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Swanage Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swanage Medical Practice on 26 August 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned for.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about treatment.

  • The practice experienced a high demand for appointments, especially during the summer months and had introduced an additional temporary residents surgery to provide care for a high number of holiday makers that attended the practice.
  • Only 70.9% of patients were satisfied with the practice’s opening hours compared to the Clinical Commissioning Group average of 78.8% and national average of 75.7%.

  • 100% of people experiencing poor mental health had a care plan documented in their records within the last 12 months and the practice was proactive in supporting people experiencing poor mental health.

  • 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.

However there were areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are:

  • The cleaning cupboard used for storing cleaning products as well as keys must be secured to prevent unauthorised access.

In addition, the provider should:

  • Ensure that all staff where relevant receive updated training in key areas such as infection control and health and safety.
  • Continue to monitor and improve access to patient appointments and publicise the times of extended hour’s surgeries to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 May 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. Patients 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 26 November 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were average for the locality. Patients experiencing poor mental health were very well supported with higher than average patient outcomes. However child immunisation rates for children under the age of five, where lower than the national average according to data available at the time of the inspection. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely but there was no single documented system to distribute NICE guidance to all staff. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs however some staff were overdue updates such as for Health and Safety. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 26 November 2015

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. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect. The practice had an identified lead to support patients who were carers and provide information about the avenues of support that were available to them.

Responsive

Good

Updated 26 November 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they found it difficult to get an appointment with a named GP and there was a high demand for appointments, especially during the summer months. Action had been taken in response to feedback about the unavailability of appointments and urgent care appointments. These consisted of sit and wait services and telephone consultation services. The practice also provided information to patients about other places where they could obtain treatment such as minor injuries units and pharmacies. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. Some but not all learning outcomes were recorded.

Well-led

Good

Updated 26 November 2015

The practice is rated as good for being well-led. It had a clear documented vision and strategy. 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 were systems in place to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients, which it acted on. Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

People with long term conditions

Good

Updated 26 November 2015

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 two nurses had completed a diploma in diabetes care. Longer appointments and home visits were available when needed. The practice also employed a nurse who specialised in cardiac care to manage and monitor the care of patients who had a history of stroke or coronary heart disease. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, named GPs and nurses worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 26 November 2015

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. Immunisation rates were comparable with national averages for children under the age of two. However, data available at the time of our visit indicated that immunisation rates for children under the age of five were low in comparison to the national average. Staff followed up on children who did not attend for 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. Appointments were available outside of school hours and the premises were suitable for children and babies. Multi-disciplinary team meetings were held with health visitors and social services.

Older people

Good

Updated 26 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people and offered health checks for patients over the age of 75. It was responsive to the needs of older people, and offered home visits, care home visits and rapid access appointments for those who needed them. Multi-disciplinary team meetings were held to discuss the care of older patients and these were attended by community matrons, physiotherapists from the reablement team, district nurses and practice nurses.

Working age people (including those recently retired and students)

Good

Updated 26 November 2015

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 evening appointments and some appointments on a Saturday morning but this service was not well advertised. 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 26 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). All patients on the mental health register held by the practice had a care plan documented in their records within the last 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and supported patients to access support organisations and voluntary organisations. A counselling service was available within the practice. GPs reviewed medicines for patients experiencing poor mental health, prescribing on a weekly basis if required. The practice ran a weekly report to identify patients who had been diagnosed with depression and checked their records to see when they were next due a review.

People whose circumstances may make them vulnerable

Good

Updated 26 November 2015

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 those with a learning disability. The practice offered a directed enhanced service to patients with learning disabilities and had carried out annual health checks for patients with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.