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Inspection Summary


Overall summary & rating

Good

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We conducted a comprehensive announced inspection on 20 February 2015.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

Our key findings 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, addressed and shared with staff during meetings.
  • Risks to patients were assessed and 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 their treatment.
  • Information about services and how to complain was readily available and easy to understand. Complaints were investigated and responded to appropriately.
  • 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 May 2015

The practice is rated good for providing safe services. Staff understood their responsibilities to raise concerns, and to report incidents and near misses and we saw that significant events were reported and investigated. Lessons were learned and communicated widely to support improvement. Risks to patients and staff were identified and managed. There were systems in place for identifying vulnerable adults and children and to share information with relevant agencies appropriately. There were enough staff working at the practice on a daily basis to keep patients safe.

Effective

Good

Updated 28 May 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were above average for the locality and where there were areas for improvement the practice was proactive in dealing with these. Staff referred to guidance from National Institute for Health and Care Excellence. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and where further training needs had been identified there were plans to meet these needs. There was evidence of appraisals and identifying training and development for all staff. Staff worked with multidisciplinary teams to ensure that patients received effective care and treatment.

Caring

Good

Updated 28 May 2015

The practice is rated as good for providing caring services. Data from patient surveys showed that patients rated the practice higher than others for several aspects of care, such as how GPs and nurses explained their care to them, involving them in making decisions and listening to them. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to follow. We also saw that staff treated patients with kindness and respect, and maintained confidentiality. We received positive remarks on the comment cards we left for patients to complete about their care at the practice. The patients we spoke with during the inspection were also positive about the care they received.

Responsive

Good

Updated 28 May 2015

The practice is rated as good for providing responsive services. The Practice is rated as good for providing responsive services. It reviewed the needs of its local population by working with a proactive Patient Participation Group which is also supported by a wider Patient Reference (Virtual) Group and the local Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services. The practice had a flexible appointments system with extended hours (mornings and evening appointments were available on specific days). The majority of patients said they could make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised.

Well-led

Good

Updated 28 May 2015

The practice is rated as good for being well-led. It had a clear vision and strategy and staff knew their responsibilities in relation to this. There was a clear leadership structure and staff told us they felt supported by management. The practice had a number of policies and procedures to govern activity. 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 upon which was also evidenced through the patient surveys and work undertaken by the Patient Participation Group and a Virtual Patient Reference Group.

Checks on specific services

People with long term conditions

Good

Updated 28 May 2015

This practice is rated as good for the care of people with long term conditions. The practice had effective arrangements for making sure that people with long term conditions were invited to the practice for annual and half yearly reviews of their health. Appointments were available with the practice nurse for annual health checks and reviews for long term conditions such as diabetes and respiratory conditions including asthma and chronic obstructive pulmonary disease (COPD). When needed, longer appointments and home visits were available. For those people with the most complex needs their named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice recognised the needs of people with early onset conditions associated with older age including dementia and recently carried out work with the local Mental Health Provider (South Essex Partnership Trust) to help ensure that patients were jointly identified and supported.

People whose health prevented them from being able to attend the surgery, people whose health prevented them from being able to attend the surgery, received the same service as the Practice would refer them to the community nurse to be seen in their own home.

Families, children and young people

Good

Updated 28 May 2015

The practice is rated as good for the population group of families, children and young people. Appointments could be booked in person, on-line or by telephone. Appointments were flexible, and appointments available on Saturday mornings for routine issues.

Information and advice was available to promote health for women before, during and after pregnancy. The practice monitored the physical and developmental progress of babies and young children. There were arrangements for identifying and monitoring children who were at risk of abuse or neglect.

Records showed that looked after children (such as those in foster care / under the care of the Local Authority), those subject to child protection orders and children living in disadvantaged circumstances were discussed and any issues shared and followed up at monthly multi-disciplinary meetings. GPs and nurses monitored children and young people who had a high number of A&E attendances or those who failed to attend appointments for immunisations and shared information appropriately. Staff were trained to recognise and deal with acutely ill babies and children and to take appropriate action.

There was information available to inform mothers about all childhood immunisations, what they are, and at what age the child should have them as well as other checks for new-born babies. Staff proactively followed up patients who failed to attend appointments for scheduled immunisation and vaccination programmes. The practice performed better than the local average for uptake in childhood immunisations and vaccinations.

Information and advice on sexual health and contraception was provided during GP and nurse appointments. The practice provided clinics for long acting reversible contraceptives such as contraceptive implants and intrauterine devices (IUD coils).

Older people

Good

Updated 28 May 2015

This practice is rated as good for the care of older people. Patients over the age of 75 had a named GP to coordinate and plan care and treatment. The practice was proactive in providing health checks as part of commissioned services and upon request. The GPs carried out visits to patient’s homes if they were unable to travel to the practice for appointments and demonstrated a strong commitment to supporting older people to remain living at home through the coordinated services with local commissioners and health services.

The practice specifically worked with the local Clinical Commissioning Group to commission care co-ordination teams, comprising senior care co-ordinator and support staff to strengthen collaborative working arrangements between the GP practice teams and providers of community health and social care to enhance the care offered to people aged 75 years and older.

The practice had recently worked with NHS England and other local colleagues to organise suitable arrangements to accommodate patients at a local care home, ensuring that the transition from their existing GP went smoothly.

The practice identified people with caring responsibilities and those who required additional support which was recorded on their patient record. Patients with caring responsibilities were invited to register as carers so that they could be offered support and advice about the range of agencies and benefits available to them.

Working age people (including those recently retired and students)

Good

Updated 28 May 2015

The practice is rated as good for the population group 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. Appointments could be booked online, in person or by telephone. Appointments could be booked in advance and on the day. The practice also offers telephone consultations and was in the process of developing an online consultation service (e-consult).

Information about annual health checks for patients aged between 40 and 74 years was available within the practice and on their website. Nurse led clinics were provided for well patient health checks. The practice provided travel advice and vaccination through appointments with the practice nurse team. Information on the various vaccinations available including diphtheria, tetanus, polio, and hepatitis A was available on the practice website. When patients required referral to specialist services they were offered a choice of services, locations, and dates through the ‘Choose and Book’ system.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 May 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice provided dementia screening services and referrals were made to specialist services as required.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including MIND. Patients were referred to local counselling sessions where appropriate and patients were provided with information how to self-refer should they wish to receive counselling.

The practice worked with local care coordinators and commissioners to prevent avoidable hospital admissions in 2% of their population who were identified as at risk due frailty including those with mental health needs.

People whose circumstances may make them vulnerable

Good

Updated 28 May 2015

This practice is rated as good for the care of people living in vulnerable circumstances. The practice had a register of patients who had learning disabilities. All patients with learning disabilities were invited to attend for an annual health check. The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.