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Inspection Summary


Overall summary & rating

Good

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Upwell Street s

Surgery on 7 December 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 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.
  • 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:

  • Emergency oxygen should be available on the premises

    as recommended in Resuscitation Council (UK) guidelines

    .

  • The practice should keep a log of fire drills and all staff should have up to date fire training.
  • Administrative staff should hold regular, minuted team briefings.
  • The practice had a number of policies and procedures to govern activity although some of these needed a review.

Professor Steve Field (CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 January 2017

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events and lessons were shared to make sure action was taken to improve safety.
  • When things went wrong patients received reasonable support, truthful information, and a written apology.
  • The practice had embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were generally assessed and well managed.
  • We noted that emergency oxygen was not available on the premises and we were told that this was due to the proximity of the Northern General Hospital.
  • We were told on the day of inspection that regular fire drills were carried out although we did not see a log to confirm this.  Fire training for staff was out of date but we were told that this was currently being arranged.

Effective

Good

Updated 23 January 2017

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 for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 23 January 2017

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.
  • The practice had developed an understanding of cultural needs across the practice population for example they had developed a Ramadam protocol for patients with diabetes.

Responsive

Good

Updated 23 January 2017

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. For example the practice are part of a Federation and offer Hub appointments during the evening and at weekends.
  • Most 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.
  • The practice had a high number (24%) of Roma Slovak patients and provided a range of services for these families living in poverty with complex health and social needs. This included;weekly booked surgeries with interpreters, dedicated new patient checks and 'on' day and ‘walk in’ appointments for those patients without skills to book appointments and Hepatitis B screening. The practice had a high awareness of safeguarding issues in this group of patients.
  • 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.
  • The practice had developed an innovative Frailty Protocol to improve care for patients who were frail due to medical conditions. The protocol included detailed care plans and medication reviews.  
  • The practice had liaised with the Alzheimers Society to enable patients living with dementia in the community and their carers to receive additional support and signposting.
  • The practice had developed an awareness of Female Genital Mutilation (FGM) issues locally and offered referral for surgery and psychosexual counselling.

Well-led

Good

Updated 23 January 2017

The practice is rated as good for being well-led.

  • The practice had a strategy to deliver high quality care and promote good outcomes for patients.
  • There was a leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity although some of these were overdue a review.

  • 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 sought feedback from staff and patients, which it acted on.
  • The practice had a patient participation group although this was not currently active. However, they gained patient feedback through the national Friends and Family test, NHS choices and the suggestion box.

  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 23 January 2017

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.
  • Performance for diabetes related indicators was above the CCG and national average. For example, the percentage of patient with diabetes, on the register, in whom the last blood test was within normal limits was 85%, CCG average 78% and 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.
  • The practice had developed an understanding of cultural needs across the practice population.  For example they had developed a Ramadam protocol for patients with diabetes

    to support them with their diet during this religious period

    .

Families, children and young people

Good

Updated 23 January 2017

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.
  • 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 86%, which was comparable to the CCG average of 89% and the national average of 81%.

  • 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, health visitors and there was frequent liaison with local schools to ensure that children with increased needs were receiving educational support

Older people

Good

Updated 23 January 2017

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 people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice carried out regular medication reviews to avoid polypharmacy (the concurrent use of multiple medications).

  • The practice had developed an innovative Frailty Protocol to improve care for patients who were frail due to medical conditions. The protocol included detailed care plans and medication reviews.
  • The practice had liaised with the Alzheimers Society to enable patients living with dementia in the community and their carers to receive additional support and signposting.
  • The practice employed two salaried GPs to provide daily visits and weekly ward rounds to local nursing homes. All nursing home patients had detailed annual care plans and end of life care plans. The practice had low hospital admission rates, or hospital deaths of nursing home patients in their care.

Working age people (including those recently retired and students)

Good

Updated 23 January 2017

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 reflects the needs for this age group. 

People experiencing poor mental health (including people with dementia)

Good

Updated 23 January 2017

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

  • 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and the national average of 84%.
  • Performance for mental health related indicators was similar to the CCG and the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94%, CCG average 90% and national average 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice carried out advance care planning for patients living with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and liaised closely with the Alzheimers Society.
  • 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 those living with dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 January 2017

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

  • The practice had a high number (24%) of Roma Slovak patients and provided a range of services for these families living in poverty with complex health and social needs. This included;weekly booked surgeries with interpreters, dedicated new patient checks and 'on' day and ‘walk in’ appointments for those patients without skills to book appointments and Hepatitis B screening. The practice had a h

    igh awareness of safeguarding issues in this group of patients.

  • 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.

  • The practice had developed an awareness of Female Genital Mutilation (FGM) issues locally and offered referral for surgery and psychosexual counselling.