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Inspection Summary


Overall summary & rating

Good

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portugal Place Health Centre on 7 September 2016. Overall the practice is rated as good.

Our key findings were as follows:

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Although it was not always clear what action had been taken to improve safety in the practice, and prevent a reoccurrence of incidents and significant events.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Many patients were unhappy with the appointments system; managers were aware of this and were taking action to improve access.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
  • There were effective arrangements in place to ensure all staff received training appropriate to their role.
  • Staff throughout the practice; and the other external agencies based in the same building, worked well together as a team.

The area where the provider should make improvements is:

  • Take steps to ensure that learning from significant events is identified and appropriate action taken to reduce the risk of similar incidents occurring in the future.
  • Take action to ensure that the refrigerators used to store vaccines are serviced in line with manufacturer’s guidelines.
  • Develop arrangements for identifying patients who are carers so they can be offered appropriate care and support.
  • Take steps to improve the system for investigating and responding to complaints, including providing advice on what to do if the complainant was unhappy with the response to their complaint.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 October 2016

The practice is rated as good for providing safe services.

The nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. However, it was not always clear what action had been taken to improve safety in the practice, and prevent a reoccurrence of incidents and significant events.

There was evidence of good medicines management. Good infection control arrangements were in place and the practice was clean and hygienic. One of the clinical rooms was carpeted; managers told us they had plans to replace the carpet with suitable flooring.

Effective staff recruitment practices were followed and there were enough staff to keep patients safe. Disclosure and Barring Service (DBS) checks had been completed for all staff employed since 2014. A decision had been taken not to carry out retrospective checks on existing (clinical and non-clinical) staff.

Effective

Good

Updated 20 October 2016

The practice is rated as good for providing effective services.

The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 95.8% of the points available. This was above the national average of 94.7%. Information about patients’ outcomes was used to make improvements. The practice used an analysis tool, Reporting Analysis and Intelligence Delivering Results (RAIDR) to look at trends and compare performance with other practices.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. There were designated leads for clinical areas, they attended relevant training and kept up to date with new guidance, then cascaded that to colleagues. A number of clinical protocols had been devised; which incorporated NICE and local guidelines. These were reviewed regularly and were available to all clinical staff.

Arrangements had been made to support clinicians with their continuing professional development. Staff had received training appropriate to their roles. There were systems in place to support multi-disciplinary working with other health and social care professionals in the local area. The district nursing team and health visitors were based in the same building so there was regular informal communication.

Caring

Good

Updated 20 October 2016

The practice is rated as good for providing caring services.

Patients said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about support groups and services was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality. Some patients commented that they felt their conversations with the receptionist could be overheard. Managers were aware of this issue and had tried several options to reduce the risks.

The National GP Patient Survey published in July 2016 showed satisfaction scores on consultations with doctors and nurses were broadly in line with national averages. Results showed that 95% of respondents had confidence and trust in their GP, the same as the national average; 100% said they had confidence and trust in their nurse, compared to the national average of 97%. However, some scores were slightly below average, for example, 88% said the nurse was good at treating them with care and concern compared to the national average of 91%.

There was no specific written information available for carers to ensure they understood the various avenues of support available to them. Patients were invited to register as a carer when they registered with the practice. Staff told us the clinical staff would ask those patients who they considered may have been carers but there were no plans to reach out to the wider practice population.

Responsive

Good

Updated 20 October 2016

The practice is rated as good for providing responsive services.

The practice had good facilities and was well equipped to treat patients and meet their needs. Extended hours surgeries were offered every Wednesday and Thursday evening; appointments with GPs and nurses were available outside of normal working hours.

However, the practice’s scores in relation to access in the National GP Patient Survey were below average. The most recent results (published in July 2016) showed 80% (compared to 85% nationally and 86% locally) of respondents were able to get an appointment or speak to someone when necessary. The scores on the ease of getting through on the telephone to make an appointment were also below average (60% of patients said this was easy or very easy, compared to the national average of 73% and a CCG average of 79%). Some of the patients we spoke with also expressed dissatisfaction at the appointments system. Managers were aware of patients’ views on access and had carried out a detailed review of capacity and demand. New ways of working had been implemented to improve access; this included employing a nurse practitioner and increasing the number of telephone consultations available.

The practice had a system in place for handling complaints and concerns but this was not always effective. We looked at six complaints received in the last 12 months. Many of the responses did not give the complainant advice on what to do if they were unhappy with the response to their complaint.

Well-led

Good

Updated 20 October 2016

The practice is rated as good for providing well-led services.

The leadership, management and governance of the practice assured the delivery of person-centred care which met patients’ needs. There was a clear and documented vision for the practice. Staff understood their responsibilities in relation to the practice aims and objectives. There was a well-defined leadership structure in place with designated staff in lead roles. Staff said they felt supported by management. Team working within the practice between clinical and non-clinical staff was good.

The practice had a number of policies and procedures to govern activity and held regular governance meetings. The practice proactively sought feedback from staff and patients, which they acted on. Staff had received inductions, regular performance reviews and attended staff meetings and events.

There was a focus on continuous learning and improvement at all levels within the practice. New ways of working had been implemented to improve access. Staff were involved in making improvements to the practice.

Checks on specific services

People with long term conditions

Good

Updated 20 October 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
  • Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
  • Patients had regular reviews to check health and medicines needs were being met.
  • For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Performance in the Quality and Outcomes Framework (QOF) for peripheral arterial disease (a circulatory problem) indicators was above the national average (100% compared to 96.7% nationally). For example, the percentage of patients with peripheral arterial disease with a record in the preceding 12 months that aspirin or an alternative anti-platelet was being taken was 96.5%, compared to the national average of 92.7
  • QOF performance for asthma related indicators was below the national average (82.1% compared to 97.4% nationally). For example, the percentage of patients with asthma who had had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP questions was 65.7%, compared to the national average of 75.3%. However, action had been taken, including further training for clinicians and the implementation of a new protocol on dealing with suspected asthma in the under 16s. Data, provided by the practice, for 2015/2016 showed that performance had improved and the practice had achieved all of the points available for the asthma related indicators.

Families, children and young people

Good

Updated 20 October 2016

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

  • The practice had identified the needs of families, children and young people, and put plans in place to meet them.
  • 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. The practice hosted open access baby clinics every week.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The practice’s uptake for the cervical screening programme was 80.6%, which was slightly below the CCG average of 83.1 and the national average of 81.8%.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Older people

Good

Updated 20 October 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. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Working age people (including those recently retired and students)

Good

Updated 20 October 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 and flexible. Extended hours surgeries were offered on Wednesday and Thursday evenings until 8pm for working patients who could not attend during normal opening hours.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
  • Additional services were provided such as health checks for the over 40s and travel vaccinations.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 October 2016

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

  • The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
  • Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
  • The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

People whose circumstances may make them vulnerable

Good

Updated 20 October 2016

The practice is rated as requires improvement 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.
  • Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
  • The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people.
  • 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 and out of hours.
  • The practice had a comprehensive system for recording child safeguarding concerns; there was a shared electronic document which was regularly reviewed and updated by the health visiting team.
  • There was no specific written information available for carers to ensure they understood the various avenues of support available to them. Patients were invited to register as a carer when they registered with the practice. Staff told us the clinical staff would ask those patients who they considered may have been carers but there were no plans to reach out to the wider practice population.