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Inspection Summary


Overall summary & rating

Good

Updated 6 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lichfield Street Surgery on 3 February 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.
  • 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 and had received training appropriate to their roles and any further training needs had been identified and planned.

  • 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.
  • 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.

  • 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.

  • 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 provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 April 2016

The practice is rated as good for providing safe services. There was an effective system in place for reporting and recording significant events and incidents and lessons were shared with staff to make sure action was taken to improve safety in the practice. When there were unintended or unexpected safety incidents, patients received reasonable support and 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 and staff were aware of their role and responsibilities in relation to safeguarding children and vulnerable adults. Systems were in place to ensure the safe storage of vaccinations and patient samples. There was evidence to demonstrate that checks had been undertaken on emergency medical equipment. Risks to patients were assessed and well managed and there were effective infection control procedures in place.

Effective

Good

Updated 6 April 2016

The practice is rated as good for providing effective services. The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. The practice provided enhanced services which included personal health and advanced care planning. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and patients’ needs and care were planned and delivered in line with current evidence based guidance. The practice was proactive in completing clinical audits that demonstrated quality improvement. There was evidence that clinical audits were effective in improving outcomes for patients. The practice was proactive in ensuring staff learning needs were met and 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 in managing the needs of patients with long term conditions and complex needs.

Caring

Good

Updated 6 April 2016

The practice is rated as good for providing caring services. Data from the national GP patient survey results published in January 2016 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.

The practice offered flexible appointment times based on individual needs and we saw evidence of how the practice had responded to the needs of vulnerable patients with compassion and empathy.

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 6 April 2016

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. A CCG is an NHS organisation that brings together local GPs and experienced health professionals to take review and commission local health services. 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. For example, the practice provided an anti-coagulation service and patients could have their blood tests, medication dosage checks and reviews completed at the practice. 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. 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.

Well-led

Good

Updated 6 April 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 meetings within the individual departments. Although the whole practice did not meet as a team, information was disseminated through departmental leads. 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 participation group (PPG) was active. PPGs are a way in which patients and GP surgeries can work together to improve the quality of the service. The PPG had a display in the waiting area, detailing the date of the next meeting and minutes of the previous meeting were available to view. Staff had received inductions and had regular performance reviews. There was a strong focus on continuous learning and improvement and the practice worked closely with other practices and the local Clinical Commissioning Group.

Checks on specific services

Older people

Good

Updated 6 April 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 people in its population, this included enhanced services for dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required and patients over 75 years of age were offered an annual face to face review with a GP and all patients had a named GP. The practice worked closely with district nurses and the community matron and used the Integrated Care Team for conditions that could be safely managed in the community including cellulitis and DVT. The practice actively promoted the national Aortic Aneurysm Screening Programme and hosted the service in the practice.

People with long term conditions

Good

Updated 6 April 2016

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. The practice ran an anti-coagulation clinic service on a weekly basis for their patients and the local population and a specialist diabetic nurse and heart failure team ran regular clinics at the practice. Longer appointments and home visits were available when needed. All patients with a long-term condition 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. Patients were encouraged to engage with the Expert Patients Programme. This is a self-management programme for people living with long-term conditions which supports them by increasing their confidence, improving their quality of life and helping them manage their condition more effectively.

Families, children and young people

Good

Updated 6 April 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 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. The practice’s uptake for the cervical screening programme was 82% which was in line with the national average of 82%. Appointments were available outside of school hours and urgent appointments were allocated each day for children. The premises were suitable for children and babies. The practice held nurse-led baby immunisation clinics weekly and vaccination targets were in line with the national averages. We saw positive examples of joint working with midwives and health visitors and the midwife ran an ante natal clinic on a weekly basis.

Working age people (including those recently retired and students)

Good

Updated 6 April 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. The practice was proactive in offering online services such as appointment booking and repeat prescriptions services and telephone consultations, as well as a full range of health promotion and screening that reflects the needs for this age group. It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years. It offered an appointment reminder text messaging service and appointment times were offered early each morning. The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

People whose circumstances may make them vulnerable

Good

Updated 6 April 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 those with a learning disability. We saw that there were 35 patients on the learning disability register and the practice had carried out 14 annual health checks for patients on the register. The practice held a register of carers, and had a carers corner in the waiting room which had information and advice about local support groups and services. There was a system in place to identify patients with a known disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and provided shared care for patients with opiate dependency allowing them to obtain their opiate prescribing at the surgery.

It had told vulnerable patients about how to access various support groups and voluntary organisations and there was a system in place to identify patients who required additional support and extra time during appointments. Staff had received safeguarding training and 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. There were examples of how the practice had responded to the needs of vulnerable patients; for example the practice supplied hearing aid batteries for the local community.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 70 patients on the dementia register and 44 had had their care plans agreed in a in the last 12 months. The community psychiatric nurse held clinics twice a week at the practice for continuity of care and support to patients. The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact. We saw that there were 141 patients on the mental health register and 102 had had care plans agreed. Patients experiencing poor mental health were signposted to various support groups and voluntary organisations. Staff had a good understanding of how to support patients with mental health needs and dementia and had held a dementia awareness day with guest speakers to offer patients detailed information. The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.