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Inspection Summary


Overall summary & rating

Good

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Regal Chambers Surgery on 14 January 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.                      

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 April 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 and 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 20 April 2016

The practice is rated as good for providing effective services.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients.
  • The practice provided enhanced services which included personal health and advanced care planning.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • The practice was proactive in ensuring staff learning needs were met.
  • 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 20 April 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey results published in January 2016 showed patients rated the practice higher than others for several aspects of care.
  • The practice offered flexible appointment times based on individual needs.
  • 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 20 April 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a nurse from a local practice provided an anti-coagulation service and patients were able to have their blood tests, medication dosage checks and reviews completed at the practice.
  • 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 signed up to the CCG led winter resilience scheme and provided extra appointments. This service had given patients the opportunity to attend the practice for emergencies rather than travel to the local accident and emergency unit.
  • 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 20 April 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.
  • 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.
  • There was a strong focus on continuous learning and improvement and the practice worked closely with other practices and the local Clinical Commissioning Group.
Checks on specific services

People with long term conditions

Good

Updated 20 April 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. The practice held weekly nurse-led COPD (chronic obstructive pulmonary disease) and asthma clinics.
  • The overall performance for diabetes related indicators was below the local Clinical Commissioning Group (CCG) and national averages.
  • The practice held a multidisciplinary diabetic clinic for patients on a weekly basis, providing all aspects of diabetes management including insulin initiation. The practice worked closely with the secondary care diabetes consultant and completed an annual review of patients.
  • Longer appointments and home visits were available when needed.
  • The practice held a register of cancer patients and regularly reviewed new cancer diagnosis.
  • All patients with a long-term condition 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 20 April 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, 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.
  • 69% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months which was comparable with the national average of 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 practice’s uptake for the cervical screening programme was 83% which was comparable with the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice held nurse-led baby immunisation clinics twice a week.
  • The practice provided GP services to a local independent school.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 20 April 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, this included enhanced services for dementia and end of life care.
  • Weekly visits to three local care homes were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required.
  • The practice worked closely with a rapid response and case management service in place to support older people and others with long term or complex conditions to remain at home rather than going into hospital or residential care.
  • The practice had completed 366 over 75 health checks in the last 12 months, which was 32% for this population group.
  • Flu vaccination rates for the over 65s were higher than the national average.

Working age people (including those recently retired and students)

Good

Updated 20 April 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.
  • It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
  • The practice was proactive in offering online services such as appointment booking and repeat prescriptions services, as well as a full range of health promotion and screening that reflects the needs for this age group.
  • It offered an appointment reminder text messaging service and appointment times were extended four times a month, including one Saturday morning each month.
  • The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice. 

People experiencing poor mental health (including people with dementia)

Good

Updated 20 April 2016

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

  • 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
  • Fortnightly visits to two local mental health/learning disability facilities were carried out by named GPs for continuity of care and emergency visits were also provided when needed.
  • The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
  • It had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Patients were referred to the Improving Access to Psychological Therapies (IAPT) service and these sessions were delivered at the practice by the local community wellbeing team.
  • 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 20 April 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 provided same day appointments for people from a nearby hostel.
  • It offered longer appointments and annual health checks for people with a learning disability.
  • The practice held a register of carers, there was a nominated carer’s champion who was proactive in offering health checks, flu vaccinations and information and advice about local support groups and services.
  • There was a system in place to identify patients with a known disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations.
  • There was a system in place to identify patients who required additional support and extra time during appointments.
  • Staff had received safeguarding training and 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.