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Dr N Essa & Dr M Harrold Good Also known as London Street Surgery

Inspection Summary


Overall summary & rating

Good

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr N Essa and Dr M Harrold in April 2016. At that time we found the practice had made improvements and removed them from special measures. However, a number of concerns were found and the practice was rated as requires improvement for the provision of safe, caring and well led services.

The practice sent us an action plan setting out how the changes they were making to address the issues that led to our concerns. We commenced reviewing data available to us about the practice on 23 November 2016 and returned to inspect the practice on 25 November 2016 to check that the practice had taken the actions they told us they would take in their action plan. We found significant improvement had been achieved. Specifically the practice had:

  • Introduced an effective system to record and deal with safety alerts.

  • A system in place to review and share learning from significant events.

  • Completed DBS checks for all relevant staff.

  • Effective systems in place to manage risk.

  • Surveyed patients to obtain feedback about the care they received. This resulted in an improved perception of care.

  • Taken action to promote the benefits of cancer screening programmes.

  • Encouraged patients with caring responsibilities to register their carer role and worked with other organisations to support carers.

  • Updated staff appraisals and taken action on the outcomes of appraisals.

The range of improvements made by the practice has resulted in the practice achieving a good rating for provision of safe, caring and well led services and an overall rating of good. This revised rating and the improvements the practice had undertaken were achieved at a time when the practice registered population had increased by approximately 200 in six months.

The area where the provider should make improvement is:

  • Ensuring information in different languages setting out the benefits of cancer screening programmes is made available at the earliest possible opportunity. Also ensuring the benefits of cancer screening programmes were promoted at every opportunity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 December 2016

The practice is now rated as good for providing safe services. Since our last inspection in April 2016 the practice had completed a range of improvements. For example:

  • 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.

  • Medicines were managed effectively and safely

  • The practice had introduced systems, processes and practices to keep patients safe and manage risk.

  • Appropriate systems had been introduced to monitor, act on and record national patient safety alerts.

  • Relevant control measures had been put in place to reduce the risk of legionella.

Effective

Good

Updated 16 May 2016

The practice is rated as good for providing effective services.

  • Following our previous inspection in August 2015 the practice had made significant improvements in areas relating to clinical audit cycles and all staff had received relevant role specific mandatory training.
  • At the inspection in April 2016, data from the Quality and Outcomes Framework (QOF) showed patient outcomes were 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 most staff. However, the practice was still in the process of completing staff development plans as part of staff annual appraisals and we saw evidence that all three remaining appraisals meetings were planned with in next two weeks.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patient’s needs.

Caring

Good

Updated 16 December 2016

The practice is now rated as good for providing caring services. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • Data from the national GP patient survey continued to show mixed feedback from 117 patients who completed questionnaires.

  • A practice survey of 308 patients showed that 87% felt they were given enough time for their consultations and were involved in decisions about their care and treatment.

  • The practice was active in promoting the benefits of registering as a carer. There had been an increase of 21 registered carers (from 29 to 50) in the last six months.

  • 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 16 May 2016

The practice is rated as good for providing responsive services.

  • Following our previous inspection in August 2015 the practice had made significant improvements in areas relating to access the service for patients with limited mobility. The practice had installed an automatic door activation system at both doors used to enter the premises and undertaken a repair work to widen the lift to meet the needs of the patients with limited mobility. The practice had designated a parking space for disabled patients in the practice car park and installed a grab rail on the inside of the door in disabled toilet.
  • Feedback from patients reported that access to a named GP and continuity of care was available quickly, 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 16 December 2016

The practice is now rated as good for being well-led. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • 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.

  • A programme of practice meetings was in place and all staff were encouraged to attend and contribute to the development of the practice.

  • The practice had developed a sharper focus on health promotion and prevention of ill health.

  • Provision had been increased and enhanced by the appointment of a second practice nurse. Staffing levels were kept under review as the practice list size was increasing.

  • There was a 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 focus on continuous learning and improvement at all levels underpinned by an effective appraisal system.

Checks on specific services

People with long term conditions

Good

Updated 16 December 2016

The practice is rated as good for the care of people with long-term conditions. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The nursing team had been expanded to offer better opportunity to follow up patients diagnosed with diabetes.

  • 86% of patients diagnosed with diabetes were achieving target blood pressure which was better than the clinical commissioning group CCG average of 77% and national average of 78%. This performance was achieved with 2% fewer patients than both local and national averages excepted from the indicator

  • 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.

Families, children and young people

Good

Updated 16 December 2016

The practice is rated as good for the care of families, children and young people. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • 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.

  • 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.

  • 77% of women eligible for cervical screening attended which was similar to the CCG average of 78% but below the national average of 82%. The practice had ordered leaflets in four different languages that explained the benefits of cervical cancer screening.

  • 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.

Older people

Good

Updated 16 December 2016

The practice is rated as good for the care of older people. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • 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.

  • Longer appointments could be booked for patients with multiple health needs.

  • The practice promoted the benefits of registering as a carer and worked with local groups to support patients who were also carers.

  • One of the nurses had enhanced skills in treating patients with ulcers and in undertaking tests to identify patients at risk of developing an ulcer.

Working age people (including those recently retired and students)

Good

Updated 16 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • 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 reflects the needs for this age group.

  • The practice had identified the smoking status of 91% of its practice population aged over 15. This was better than the CCG average of 85% and national average of 88%. Smoking cessation support was available from a counsellor who visited the practice.

  • The practice operated a reminder system for patients who had not attended for the national bowel cancer screening programme.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 December 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • The practice achieved the 80% target for holding a face to face review with patients diagnosed with dementia. This was 9% below the CCG average. However due to the younger age profile of the practice population there were very few patients diagnosed with dementia and this affected the percentage.

  • 94% of patients diagnosed with a severe and enduring mental health problem had their care plan reviewed in the last year which was better than the CCG and national average of 88%.

  • 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 16 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Since our last inspection in April 2016 the practice had completed a range of improvements. For example

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

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

  • The practice regularly worked with other health care professionals 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.

  • Annual health checks for patients diagnosed with a learning difficulty were offered and a home visit was available for those who found it difficult to attend the practice.