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Inspection Summary


Overall summary & rating

Good

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pemberton Surgery on 22 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • The practice looked after multiple vulnerable children over 100 in total. We saw good examples of the team maintaining and updating regular record checks and performing regular audits to maintain the registers.
  • There were an open and transparent approach to safety and a 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • One member of staff was nominated and won a Kindness and Dignity Award.
  • 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.

We did see one area of outstanding practice:

The GP partner had developed an in-house alternative to replace patients INR yellow card. INR is a test used for people using the medicines called Warfarin.

Warfarin is a medicine taken to prevent the blood from clotting and to treat blood clots. Warfarin is also used to reduce the risk of clots causing strokes or heart attacks.

The Warfarin treatment summary template was a computerised record for every patient on the medicine called Warfarin. This detailed records of past and current INR results and also included a dosing schedules, next testing dates and comment section within the template. Making the process of monitoring and prescribing Warfarin safer.

This system had been shared with the wider community where five other practices have implemented the template.

The areas where the provider should make improvements are:

  • Consider having one person taking overall responsible for the infection control of the practice, whilst making sure all staff receive training.
  • Develop a schedule to have full practice meetings.
  • Keep reviewing, maintaining and improving the appointment system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 October 2016

The practice is rated as good for providing safe services.

  • The practice had strong systems and processes to keep patients safe and safeguarded from abuse.
  • There was a 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 things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 October 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 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 7 October 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.
  • The practice had an active patient participation group (PPG) who support the community and patients.
  • 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 7 October 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 to secure improvements to services where these were identified.
  • 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 7 October 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 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.
  • 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 notifiable safety incidents and ensured this information was shared with staff so that appropriate action was taken
  • The patient participation group was extremely active in supporting the practice with 11 active members regularly meeting and reviewing the patient journey.
  • The practice proactively sought feedback from staff and patients, which it acted on.
Checks on specific services

People with long term conditions

Good

Updated 7 October 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 percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12months) is 140/80 mmHg or less was 81% compared to CCG average of 83% and national average of 78%.
  • A new call and recall system had been implemented to ensure patients with long term conditions are recalled for regular reviews and blood monitoring.
  • 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 7 October 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.
  • In the last five years 86.5% of patients had received cervical screening compared to the clinical commissioning group (CCG) average of 84% and national average of 82%.
  • Evening appointments and early morning appointments were available.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 7 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.
  • The GP made regular visits to the nursing and residential homes in the area, making sure care plans were in place.
  • A weekly link worker attended the practice to offer support to patients by providing advice about benefits, housing, bereavement and counselling.

Working age people (including those recently retired and students)

Good

Updated 7 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, flexible and offered continuity of care.
  • The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offered a late evening nurse led clinic for patients.
  • The practice had a text reminder service for all patients, which helped to reduce missed appointments.
  • The practice offered NHS health check to all patients 40 years and above.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 2016

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

  • 73% of patients diagnosed with dementia had received a face to face review in the last 12 months, which is lower than the CCG of 84% and national 84%
  • 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 a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 7 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice looked after multiple vulnerable children over 100 in total. We saw good examples of the team maintaining and updating regular record checks and performing regular audits to maintain the registers.
  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability with all patients in the group having a health action plan in place.
  • 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.