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Archived: Family Health Care Good Also known as Lydia House Surgery

Inspection Summary


Overall summary & rating

Good

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

This inspection of Family Health Care practice was carried out on 12 July 2017 and was to check improvements had been made since our previous inspection on 5 May 2016. Following our May 2016 inspection the practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe, effective, responsive and well led and good for caring. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Family Health Care on our website at www.cqc.org.uk.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the previous inspection on 5 May 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

At this inspection we found that the majority of the improvements had been made and progress had been made across all areas of concern. Overall the practice is now rated as good.

Our key findings were as follows:

  • Significant events were fully investigated; patients received support, honest explanations and apologies. The learning was shared with appropriate staff.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • Staff received appropriate training to fulfil their roles.
  • There was a clear recruitment process in place for permanent and locum staff, however some staff files did not contain evidence of photographic identify checks. Clinical staff files contained evidence of vaccination and level of immunity against Hepatitis B.
  • There were systems in place to ensure safe medicines management including the monitoring of fridges to ensure medicines were stored at the correct temperatures.
  • Patients prescribed high risk medicines received appropriate review.
  • The practice had a system in place to deal with any medicines alerts although this could be strengthened by maintaining an audit trail of action taken.
  • Infection control audits were completed and action taken to resolve any issues.
  • The practice had installed a new fire alarm which complied with recommendations from a fire risk assessment.
  • A Legionella risk assessment had been completed. The practice monitored temperatures however had not followed up on other recommendations from the risk assessment. Following our inspection they took action to rectify this.
  • Policies and procedures were up to date, practice specific and staff were aware of where to find them and their contents.
  • Feedback from patients about their care was consistently positive.
  • One two cycle clinical audit had been completed since our last inspection. The practice had recently employed a pharmacist and reviewed their staffing structure to allow for more quality improvement activity to take place.
  • The practice had a system for identifying and supporting the carers on their register.
  • The complaints policy was clearly visible to patients. Complaints were fully investigated and there was a clear audit trail of actions taken by the practice. Informal complaints were not being analysed for themes and trends.
  • There were processes in place to gather and act on patient feedback including a patient participation group (PPG).
  • Staff had worked as a team to act on the feedback from the previous inspection.

However, there were still areas of practice where the provider needed to make improvements.

The provider should:

  • Implement a system for evidencing action taken to respond to medicine alerts.
  • Continue to increase quality monitoring and improvement activity through audits and other reviews.
  • Make an action plan for dealing with the recommendations from the Legionella report and identify a person to be responsible for actions with deadlines for action.
  • Consider how to encourage attendance for breast screening.
  • Consider keeping a log of informal complaints for trends analysis and audit trail.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 August 2017

The practice is rated as good for providing safe services.

  • There was a system in place for the investigation of significant events. Following investigation the outcome was shared with appropriate staff to ensure that lessons were learned and action was taken to improve safety in this area in the future.
  • When things went wrong, appropriate actions were taken and a full investigation completed, with the person affected, or their designated next of kin, given accurate and honest information as well as an apology.
  • There were clear safeguarding processes in place for adults and children. Staff were aware of their roles and responsibilities with regards to safeguarding and were aware of potential signs of abuse.
  • There were systems in place to ensure safe medicines management including the monitoring of fridges to ensure medicines were stored at the correct temperatures.
  • Where patients were prescribed medicines requiring monitoring we found that the system in place was effective.
  • There was a process in place for staff to receive action and disseminate patient and medicine safety alerts. There was no audit trail to demonstrate actions taken however the provider contacted the organisation responsible for the alerts and showed us evidence that they had taken action.
  • There were systems in place for the identification and assessment of potential risks to patients, staff and the premises, and plans in place to minimise these.
  • A Legionella risk assessment had been completed. The practice monitored temperatures however had not followed up on other recommendations from the risk assessment. Following our inspection they took action to rectify this.
  • The practice had installed a new fire alarm which complied with recommendations from a fire risk assessment.
  • Infection control audits were completed and action taken to resolve any issues highlighted.
  • Staff received appropriate training to fulfil their roles.
  • There was a clear recruitment process in place for permanent and locum staff, however some staff files did not contain evidence of photographic identify checks. Clinical staff files contained evidence of vaccination and level of immunity against Hepatitis B.
  • Policies and procedures were in place and updated appropriately.

Effective

Good

Updated 11 August 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed the majority of patient outcomes were comparable or higher than the CCG and national averages. For example, performance for diabetes related indicators was in line with or below the CCG and national average. Indicators for mental health outcomes were also lower than average.
  • Staff had access to the latest clinical guidelines and best practice guidance and used these to assess and deliver patient care.
  • Staff used a range of measures to ensure they had the skills, knowledge and experience to provide effective care.
  • One two cycle clinical audit had been completed since our last inspection. The practice had recently employed a pharmacist and reviewed their staffing structure to allow for more quality improvement activity to take place.
  • The practice had positive working relationships with other health and social care staff.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 11 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey, published July 2017, showed patients rated the practice above others for most aspects of care.
  • All of the patients we spoke with during the inspection told us that they felt treated with dignity and respect by staff and that staff were good. They felt involved in decisions about their care. These views were backed up by responses on the comments cards we received.
  • We saw that staff treated patients with dignity, respect and kindness.
  • Patient and information confidentiality was maintained.
  • The practice had identified 23 patients (approximately 1.3%) who were carers.
  • The practice had access to language line for translation services.

Responsive

Good

Updated 11 August 2017

The practice is rated as good for providing responsive services.

  • Following our previous inspection the practice had worked to make improvements in the areas identified in our previous report.
  • The latest GP survey, published in July 2017, showed the practice was rated mostly above the CCG and national average with regards to satisfaction with opening hours and making an appointment generally.
  • The practice had accessible facilities and was equipped to treat patients and meet their needs.
  • Information on how to complain was clearly displayed in the waiting area. Complaints were responded to appropriately, a record kept and lessons learned had been shared with appropriate staff.

Well-led

Good

Updated 11 August 2017

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

  • There was a leadership structure in place, which had changed slightly since our last inspection. The issues identified at the last inspection had been pro-actively managed and improvements achieved.
  • The practice had some systems in place for monitoring and assessing the quality of services and had recruited staff to further improve this work.
  • Staff felt able to raise concerns and also give suggestions for improvements to the running and development of the practice.
  • The practice had policies and procedures in place, which were relevant to the practice, reviewed and updated as required.
  • There were systems in place for notifying about safety incidents and evidence showed that the practice complied with the duty of candour when investigating and reporting on these incidents.
  • The practice sought feedback from staff and patients, which it acted on. The patient participation group (PPG) had a small group of members, however plans were in place to increase this. The practice had shared the last CQC inspection report with the PPG.
Checks on specific services

People with long term conditions

Good

Updated 11 August 2017

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

  • Nursing staff had lead roles in long-term disease management.
  • Nationally reported data showed that outcomes for patients for long-term conditions were in line with other practices within the Clinical Commissioning Group (CCG) and nationally. For example, numbers of patients with diabetes receiving appropriate reviews were in line with the CCG and national average.
  • The practice followed up on patients with complex long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • There was a system to recall patients for 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 11 August 2017

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

  • We found there were systems to identify, monitor and follow up children living in disadvantaged circumstances and/or who were at risk.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • The practice had access processes for acutely ill children.
  • Appointments were available outside of school hours and the premises were suitable for babies and children.
  • There was no baby changing facilities available.
  • Clinical staff had an understanding of Gillick competence and Fraser guidelines.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Older people

Good

Updated 11 August 2017

The practice is rated as good for the care of older people.

  • Patients over the age of 75 all have a named GP.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • The practice was responsive to the needs of older patients, and offered home visits. If annual checks, flu vaccinations or other referrals where required these would also be completed during home visits.
  • Urgent appointments were available for those with enhanced needs as well as telephone consultations.
  • The practice actively encouraged patients to attend for flu vaccinations or other regular health monitoring checks.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 11 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The practice worked closely with Queensway Surgery to offer appointments, home visits and telephone appointments on a Wednesday afternoon when the practice is shut.
  • The practice offered as a full range of health promotion and screening that reflects the needs for this age group. These included, well woman and well man checks.
  • Nationally reported data showed that outcomes for patients for uptake of cervical smears were higher than other practices locally and nationally.
  • The practice offered the electronic prescription service. This service allows patients to choose or ‘nominate’ a pharmacy to get their medicines from, the GP then sends the prescription electronically to the nominated place.
  • The practice offered a range of online service such as online booking and repeat prescription ordering.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 August 2017

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

  • 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was in line with the CCG and national average.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses, had a care plan in their notes, which was higher than the CCG and national average.
  • 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 had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to support patient that may be in crisis with their mental health.
  • Staff interviewed had an understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 11 August 2017

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.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered urgent appointments for those patients who needed them.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.