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Inspection Summary


Overall summary & rating

Good

Updated 2 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Great Bentley Surgery on 23 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff knew how to raise concerns, and report safety incidents. Safety information was recorded, monitored, and reviewed to identify trends or recurrent themes. When safety events occurred they were investigated and any issues identified were shared with all staff members.
  • Risks to patients were monitored, assessed, and well managed. The system for assessing risks included those associated with; premises, equipment, medicines, and infection control.
  • Patient care was planned and provided to reflect best practice and recommended current clinical guidance.
  • Staff had received appropriate training for their roles and further training had been encouraged, recognised and planned.
  • Information regarding how to complain was available at the practice and on the practice website.
  • The practice staff members had received training regarding the safeguarding of children and vulnerable adults, and knew who to contact with any concerns.
  • The practice was suitably equipped to treat patients and meet their requirements. The equipment had been checked and maintained to ensure it was safe to use.
  • Patient comments were positive in the main when we spoke with them during the inspection. They also told us it was relatively easy to make an appointment and there was continuity of care. Members of the virtual practice patient participation group were proactive and keen to be involved with practice development.
  • The leadership structure at the practice was well-established and all the staff members we spoke with said they felt supported in their working roles by both the practice manager and the GPs.

  • There were good facilities and equipment to treat patients.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice donated funds to support the Little Clacton community car scheme that provided door to door transport for patients to healthcare appointments living in the Little Clacton and Weeley areas. This directly benefitted patients at the practice living in rural areas that were not connected by public transport or owned their own transport to attend for their appointments/treatment at the practice.

The area where the provider should make improvement are:

Explore new sources and continue to identify patients who are carers to provide them with support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 June 2016

The practice is rated as good for providing safe services.

  • Safety incidents were documented and shared with the staff members to ensure practice safety lessons were learnt from the actions that were taken. Patients involved in incidents received an explanation of actions taken to resolve the incident, and/or an apology when appropriate.

  • Infection control procedures were completed to a satisfactory standard and documented.

  • Systems were embedded and staff trained to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and were well managed.

  • The practice had appropriate premises and equipment to treat and care for patients and staff that would keep them safe.

Medicines and prescribing medicine was managed safely and securely.

Effective

Good

Updated 2 June 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were above average in comparison with local and national practices.

  • Patient care was planned and provided in a way that reflected best practice and followed recommended current clinical guidance.

  • Clinical audits undertaken at the practice showed the GPs used auditing as a tool to improve the practice service quality and patient outcomes.

  • We found the staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was a system in place to ensure that staff received supervision and appraisals.

Meeting minutes seen showed staff communicated with multidisciplinary teams to understand and meet the range and complexities of people’s needs.

Caring

Good

Updated 2 June 2016

The practice is rated as good for providing caring services.

  • There were aspects of care from the national GP patient survey that showed patients rated the practice higher than others.

  • Patients told us they were involved in decisions about their care and treatment. We were also told they were treated with compassion, dignity and respect.

  • There was information for patients that was easy to understand and accessible about the services available.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

The practice recognised the needs of patients who were carers and provided support and information about the range of agencies and organisations available to support them.

Responsive

Good

Updated 2 June 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 (CCG) to secure improvements to services in the local area where these were identified. Both the senior GP partner and the practice manager were elected CCG members

  • Appointment times and availability were flexible to meet the varying needs of different patients and population groups. Same day and next day appointments were available with home visits and telephone consultations provided when needed. The practice offered its patients access to book appointments with a GP online.

  • The practice had good facilities and was well equipped to treat patients and meet their various needs. Accessible toilets and baby changing facilities were available.

Information about how to complain was available and easy to understand. Evidence we viewed showed the practice responded quickly to complaints raised. Lessons learned from complaints were shared internally with staff and externally with partner and other stakeholders.

Well-led

Good

Updated 2 June 2016

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

  • The practice promoted their mission statement and this was on display in the entrance to the practice. This underpinned their vision and strategy to deliver high quality care and promote good outcomes for patients. Staff members were clear about the vision and any responsibilities they had in relation to delivering it.

  • Information about the practice was readily available to staff and patients in both paper and electronic formats. There was a clear leadership structure that staff told us made them feel supported by the management and GPs.

  • Accessible policies and procedures reinforced the practice governance framework which supported the delivery of their strategy to provide good quality care. This included arrangements to monitor and improve quality and identify risks.

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

  • GP partners urged an ethos of honesty and openness throughout the practice and

    had systems in place to monitor notifiable safety incidents. This information was shared appropriately and we saw actions were taken to resolve them.

The practice proactively sought feedback from staff and patients, which it acted on. There was a strong focus on continuous learning evidenced in the training records, and the developments seen at all levels.

Checks on specific services

People with long term conditions

Good

Updated 2 June 2016

The practice is rated good for the care of people with long-term conditions. Performance for the management of long term conditions was higher than other GP practices nationally.

The practice responded to the needs of people with long-term conditions by providing:

  • Longer appointments and home visits were available when needed.

  • We found a robust recall system and regular clinics for diabetes patients; they also offered coaching in self-management to keep diabetic patients condition under control.

  • Patients had a named GP and a structured annual review to check that their health and medicine needs were met.

  • The long term condition patients named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care with monthly meetings.

  • Shared care with Colchester General Hospital was delivered for the monitoring of various disease-modifying medicines. The practice arranged and consistently reviewed blood test results to maintain patients with long-term conditions.

  • Flags within the clinical system alerted prescription issuers to the medicines to monitor. Robust protocols alerted staff members when blood tests were required.

  • Patients were seen and monitored according to their clinical need and sent a reminder for their review when it was due. The practice collected with people’s agreement mobile phone numbers to enable them to text message patients.

  • Long term condition patients were provided with longer appointments dependant on their condition and need.

Families, children and young people

Good

Updated 2 June 2016

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

  • Children under five years old were not triaged. They were automatically offered same day appointments due to GPs experience around the anxiety that parents of young children can be affected by.

  • Phlebotomy services were available for children over five years of age. This avoided

    unnecessary travel to hospital for families particularly for those with more than one child.

  • The practice engaged with teenagers through ‘Facebook’ and ‘Twitter’. This helped to get important messages to these patients informally from this population group. They had strict protocols regarding online access for those less than 16 years of age.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • There was a strong system in place to ensure

    childhood vaccinations were carried out and followed up to maintain a high uptake at the practice.

  • Anaphylactic medicines (to counteract allergic reaction) were available in all GP consultation rooms and treatment rooms to ensure clinicians were prepared for severe allergic reactions throughout the practice.

  • A midwife clinic was available each week to avoid pregnant ladies needing to travel unnecessarily. This was particularly important for mothers who had other young children to care for.

  • 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.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • Family planning advice and contraception fitting services were provided.

The cervical screening data showed

the percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years for 2014 to 2015 was 86% compared to the national average of 81%.

Older people

Good

Updated 2 June 2016

The practice is rated good for the care of older people. The practice offered proactive, bespoke care to meet the needs of the older people in its population.

All patients over 75 years were told who their named GP was and could change this GP if they wished. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice responded to the needs of older people, this included:

  • Home visits were available with GPs, nurses and healthcare assistants for the housebound.
  • Hospital admissions avoidance care plans were discussed at monthly multidisciplinary team meetings to reduce unplanned hospital admissions for those patients at risk.
  • The GP lead for palliative patients met monthly with all the practice GPs, community nursing team, GP Care Adviser, hospice and Macmillan nurses.
  • A practice phlebotomy service negated the need for elderly patients to travel for blood tests.
  • The practice provided room for community care that ran hearing tests, physiotherapy and abdominal aortic aneurysm (AAA) screening to ensure access for older and less mobile people. AAA screening is a way of detecting a dangerous swelling (aneurysm) of the aorta more common in men over 65 years of age. The aorta is the main blood vessel from the heart, through the abdomen to the rest of the body.
  • Emergency admissions for patients from this population group were reviewed on discharge, to ensure patients and their carers had the clinical input and medicine they needed.

  • Following admissions for a fall patients they were referred to specialists who were experienced in falls prevention.

  • The provision and encouragement of staff members for patients to have a senior health check.
  • High rates of seasonal flu/shingles vaccinations in comparison with national and local practices.
  • Dementia screening was provided opportunistically and on request. The practice focused on primary prevention wherever possible.

Patients coded as carer’s on the practice computer records system, were provided details of local and voluntary agencies to provide support.

Working age people (including those recently retired and students)

Good

Updated 2 June 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 as well as a full range of health promotion and screening that reflected the needs for this age group. For example social media including ‘Facebook’ and ‘Twitter’.

  • Invites were sent to patients between 40-75 years of age to encourage people to attend NHS health checks provided at the practice.

  • Although extended hours to the practice core hours of 8am to 6.30pm were not provided the practice tried to allocate early and late appointments to working age patients wherever possible.

  • There was a telephone triage/consultation service provided daily. Patients unable to secure a convenient appointment for their working hours received a telephone consultation with a GP.

A virtual patient participation group (PPG) in addition to the existing PPG has been set up and designed mainly for people from this population group. This allowed them to participate in activities and meetings without the need to attend.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 June 2016

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

  • 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.

  • Case management of patients experiencing poor mental health based upon input from psychiatrists, were discussed in multi-disciplinary team meetings. Patients with dementia had advanced care plans.

  • Double appointments were booked for patients with mental health issues. Alerts were placed in patient records to ensure receptionists knew they needed longer appointments.

  • Patients experiencing poor mental health had advised about how to access various support groups and voluntary organisations.

  • The practice followed up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Dementia patients were invited to attend a help and advice clinic with a representative from the Alzheimer’s Society. The full day’s clinic was booked at the practice and was well attended and received.

  • Staff members understood how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 2 June 2016

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

  • The practice identified patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The village regularly hosted a travelling circus and the practice provided primary care services to those involved. Where possible contact was made with their registered practice to obtain relevant medical records to treat their long term conditions.
  • Patients with a learning disability were offered longer appointments. Learning disability patients had a priority to be seen so that they did not have to spend a long time in the waiting room.
  • Home visits were carried out for vulnerable people unable to attend the practice.
  • The practice policy for travellers and homeless patients ensured that they received appropriate care and treatment.
  • Patients in this population group were provided with a regular GP to minimise any anxiety that may be caused by consultations with GPs not known to them.
  • If a patient with learning disabilities did not attend for their appointment, they were contacted by phone to ensure their wellbeing.
  • For patients unable to speak English the GPs used the Google translation service, when they did not get sufficient notice to arrange an interpreting service.
  • A regular signing interpreter was arranged for deaf patients prior to appointments. A protocol within the clinical system also provided a prominent message that had to be acknowledged by staff so they were aware of communication difficulties and the need to contact these patients other than by phone.
  • The practice worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients and their carer’s about how to access various support groups and voluntary organisations.

Staff had been trained to recognise signs of abuse in vulnerable adults and children and knew their responsibilities regarding information sharing. The staff members knew the documentation required to raise safeguarding concerns and how to contact relevant agencies.