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Inspection Summary


Overall summary & rating

Good

Updated 3 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Summerhill Surgery on 30 September 2015. Overall the practice is rated as good.

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

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • The practice held an intermediate care contract and provided GP services to approximately 50 nursing homes across the area. The practice had a dedicated nursing home team who worked within the nursing home division of the practice.

  • Risks to patients were assessed and well managed, with the exception of risk assessments in the absence of disclosure and barring checks (DBS checks) for staff that chaperoned.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • There was evidence of appraisals and personal development plans for staff, with the exception of one member of the nursing team.

  • 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 good facilities and was equipped to treat patients and meet their needs.

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

Importantly the provider must:

  • Ensure risk assessments are in place to assess the risk of not having disclosure and barring checks (DBS) for staff who chaperone.

The areas where the provider should make improvement are :

  • Ensure staff performance and training needs are identified and documented for all members of the nursing team through a programme of annual appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 December 2016

The practice is rated as good for providing safe services.

  • As part of our desk based inspection the practice manager shared information and supporting evidence to demonstrate how the practice had introduced a more formal programme of practice meetings.

  • Topics such as significant events and complaints were discussed during practice meetings. Minutes of meetings highlighted that shared learning took place throughout the practice. This included learning as a result of significant events, incidents and complaints.
  • When we inspected the practice during September 2015 we found that the practice had not formally assessed the risk in the absence of disclosure and barring (DBS) checks for non-clinical staff that chaperoned. As part of our desk based inspection we saw evidence to demonstrate that DBS checks had since been completed for the four non-clinical members of staff who chaperoned.

Effective

Good

Updated 16 December 2016

The practice is rated as good for providing effective services.

  • When we inspected in September 2015 we identified that that one of the clinical staff members had not had an appraisal for two years. As part of our desk based inspection we saw evidence of the most recent appraisal completed in September 2016 for the staff member in question.

Caring

Good

Updated 3 December 2015

The practice is rated as good for providing caring services. Data from the national GP patient survey published in July 2015 showed that patients rated the practice higher than others for several aspects of care. For example, 94% found the receptionists at this surgery helpful compared with the CCG and national averages of 87% and 98% said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 91% and national average of 90%. 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’s computer system alerted GPs if a patient was also a carer. There was a practice register of all people who were carers and 9% of the practice list had been identified as carers and were being supported, for example, by offering health checks, flu vaccinations and referral to a variety of support organisations.

Responsive

Good

Updated 3 December 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 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 equipped to treat patients and meet their needs.

The practice held an intermediate care contract and provided a dedicated service to approximately 50 nursing homes across the area. Each nursing home was assigned a lead GP and an advanced nurse practitioner who would carry out structured ward rounds and twice weekly visits to each home. The GPs also worked fixed shifts to offer regular care to their patients in the nursing homes.

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 individually and in small teams. The partners at the practice were in the process of scheduling wider team meetings to bring all divisions of the practice together and to discuss themes and learning points from significant events and complaints as part of their practice meetings.

Well-led

Good

Updated 3 December 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. 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. Staff told us they felt involved and engaged to improve how the practice was run and the partners encouraged staff to identify opportunities to improve the service delivered by the practice. 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 had an active patient participation group (PPG) and shared their plans to increase numbers and patient representation. The practice proactively sought feedback from staff and patients, which it acted on. For example, the practice acted on feedback from patients by introducing a phlebotomy clinic in line with patient requests.

Checks on specific services

People with long term conditions

Good

Updated 3 December 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 patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. The advanced nurse practitioners also offered home visits for chronic disease management. All these patients had a structured annual review to check that their health and medication needs were being met. Performance for overall diabetes related indicators was 89% compared to the CCG average of 86% and national average of 90%. The practice shared a report which highlighted that 88% of their patients with diabetes had received an annual review.

For those people with the most complex needs, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. 

Families, children and young people

Good

Updated 3 December 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, 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. Childhood immunisation rates for vaccinations given to under two year olds ranged from 95% to 100% compared to the national averages which ranged from 40% to 100%. Immunisation rates for five year olds ranged from 87% to 100% compared to the national averages which ranged from 94% to 98%. 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. When providing care and treatment for children and young people, assessments of capacity to consent were also carried out in line with relevant guidance. Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 3 December 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 shared a report which highlighted that 96% of their patients with Chronic Obstructive Pulmonary Disease (COPD) had received an annual review.The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services. The practice held an intermediate care contract and provided a dedicated service to approximately 50 nursing homes across the area which involved regular structured ward rounds and twice weekly visits to each home.

The practice regularly engaged with this patient group to improve services for them. Examples included monthly monitoring systems to check all fall related attendance at A&E. The practice followed up on monthly checks by liaising with the care home teams and ensuring specific falls prevention care plans were in place. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 3 December 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 and provided extended hours 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 comprehensive screening programme that reflects the needs for this age group. The practice’s uptake for the cervical screening programme was 92%, compared to the national average of 81%.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Patients’ consent to care and treatment was always sought in line with legislation and guidance. The practice provided GP services to a number of nursing homes, as a result staff were very knowledgeable and understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

Staff carried out annual health check, offered longer appointments and offered appointments at quieter times for people experiencing poor mental health. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 3 December 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 homeless people, travellers and those with a learning disability. It had carried out annual health checks, offered longer appointments and offered appointments at quieter times for people 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.