions were considered for inclusion in the admission avoidance register.
  • 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.
  • The practice worked closely with the specialist teams such as the heart failure nurse, diabetes specialist nurse and local respiratory team to provide coordinated care.

Families, children and young people

Good

Updated 3 May 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. Immunisation rates were high for all standard childhood immunisations.
  • 75% of patients diagnosed with asthma on the register, had had an asthma review in the last 12 months.
  • 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.
  • 85% of eligible patients had received cervical screening which was above the local and national averages.
  • 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 and health visitors.

Older people

Good

Updated 3 May 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.
  • They carried out weekly ward rounds at a local care home and provided care and treatment where necessary.
  • The practice had a system to alert staff to older patients who needed rapid access to services and medical staff.

Working age people (including those recently retired and students)

Good

Updated 3 May 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. This included extended hours appointments until 7.30pm some evenings.
  • 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 offered text reminders for appointments to prevent patients not attending.
  • Electronic prescribing was available which removed the need for working people to attend the surgery to collect their prescriptions.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 May 2016

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

  • 90% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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, such as the Alzheimer’s Society and CHAT a teenage counselling service.
  • 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 3 May 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.
  • Longer appointments were offered for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations, such as the local food bank and local Sure Start.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.