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Pembroke Road Surgery Good Also known as Dr Fielding and Partners

Inspection Summary


Overall summary & rating

Good

Updated 15 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pembroke Road Surgery on 19 January 2016. Overall the practice is rated as good with outstanding features.

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.
  • Feedback from patients about their care was consistently and strongly positive.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient reference group (PRG). For example, they had introduced at the suggestion of the PRG, a ‘next step’ card which informed patients, who required further intervention after their initial consultation, what was happening subsequently.
  • 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.
  • 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. For example, when a nearby practice had closed at short notice, patients receiving treatment for substance misuse, were transferred to the Pembroke Road Surgery where they were accommodated and treated on the same day. This meant there were no delays or interruptions in treatment for the patients.

  • There was a clear leadership structure and staff felt supported by management.

We saw some areas of outstanding practice:

  • The practice ran a series of pilot ‘Memory Cafes’ and invited patients living with dementia and their carers to the practice where the waiting room was turned in to a café for were refreshments. Patients living with dementia were engaged in ‘fun’ mental agility exercises, and education sessions were available for carers. The impact for the patients was being integrated into the practice, education about dementia for both a social and medical stance and the development of informal support networks for patients and carers.

  • There was a Volunteers Group at the practice which helped patients with transport to and from the practice and hospital appointments. The members worked with the practice to offer a befriending service for lonely or isolated patients who could benefit from someone visiting them regularly at home or in hospital.

  • The practice ran two ‘Pulmonary Rehabilitation’ courses in conjunction with the local community health partnership. The courses were two programmes for six weeks with two hours sessions of exercise and education held twice weekly. This was held in the waiting room at the practice as there were no public facilities available. The impact on patients was measured by the improvements in the four areas of the Chronic Respiratory Disease Questionnaire and improvements in patients’ shuttle walking test. For example, patients were less reliant on walking aids and had continued with the exercises outside of the practice organised courses.

The areas where the provider should make improvement are:

  • The practice should ensure all personnel files have the information as required by regulation.

  • The practice should review the prescription security protocol to ensure there was an audit trail in the event of any security incident

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 March 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.

  • We found some of the processes in place for the management of the practice could be more robust for example, the process which ensured prescription security should have provided an audit trail in the venet of any security breach.

Effective

Good

Updated 15 March 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 all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 15 March 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

  • The practice ran a series of pilot ‘Memory Cafes’ to which invited patients living with dementia and their carers to the practice where the waiting room was turned in to a café for were refreshments. Patients living with dementia were engaged in ‘fun’ mental agility exercises, and education sessions were available for carers. The impact for the patients was being integrated into the practice and informal support networks.

  • There was a Volunteers Group at the practice which helped patients with transport to and from the practice and hospital appointments. The members also offered a befriending service for lonely or isolated patients who would benefit from someone visiting them regularly at home or in hospital.

Responsive

Outstanding

Updated 15 March 2016

The practice is rated as outstanding 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 such as the Web GP online consultation service.

  • 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.

  • The practice ran two ‘Pulmonary Rehabilitation’ courses in conjunction with the local community health partnership. The courses ran for six weeks with two hours sessions of exercise and education held twice weekly. This was held in the waiting room at the practice as there were no public facilities available. The impact on patients was measured by the improvements in the four areas of the Chronic Respiratory Disease Questionnaire and improvements in patients’ shuttle walking test. For example, patients were less reliant on walking aids and had continued with the exercises outside of the practice organised courses.

  • We were told about a recent event whereby a nearby practice had closed at short notice. There were vulnerable patients receiving treatment for substance misuse, who had an appointment for that day who were transferred to the Pembroke Road Surgery where they were accommodated and treated. This meant there were no delays or interruptions in treatment for the patients. Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 15 March 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 on. The patient reference 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 March 2016

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had specialist training for the management of chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice managed patients with long term conditions well, for example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) at 93.56% exceeded the national average of 88.3%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that 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.

  • The practice participated in the 3D Study which looked at the GP management of care for patients with three or more long term health conditions. The aim was to treat the whole patient in a consistent, joined up manner in order to improve their overall quality of life.

  • The practice Quality and Outcomes Framework achievement for 2014-15 was 557/559 points (99.6%) with an exception coding rate comparable to the Clinical Commissioning Group average results

  • The practice ran two ‘Pulmonary Rehabilitation’ courses which involved patients attending structured exercise programmes and education sessions, as this was one of the few interventions indicated by research known to reduce emergency admissions for patients with long term conditions.

  • Pembroke Road also undertook on site monitoring for patients taking anticoagulant therapy.

Families, children and young people

Good

Updated 15 March 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 relatively high for all standard childhood immunisations.

  • The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the three Royal College of Physicians questions. (01/04/2014 to 31/03/2015) was 80.18% which exceeded the national average of 75.35%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked to provide inclusive services for younger patients, such as hosting the 4YP (for young people) initiative which enabled young patients to access sexual health care.

  • There was a practice leaflet given to new parents to help them manage minor illness, and when to ask for medical advice. The practice had a policy that ‘hot babies’ were slotted into emergency appointments by the reception staff, rather than having to wait for telephone triage. These babies are then seen as soon as possible after arrival.

Older people

Good

Updated 15 March 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. When allocating visit requests, the same doctor visited which promoted a continuity of care.

  • The practice was responsive to the needs of older patients, and offered urgent appointments for those with enhanced needs.

  • Older patients who were included in the Admission Avoidance enhanced service had care plans which were reviewed regularly.

  • The practice participated in the care homes without nursing enhanced service and had a designated GP who made weekly visit to the care home.

  • The practice had a dedicated professional telephone number for care homes, local hospitals, the ambulance service and community services.

Working age people (including those recently retired and students)

Good

Updated 15 March 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. For example, routine appointments were available throughout the working day, including at lunchtime.

  • 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 had an ‘Open Surgery’ each morning for patients to attend for a same day appointment.

  • Appointments were booked in person, on the automated phone system and on line. Text reminders for appointments were sent with the facility for patients to send a text message to cancel appointments

  • The practice participated in the Web GP scheme of online consultation.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 March 2016

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

  • 98.36% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) exceeding the national average of 88.7%.

  • 82.93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months which was comparable to the national average of 84.01%.

  • The practice carried out advance care planning for patients with dementia and worked closely with the community based dementia navigators.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice ran a series of pilot ‘Memory Cafes’ to which they invited patients living with dementia and their carers to the practice. The practice worked with volunteers to provide refreshments, and ‘fun’ mental agility exercises for those living with dementia. There were education and support sessions available for the carers. The impact for the patients was being integrated into the practice, education about dementia for both a social and medical stance and the development of informal support networks for patients and carers.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 15 March 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, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • The practice had told vulnerable patients about how to access various support groups and voluntary organisations such as referring homeless patients to the local NHS Homeless Service.

  • The practice had accommodated vulnerable patients receiving treatment for substance misuse from a nearby practice had closed at short notice. This meant there were no delays or interruptions in treatment for the patients.

  • 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.