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Inspection Summary


Overall summary & rating

Good

Updated 28 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (At the previous inspection on 26 January 2016 the overall rating was also Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out this announced comprehensive inspection of Burney Street PMS on 9 January 2018 as part of our inspection programme. We visited the main site at 48 Burney Street, Greenwich and the branch surgery at Wallace Health Centre, Deptford.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved patients in decisions about their care and treated them with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.
  • The provider should continue to monitor their performance against the Quality and Outcomes Framework and implement changes to improve outcomes for patients where necessary.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 February 2018

Effective

Good

Updated 28 February 2018

Caring

Good

Updated 28 February 2018

Responsive

Good

Updated 28 February 2018

Well-led

Good

Updated 28 February 2018

Checks on specific services

People with long term conditions

Good

Updated 23 March 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.

  • Seventy-five percent of patients with diabetes had well-controlled blood sugar levels, which was comparable to the national average of 77%.

  • Longer appointments and home visits were available for these patients when needed.

  • All these patients had a named GP and the practice was performing in line with national averages for conducting annual reviews of patients with a long term condition. For example, 73% of patients had a review in the previous 12 months (national average 75%) and 87% of patients with chronic obstructive pulmonary disorder had a review in the previous 12 months (national average 90%).

  • 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.

  • There were monthly meetings to discuss patients at risk of unplanned hospital admission.

Families, children and young people

Good

Updated 23 March 2016

The practice is rated as outstanding 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.

  • Childhood immunisation rates for the vaccinations given to children aged under two years ranged from 75% to 100%, and for five year olds from 56% to 83%. Eighty-two percent of women aged 25 to 64 years had a cervical screening test in the previous five years, which was comparable to the national average of 82%.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. The practice was awarded a young people friendly award every year from 1999 to 2015, most recently by the Royal Borough of Greenwich local authority, following a ‘mystery shopper’ programme of assessments carried out by young people seeking advice about contraception and sexual health in the practice.

  • There was a system to alert practice staff to vulnerable young patients living at a local youth hostel. These patients were prioritised for urgent appointments after the practice identified there was a high incidence of non-attendance to booked appointments by this group due to poor mental health and emotional problems.

  • 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 23 March 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.

  • Longer appointments and home visits were available for older people when needed.

  • Every patient aged 75 and over had a named GP.

  • The GPs provided care for a local residential care home twice a week, and feedback from the manager of this home was positive about the level of service they received.

  • Seventy percent of patients aged over 65 years received the annual flu vaccine, which was comparable to the national average of 73%.

  • All female patients aged above 60 years were given an optional bone density scan to detect those at risk of osteoporosis.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, 100% of patients aged 75 years or over with a fragility fracture and a diagnosis of osteoporosis were being treated with a bone-sparing agent, compared to the clinical commissioning group average of 97% and the national average of 93%.

Working age people (including those recently retired and students)

Good

Updated 23 March 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 were available from 7.00am to 8.00am Monday to Thursday for patients who could not attend during normal opening hours.

  • The practice offered online appointment booking and repeat prescription requests as well as a full range of health promotion and screening that reflected the needs of this age group.

  • Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 March 2016

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

  • Eighty percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%.

  • Eighty percent of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was below the national average of 88%. The practice had implemented changes to improve their management of patients with poor mental health.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They carried out review consultations with a local psychiatrist to improve the management of these patients.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • A consultation room was used for counselling sessions provided by a local psychological therapies group, for patients at the practice.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • 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 23 March 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. They told us homeless people were able to register as patients.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and 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.