You are here

Oldwood Surgery Good Also known as Dr Rodgers & Partner

Inspection Summary


Overall summary & rating

Good

Updated 8 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oldwood Surgery on 05 April 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.
  • 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 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.

The areas where the provider should make improvement are:

To consider ways to increase the identification of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 June 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 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 to patients were assessed and well managed.

Effective

Good

Updated 8 June 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 for 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 personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 8 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey 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.

  • 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 8 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 where these were identified. For example, they had identified their current premises as being the main barrier to improving services. They had identified a site and submitted plans for new premises. The CCG had approved the plans and they were applying, via NHS England, for funding.

  • 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 and other stakeholders.

Well-led

Good

Updated 8 June 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.

  • The practice mission statement was clearly posted in every room in the practice.

  • 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 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 strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 8 June 2016

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

  • Each GP had lead roles in specific long term conditions and was responsible for overseeing the care of patients with that condition. They also attended annual training specific to their lead roles. .

  • Nursing staff had significant roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 88.3% (national average 78%)

  • Longer appointments and home visits were available when needed.

  • All these patients 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.

  • All clinical staff attended multi-disciplinary team (MDT) and Palliative Care team meetings where possible.

  • The practice held a palliative care register and a register of patients at risk of hospital admission.

Families, children and young people

Good

Updated 8 June 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. The child safeguarding lead GP had recently reviewed all patients who had a record of a Child Protection Plan in their notes. When a new child joined the practice the Children’s Index was checked to see if they had had any social services input in the past.

  • Published figures of immunisation rates for the standard childhood immunisations appeared mixed. For example published figures show children receiving vaccination aged 12 months was 90% (clinical commissioning group (CCG) average 92% to 93%). Children aged two years receiving vaccination 85% to 93% (CCG 91% to 97%). Children of five years receiving vaccination 83% to 97% that there had been errors in the returns leading to the (CCG 90% to 96%). However we were shown unverified evidence that there had been clerical errors in the returns from the practice and that the actual figures were higher than those published.

  • The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months was 94% (national average 75%)

  • 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 percentage of women aged 25-64 whose notes record that a cervical screening test was performed in the preceding 5 years was 86% (national average 82%). Recent figures provided by the practice but not yet verified, showed that at the end of March 2016, the uptake was 90%.

  • 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 and health visitors. Ante natal clinics were run by midwives at both the main surgery and at the branch surgery.

  • Mothers were seen for their postnatal check at the same time as their baby’s six to eight week check.

  • The practice offered newborns examinations when required.

  • The practice offered a minor injuries service, to help avoid unnecessary visits to A&E.

  • The main surgery at Robertsbridge provided a GP run Friday afternoon urgent appointment surgery, to try to resolve any urgent patient concerns before the weekend.

Older people

Good

Updated 8 June 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 patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Each care home that the practice looked after had a named GP who they could contact when required and who carried out a regular weekly visit of the patients at the home.

  • The practice had a housebound patients’ register and a system whereby housebound patients were visited by a practice nurse or GP to assess their needs and review medicines.

  • Flu clinics were held at convenient times for older patients and practice nurses also visited housebound patients, not on the district nurse caseload, to give them the flu vaccine.

  • Some housebound patients were visited by the practice nurse for dressings and foot care on a regular basis.

Working age people (including those recently retired and students)

Good

Updated 8 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.

  • Text message appointment reminders were offered and patients could download an app that allowed them to book and cancel appointments from their phone.

  • Bookable early morning and evening appointments were available as well as the option of telephone consultations.

  • The practice offered NHS health checks to patients in the 40-65 age group.

  • Travel clinic appointments were available with the practice nurse.

  • The Monday evening nurses clinic was extended to allow extended access for cervical screening.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 June 2016

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

  • From April 2014 to March 2015, 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average (84%). However, the practice had identified this as an issue and had worked to improve this. Their current unverified figures showed that they had carried out reviews on 95% of their patients with dementia over the year April 2015 to March 2016. The unverified exception rate was 9%.
  • The practice were aware that their prevalence for dementia was lower than expected and had participated in a clinical commissioning group (CCG) wide drive to improve dementia diagnosis rates. We saw unverified evidence that dementia prevalence rates had improved significantly.

  • The practice cared for patients at a specialised dementia home and a care home. Each home had a designated GP who carried out a weekly visit in protected time and carried out a dementia annual review.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 96% (national average 89%)

  • The practice provided medical care for patients with complex physical and mental health needs in a care home, including end of life care.

  • The practice provided medical care for a long stay unit for patients with mental health needs.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • 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.

  • 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 8 June 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.

  • The practice looked after three care homes for patients with learning disabilities.

  • There was a lead GP who carried out annual assessments of patients with learning disabilities. The assessments could be done at the patient’s home or at the surgery depending on the patient’s needs.

  • They had recently introduced a Health Action Plan for those with learning disabilities.

  • The practice ensured that patients classed as vulnerable had annual health checks and was active in ensuring that they attended chronic disease reviews when appropriate. They would telephone patients to remind them of their appointment when necessary. They also had a good relationship with the specialist health visitor.

  • 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 patients.

  • 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.

  • Staff were all aware of the vulnerable patients that the practice cared for and would alert the GPs to any concerns that they might have.