You are here

Inspection Summary


Overall summary & rating

Good

Updated 11 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastview Surgery on 19 November 2015. The overall rating for the practice was requires improvement and requirement notices were made as improvements were needed in safeguarding, suitability of the premises and to governance systems. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for Eastview Surgery on our website at www.cqc.org.uk.

This inspection was undertaken on 30 August 2017 and was an announced comprehensive inspection.

Overall the practice is rated as good.

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

  • There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to prevent the spread of infection.

  • Staff were trained, understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Staff felt supported. They had access to training and development opportunities appropriate to their roles.

  • Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

  • Services were planned and delivered to take into account the needs of different and diverse patient groups.

  • Access to the service was monitored to ensure it met the needs of patients.

  • There was a system in place to manage complaints.

  • There were systems in place to monitor and improve quality and identify risk.

  • The premises and equipment were clean and suitable for use.

However, there are areas of practice where the provider should make improvements:

  • Review the system for reviewing significant events and complaints on a regular basis in order to identify themes and trends and learn from these.

  • Review the system for documenting action taken in response to patient safety alerts.

  • Review policies and procedures to ensure they are up to date and specific to the practice.

  • Implement a schedule for cleaning of clinical equipment and formal monitoring of the general housekeeping cleaning schedules.

  • Implement a quality improvement programme which includes clinical audits being undertaken in response to local and national priorities. This should include infection prevention and control audits undertaken annually.

  • Review communication with the patient participation group to actively encourage seeking feedback from this means.

  • Review health and safety procedures to ensure that risks are assessed fully and control measures are in place and monitored.

  • Implement a system for checking the validity of professional registrations for clinical staff

  • Review and monitor the training plan for clinical and non-clinical staff to ensure all staff continue to be updated in their required training specific to their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 October 2017

The practice is rated as good for providing safe services. There were appropriate systems in place to ensure that equipment was safe to use and that the premises were safe. The practice maintained appropriate standards of cleanliness and hygiene. Staff knew how to report safety issues. Staff were trained in and aware of procedures for safeguarding patients from the risk of abuse.

  • We found there was a system in place for reporting, recording and analysing significant events; lessons were shared to make sure action was taken to improve safety in the practice. However, significant events were not reviewed on a regular basis in order to identify themes and trends.

  • Staff demonstrated that they understood their responsibilities and had received training on safeguarding children and vulnerable adults relevant to their role.

  • There were some systems in place to reduce risks to patient safety. For example, checks were carried out on equipment on a regular basis. Risk assessments for health and safety, including fire safety were in need of updating and mitigating control measures needed applying. These were addressed immediately following the inspection.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

  • Required pre-employment checks had been carried out to ensure staff suitability for the sample of staff files we looked at

  • We observed the premises to be clean and tidy. There were cleaning schedules in place that were informally monitored. A range of infection control policies and protocols were available however needed up dating to be specific to the practice.

Effective

Good

Updated 11 October 2017

The practice is rated as good for providing effective services.

  • Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff had access to guidance from the National Institute for Health and Care Excellence (NICE) and referred to it.

  • Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • Staff had access to training and development opportunities and had received training appropriate to their roles.

Caring

Good

Updated 11 October 2017

The practice is rated as good for providing caring services.

  • The patient spoken with and those who returned comment cards were very positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, compassionate and supportive.

  • Responses to the National GP Patient Survey (July 2017) relating to the caring approach of the practice were overall in-line with or above local and national averages.

  • Information for patients about the services available was accessible.

  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 11 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and used this understanding to meet the needs of its population. For example it understood the needs of the vulnerable population and tailored services to the needs of this population group.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer, those at the end of their life and patients living with dementia.

  • A range of appointments were provided to meet the needs of patients, including booking on line, pre bookable up to four weeks in advance, on the day, emergency appointments and home visits.

  • Information about how to complain was available and evidence reviewed showed the practice responded to issues raised. Learning from complaints was shared with staff and other stakeholders. However the practice did not routinely review all complaints in order to identify themes and trends and to learn from these.

Well-led

Good

Updated 11 October 2017

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

  • The practice had a mission statement and staff could articulate its values and ethos to provide high quality general medical services.

  • 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 and staff meetings. Some of these policies such as infection prevention and control, health and safety and safeguarding needed updating and to ensure they were practice specific.

  • The practice sought feedback from staff and patients, which it acted on. Development of communication with the patient participation group needed improving to actively encourage feedback from patients by this means.
Checks on specific services

People with long term conditions

Good

Updated 11 October 2017

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

  • The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required regular checks received these.

  • The practice nurses specialised in long-term/chronic disease management and provided regular, structured reviews of patients’ health.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There was a system to recall patients for a structured annual review to check their health and medicine needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

  • Longer appointments and home visits were available for patients with long term conditions when these were required.

  • Patients with multiple long term conditions could be offered a single appointment to avoid multiple visits to the surgery.

Families, children and young people

Good

Updated 11 October 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • 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 October 2017

The practice is rated as good for the care of older people. The practice kept registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • All patients over the age of 75years had been allocated a named GP.

  • The practice was responsive to the needs of older patients, and offered home visits, extended appointments and urgent appointments for those with enhanced needs.

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, carrying out over 75’s health checks, frailty assessments and Flu vaccinations for the elderly.

Working age people (including those recently retired and students)

Good

Updated 11 October 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, telephone consultations and an electronic prescribing service.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflect the needs for this age group.

  • The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, contraceptive services, smoking cessation advice and family planning services.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 October 2017

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

  • The practice held a register of patients experiencing poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review.

  • Care plans were developed to support patients and patient records were coded with carers’ details to enable them to attend with the patient where appropriate.

  • Accident and emergency attendance was monitored for patients identified as a high risk.

  • 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 referred patients to appropriate services such as memory clinics, psychiatry and counselling services.

People whose circumstances may make them vulnerable

Good

Updated 11 October 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 and alcohol and substance misuse. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance.

  • 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 longer appointments for patients with a learning disability.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. Services for carers were publicised and a record was kept of carers to ensure they had access to appropriate services

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding safeguarding, how to raise concerns and how to contact relevant agencies in normal working hours and out of hours.