You are here

Salisbury House Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salisbury House Surgery on 23 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 mitigating actions were implemented, however not all records were filed centrally.

  • 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.
  • 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 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.

The area where the provider should make improvement is:

  • Ensure that all records for significant events are centrally held to ensure accessibility when required.
  • Ensure that all staff receive timely renewal of basic life support training.
  • Formalise checks on water temperatures ensuring they are documented and available for viewing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 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. Although records were not all stored together as some staff kept records separately to the core file held by the practice manager.
  • 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 associated with non clinical staff carrying out chaperoning duties had been assessed and mitigated.
  • Risks to patients were assessed although not all records of checks on water temperatures were available for review on the day of inspection.
  • There were emergency medicines available and whilst we saw that all staff were scheduled to receive regular basic life support training, two clinical members of staff had not received training for over 18 months. We saw that training for these staff was scheduled to be completed in April 2016.

Effective

Good

Updated 7 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were similar to those of others in 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 support for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs, for example for patients requiring end of life care.

Caring

Good

Updated 7 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published on 7 January 2016 showed patients rated the practice similar to 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.
  • We observed a strong patient-centred culture.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 7 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. For example, providing an enhanced service for patients at risk of unplanned hospital admission or readmission.
  • Patients said they found it easy to make an appointment, with urgent appointments available the same day. Some patients commented on difficulty in booking appointments with their preferred GP. However, upon investigation it became apparent that the longest standing GP had taken part retirement and reduced his availability. His clinical sessions had been replaced by other GPs and staff informed us they expected patient satisfaction to increase as patients became more familiar with new GPs.
  • 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 and other stakeholders.

Well-led

Good

Updated 7 April 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients in a traditional family practice setting. 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.
  • The practice was led by the team of partners who had an open, collaborative and informal management style and supported the delivery of the practice 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 was active.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 7 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.
  • Performance for diabetes related indicators was generally better than the CCG and national average. 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 was 98% where the CCG average was 90% and the national average was 88%.
  • 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.

Families, children and young people

Good

Updated 7 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 relatively high for all standard childhood immunisations.
  • The percentage of patients with asthma who had received an asthma review in the preceding 12 months was 73% which was comparable to the national average of 75%.
  • The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 76% and the national average of 74%
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 7 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice had introduced advanced care plans for patients in a local care home to ensure that their preferences for treatment were considered and recorded with a focus on maintaining dignity and ensuring that patients and their carers were involved in treatment planning.

Working age people (including those recently retired and students)

Good

Updated 7 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.
  • Extended hours ensured that appointments were available early in the morning, in the evenings and on Saturdays.
  • 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 7 April 2016

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

  • 77% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • Performance for mental health related indicators was generally better than the CCG and national averages. For example the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 93% where the CCG average was 87% and the national average was 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice offered enhanced services for patients with dementia, facilitating timely diagnosis.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 7 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 caring responsibility and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability and/or complex needs.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed 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.