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Inspection Summary


Overall summary & rating

Good

Updated 5 July 2016

We carried out an announced comprehensive inspection at Dr Evans & Partners which provides clinical services from two sites; Florence Road the main surgery and the branch surgery at Bramley Road, which are both situated in the London Borough of Ealing. We visited both of these locations as part of the inspection on 29 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.
  • The practice had a dedicated clinical pharmacy team that ensured robust processes in place for repeat prescription management.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said staff were caring, supportive, and friendly and treated them with dignity and respect.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • 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.
  • There was a strong focus on continuous learning and improvement at all levels.

We saw areas of outstanding practice:

  • Clinical pharmacist expertise to support GPs in the management of patients with chronic disease and elderly patient care. Attendance by the clinical pharmacist at local nursing home ward rounds had contributed to a 91% reduction of medication errors.

The areas where the provider should make improvement are:

  • Ensure that DBS checks are completed for all staff who may be required to undertake chaperone duties.

  • Ensure that fridge temperature monitoring records are complete.

  • Complete annual staff appraisals for administration staff.

  • Ensure administrative staff attend basic life support training in accordance with national guidance.

  • Improve vaccine stock records with inclusion of expiry dates and running stock totals.

  • Implement proposed procedures to identify carers to ensure they are provided with support.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 July 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 things went wrong patients received reasonable support, truthful information, and a 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 including, health and safety, Infection control and medical emergencies.

  • The practice had a dedicated clinical pharmacy team that ensured robust processes in place for repeat prescription management.

Effective

Good

Updated 5 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had a programme of clinical audit included three completed cycle audits that demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 5 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed the practice was at or above average for its satisfaction scores on consultations with GPs and nurses.

  • Patients said staff were caring, supportive, and friendly and treated them with dignity and respect.

  • 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 5 July 2016

  • 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, the practice had assisted with the national development of the clinical pharmacist role in General Practice pilot and had won funding for Ealing GP federation to mobilise the initiative across the whole CCG.

  • The practice worked closely with other organisations and with the local commumity in planning how services were provided to ensure they met patients needs. For example, the practice provided clinical facilities for annual screening of cardiac risk in the young for patients registered at the practice and from the wider Ealing community.

  • 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.

  • 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 5 July 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 it.

  • 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 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 strong focus on continuous learning and improvement at all levels. For example, the clinical pharmacy team employed by the practice was responsible for the management of repeat prescriptions and as a result had significantly reduced administration workloads for GPs. Attendance by the clinical pharmacist at local nursing home ward rounds had contributed to a 91% reduction of medication errors.

Checks on specific services

People with long term conditions

Good

Updated 5 July 2016

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

  • The practice offered nurse led chronic disease management clinics and all patients were invited for annual review.

  • Data from the Quality Outcome Framework for 2014/2015 showed the practice was performing in line with local and national averages for scores in chronic disease management.

  • Patients with newly diagnosed chronic conditions at routine health checks were reviewed promptly by the appropriate GP for education and introduction to disease monitoring.

  • Home visits were available for patients unable to attend the practice due to illness or immobility, including nurse led anticoagulation testing and flu vaccinations.

  • There were weekly appointments available with the clinical pharmacist for medication review for patients with complex medication needs and polypharmacy.

  • The practice offered in-house electrocardiograms (ECGs) and 24 hour blood pressure monitoring.

  • The practice held regular multi-disciplinary team meetings with the community nursing team to discuss the needs of patients with complex medical needs and update care plans.

Families, children and young people

Good

Updated 5 July 2016

The practice is rated as good for the care of families, children and young people.

  • There was a named lead for safeguarding children, staff had received role appropriate child protection training and understood their responsibilities to raise concerns. The practice held regular safe guarding meetings with the health visitor team to discuss patients on the safeguarding list and identify children at risk.

  • Dedicated appointments were available for children including after school hours slots.

  • The clinical pharmacist provided advice on paediatric medicine doses when required.

  • Paediatric phlebotomy services were available for children aged five to fifteen years old at Bramley Road Surgery.

  • The practice had a policy to refer all children for specialist opinion if they had consulted on three occasions within a short period of time.

  • The practice offered childhood immunisations in line with national guidance and uptake rates were comparable to national averages.

  • GP and nurse led contraception services were available, including insertion of intra-uterine contraceptive devices and implants.

  • The practice provided clinical facilities for annual screening for cardiac risk in the young for patients registered at the practice and from the wider Ealing community.

Older people

Good

Updated 5 July 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. All patients had a named GP to co-ordinate care.

  • The practice was responsive to the needs of older people, and offered home visits for patients unable to attend the practice due to illness or immobility, including nurse led anticoagulation testing and flu vaccinations.

  • The practice made use of local transport services to improve access to the surgery for older patients.

  • There were weekly appointments available with the clinical pharmacist for medication reviews for older patients with complex medication needs and polypharmacy.

  • The practice provided comprehensive services to a local nursing home for patients with complex needs. They conducted twice weekly joint ward rounds with a named GP for continuity of care and the practice clinical pharmacist. The clinical pharmacist provided medication review and advice for patients receiving medications through . The practice also provided services to two other local nursing homes with weekly visits by a GP. Since the inception of this service there had been a 91% decrease in prescribing errors.

  • The practice held regular multi-disciplinary team meetings with the community nursing team to discuss the needs of older patients with complex medical needs and update care plans.

  • The practice used risk stratification tools to identify older patients at high risk of hospital admission and invited them for review to create and update integrated care plans aimed at reducing this risk.

Working age people (including those recently retired and students)

Good

Updated 5 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice offered extended hour appointments for patients unable to attend during normal working hours. Daily telephone GP consultations were also available.

  • There was the facility to book appointments and request repeat prescriptions online.

  • There were dedicated appointment slots three times a week for local students from the university that could be booked through the student welfare service or by the patient directly. The practice had worked with the local University of West London to offer medical advice and support. For example, one of the GPs had been involved in producing guidelines during the Ebola crisis as there were a large number of overseas students from areas at high risk.

  • Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.
  • The practice offered new patient and NHS Health checks and any issues identified at these checks were followed up on appropriately.
  • There was a Health Care Assistant led smoking cessation service available on Saturday mornings.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 July 2016

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

  • The practice had engaged with the Shifting Settings of Care scheme to support patients experiencing poor mental health transferring from secondary care to community mental health services. The practice worked with the Primary Mental Health Worker to support these patients in the community.

  • GPs had daily access to the local psychiatric liaison consultant lead advice line for support when managing patients experiencing poor mental health.

  • The practice opportunistically screened patients for dementia and referred on to local memory services where appropriate.

  • Quality Outcome Framework data from 2014/2015 showed the practice was performing in line or above national averages for mental health indicators.

People whose circumstances may make them vulnerable

Good

Updated 5 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • There was a named lead for safeguarding vulnerable adults and staff had received training and were aware of their responsibilities to raise concerns.

  • Double appointments were available for vulnerable patients and those who required an interpreter.

  • Patients with learning disabilities were invited for annual review at dedicated joint GP and nurse led clinics.

  • The practice provided primary medical care to patients in a local women’s refuge and provided care of asylum seekers and young people in supported accommodation at a local hostel.

  • The practice list was open to patients with no fixed address to register and access medical services.

  • The practice held bi-weekly alcohol and substance misuse clinics for patients requiring support with these issues.