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Inspection Summary


Overall summary & rating

Good

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roselawn Surgery on 8 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.
  • Overall, risks to patients were assessed and well managed; however, further consideration of the role of the nurse practitioner was needed in order to ensure that risks are identified and mitigated.

  • 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; however, further consideration of the role of the nurse practitioner was needed in order to ensure that arrangements are in place to monitor and support this extended role.
  • 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; however, patients had to request complaints leaflets from reception staff. Improvements were made to the quality of care as a result of complaints and concerns.
  • Overall, 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 considered feedback they had received about appointments running late, and had made changes to their appointment system in order to address this.
  • 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 practice had effective governance arrangements in place; however, in some cases records, such as meeting minutes and records of audits, lacked detail.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • They should risk assess the role of the nurse practitioner, including a consideration of the scope of her knowledge and competence, and ensure that arrangments are in place to mitigate the risks identified.
  • They should review the risks associated with allowing staff to begin work at the practice without full background checks having been completed, to ensure that these are adequately mitigated.
  • Ensure that complaints leaflets are available to patients without them needing to request them.
  • Ensure that more detailed records are kept of management activity, such as meeting minutes and records of audits.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 January 2017

The practice is rated as requires improvement for providing safe services.

  • Overall, risks to patients were assessed and well managed; however, they had failed to risk assess the role of the nurse practitioner to ensure that the risks associated with this extended role were mitigated.
  • 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.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

Effective

Good

Updated 30 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.
  • 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; however, the practice had failed to fully consider the remit of the nurse practitioner’s prescribing role.
  • 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 30 January 2017

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 30 January 2017

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, the practice had a high proportion of patients who did not speak English, and they were working with a local organisation which provided English language courses, which allowed them to refer patients for English classes.
  • Most 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. Some patients commented that appointments often ran late.
  • 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; however, complaints leaflets had to be requested from reception. Evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 30 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. 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; however, records of meetings did not always contain sufficient detail to benefit staff who had not attended the meeting.
  • 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; however, some risks had not been thoroughly assessed.
  • 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 30 January 2017

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.
  • Overall, performance for diabetes related indicators were comparable to the CCG and national averages. The practice achieved 96% of the total QOF points available for diabetes indicators, compared with an average of 96% locally and 90% nationally
  • 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 30 January 2017

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 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.
  • Data available at the time of the inspection showed that cervical screening had been carried-out for 88% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%. However, their exception reporting rate for cervical screening was higher than average at 12% compared to 9% locally and 6% nationally; they explained that this reflected the cultural beliefs of a large proportion of their patient population.
  • 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 the local health visitor, who was based at the practice.

Older people

Good

Updated 30 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 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 patients who resided in a local care home and a nursing home, and the managers from these homes were members of the practice’s Patient Participation Group. We met with the deputy manager of one of the homes and received a comment card from the manager of another.
  • The practice met regularly with district nurses, community matrons and the local palliative care team to ensure that the needs of older patients were addressed.

Working age people (including those recently retired and students)

Good

Updated 30 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.
  • 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. This included the introduction of a Facebook page in order to better engage with patients in this age group.
  • The practice provided a full package of travel immunisations, including yellow fever.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 January 2017

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

  • The practice had 38 patients diagnosed with dementia and 81% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average of 84%; however, the practice had a 0% exception reporting rate for this indicator, compared to an average of 6% locally and 7% nationally.
  • The practice had 60 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 94% of these patients, compared to a CCG average of 96% and national average of 89%. They had a 0% exception reporting rate for this indicator, compared to a local average of 12% and national average of 13%.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 30 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 including homeless people, refugees and asylum seekers, 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 had identified that they had a high proportion of patients who did not speak English. All of the GPs were multilingual and spoke the same languages (Hindi and Tamil) as a large group of their patients, and they would conduct consultations with patients in these languages. A pack of information in other languages was available to assist staff in communicating with non-English speaking patients and to provide them with information about services available.
  • During the inspection we spoke to the manager of a local care home for people with learning disabilities, who told us that the practice provided an excellent service to their patients.