5 September 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Station Road Surgery on 1 December 2015. The practice had been rated as good for effective, caring, responsive and well-led, however, required improvement in safe. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-
- Ensure that all staff have completed relevant training for fire safety, infection control and information governance in line with the practice training requirements.
- Complete a legionella risk assessment.
- Carry out regular fire drills.
We undertook this announced focused inspection on 15 August 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and are rated as good under the safe domain.
This report only covers our findings in relation to those requirements.
- Staff had received training as required by the practice.
- A legionella risk assessment had taken place in December 2015 and no concerns had been found.
- A full fire drill with staff and patients had been completed in December 2015 and staff were aware of the procedures to follow in case of an evacuation.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
3 March 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.
- Longer appointments and home visits were available when needed.
- Patients on chronic disease registers were invited for six monthly reviews to ensure they were managed appropriately.
- All these patients had a named GP and a structured annual review to check that 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 lead GP for prescribing held monthly meetings with the community pharmacist to monitor prescribing and assist with any new guidance or changes.
- The practice had organised and hosted educational events on diabetes for patients.
3 March 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 patients who had a high number of A&E attendances.
- The practice had a child protection lead GP who attended regular monthly meetings with the health visitor to discuss all families on the child protection register, and to raise concerns involving any new cases where appropriate.
- Immunisation rates were relatively high for all standard childhood immunisations.
- Patients told us that children and young patients 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.
- We saw good examples of joint working with midwives and health visitors.
- The practice was able to use the services of an in-house youth counsellor.
- The practice ensured that children needing emergency appointments would be seen on the same day or were offered a same day telephone appointment to discuss any concerns.
3 March 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 practice offered continuity of care with a named GP.
- There was regular contact with district nurses and staff participated in monthly meetings with other healthcare professionals to discuss any patient concerns.
- It was responsive to the needs of older patients and offered same day telephone appointments with a GP, double appointments at the surgery within 48 hours, or a home visit when required.
- The practice had a register of patients over the age of 75 with complex medical needs or who were at high risk of hospital admission. These patients had an emergency telephone number to the practice in order to access urgent appointments and had a copy of their care plans at home.
- The practice had a member of staff who was the care co-ordinator. They telephoned patients on discharge from hospital to offer support, and enquire whether a GP visit or other assistance was required.
- Important information was recorded as alerts on patient's notes, such as keysafe codes or next of kin contact details.
- Patients were encouraged to have their flu vaccination to prevent severe flu related illnesses.
3 March 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 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 offered advice by telephone each day for those patients who had difficulty in attending the practice and there were daily evening emergency appointments available.
- Patients could book evening appointments until 8pm.
- Patients could book appointments for monitoring of long term conditions at times convenient to them rather than at fixed times.
- The practice offered patients who were over 40 a health check and could offer phlebotomy services for glucose and cholesterol blood tests.
- Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.
3 March 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice actively promoted the screening of patients for memory loss.
- 93.8% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was higher than the CCG average of 86.7% and the national average of 84%
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
- It 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.
- It 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.
- The practice promoted the use of counselling services and cognitive behaviour therapies for patients.
3 March 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
- All these patients had a named GP.
- It offered longer appointments for patients with a learning disability.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
- It had told 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 was able to use the rapid access team and social care team, to support vulnerable patients where a need had been identified.
- The practice participated in multidisciplinary telephone meetings with the integrated care team to improve communication between different services for patients.
- Where appropriate information was shared with out of hours services and ambulance services to help improve patient care and safety.
- Translation services were available for patients who did not use English as a first language. We also saw advertised a sign language service for those patients who had a hearing impairment. The practice also provided an auditory loop.
- The practice could accommodate those patients with limited mobility or who used wheelchairs.
- Carers and those patients who had carers were flagged on the practice computer system and were signposted to the local carers support team.