You are here

Inspection Summary


Overall summary & rating

Good

Updated 14 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr S Javaid & Partners (also known as Miller Street Surgery) on 12 July 2016. The overall rating for the practice was ‘Good’ with requires improvement for providing a safe service. Since the last inspection in July 2016 Miller Street Surgery changed its Care Quality Commission registered provider name from Dr S Javaid & Partners to Miller Street Surgery. The full comprehensive report for the 12 July 2016 inspection can be found by selecting the ‘all reports’ link for Dr S Javaid & Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation identified in our previous inspection on 12 July 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as Good.

Our key findings were as follows:

  • The provider had ensured recruitment checks for newly recruited staff met legislative requirements.

  • All staff that provided a chaperone service had Disclosure and Barring Service checks in place and had completed online chaperone training.

  • All persons employed had timely access to training updates.

  • The practice had completed regular analysis of significant events to identify any common trends, maximise learning and help mitigate further errors.

  • We found the practice had implemented a system to ensure patients who took long-term medicines were in receipt of appropriate monitoring and results were checked by the GPs before medicines were prescribed.

  • The practice had ensured prescriptions were checked regularly to ensure they were collected by patients.

  • The practice had improved on the identification of patients who may be carers.

  • Registers held of vulnerable children and adults were reviewed by the practice. The practice implemented regular meetings with the Health Visitor and current and vulnerable patients were clearly identified on the practice computer system.

  • We saw there had been improvement in the practice carer register since the inspection in July 2016. The findings of the inspection in July 2016 were that the practice computer system alerted staff if a patient was also a carer and had identified 33 patients as carers (0.5% of the practice list). The August 2017 inspection found that the practice had identified 101 patients as carers (1.5% of the practice list).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 August 2017

The practice is rated as good for providing a safe service.

  • The practice had completed regular analysis of significant events to identify any common trends, maximise learning and help mitigate further errors.

  • The provider ensured recruitment checks for newly recruited staff met legislative requirements.

  • All staff that provided a chaperone service had Disclosure and Barring Service checks in place and had completed online chaperone training.

  • Registers held of vulnerable children and adults were reviewed by the practice. The practice implemented regular meetings with the Health Visitor and current and vulnerable patients were clearly identified on the practice computer system.

  • All persons employed had timely access to training updates.

  • We found the practice had implemented a system to ensure patients who took long-term medicines were in receipt of appropriate monitoring and results were checked by the GPs before medicines were prescribed.

  • The practice had ensured prescriptions were checked regularly to ensure they were collected by patients.

  • The practice had improved on the identification of patients who may be carers.

Effective

Good

Updated 26 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages. The practice achieved 92% of the total number of points available in

  • Patients’ needs were assessed and care was planned and delivered in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment although we identified some gaps in training. One GP had a special interest in Ear, Nose and Throat (ENT) surgery and was able to provide a consultation service to patients within the practice.

  • There was evidence of staff appraisals and most staff felt well supported in their work.

  • Staff had regular meetings with a range of other health care professionals to discuss, understand and meet the complexity of patients’ needs.

  • Clinical audits demonstrated quality improvement.

  • The practice provided annual flu, pneumonia, and shingles vaccinations.

Caring

Good

Updated 26 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2016, showed the practice score was mostly comparable to Clinical Commissioning Group (CCG) and national averages for its satisfaction on consultations with GPs and nurses.

  • 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.

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

  • The practice had a carers’ register to raise staff awareness of patients that were also carers. There were only 33 patients (0.5% of the practice population) on the register and the practice acknowledged they needed to increase the size of the register by pro-actively identifying carers.

Responsive

Good

Updated 26 August 2016

The practice is rated as good for providing responsive services.

  • Patients said they found it easy to make an appointment with urgent appointments available the same day.

  • Patients had access to a multi-disciplinary team during extended hours, for example a GP, nurse and phlebotomist.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available but not readily accessible. The practice had responded quickly to issues raised.

  • The practice implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, improving access to appointments.

Well-led

Good

Updated 26 August 2016

The practice is rated as good for being well led.

  • The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. However, staff were not clear about the vision and values and their responsibilities in relation to it.

  • There was a leadership structure and defined roles. Most staff felt supported by the management team.

  • The practice had a number of policies and procedures to govern activity and staff knew how to access them.

  • 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 worked in partnership with patients and staff and proactively sought feedback, which it acted on. The PPG was active and contributed to improving outcomes for patients.

Checks on specific services

People with long term conditions

Good

Updated 26 August 2016

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

  • The practice offered specialist clinics to address the needs of patients with long-term conditions such as asthma, diabetes and hypertension.

  • 81% of patients on the diabetes register had a record of a blood pressure reading within the preceding 12 months compared to the local average of 76% and the national average of 78%.

  • Longer appointments and home visits were available when needed.

  • The practice provided an on-site phlebotomy (removal of blood) service.

  • Patients were offered regular checks to review their health and medicine needs. Telephone reviews were also provided.

Families, children and young people

Good

Updated 26 August 2016

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

  • The practice provided sexual health and family planning services. They were currently unable to offer implants and coil fitting but had access to the local family planning service.

  • The practice offered a full range of antenatal, postnatal services and child health clinics. A midwife regularly visited the practice.

  • Young children had access to same day appointments. Appointments were available outside of school hours.

  • The building had recently been renovated to improve access. Baby feeding and changing facilities were available.

  • Immunisation rates were comparable to local averages for all standard childhood immunisations. Flu immunisations were available for pregnant women and small children.

  • The practice’s uptake for the cervical screening programme was 96%, which was higher than the CCG and national averages of 82%.

Older people

Good

Updated 26 August 2016

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

  • The practice had a call and recall system to ensure older people attended their appointments when necessary.

  • Patients aged 75 and older had a named GP and had open access to appointments.

  • Home visits by a GP were available on a daily basis for patients with enhanced needs.

  • The practice held meetings with the palliative care team and worked in partnership with other healthcare professionals in meeting the needs of older people with complex needs.

  • The practice provided medical support to a number of patients residing in local care homes. These included weekly clinical rounds, medication reviews and flu vaccinations.

Working age people (including those recently retired and students)

Good

Updated 26 August 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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice offered extended hours on a Tuesday and Thursday morning, every other Monday evening and on one Saturday morning each month to allow flexibility for patients.

  • A range of online services were available, including booking and cancelling appointments, prescriptions and access to health medical records.

  • Free NHS Health checks were available for patients aged 40 to 74. Two hundred and twenty-five patients had received these checks in the preceding 12 months.

  • The practice provided an on-site phlebotomy (removal of blood) service to avoid patients having to access a hospital.

  • The practice utilised the electronic prescribing system (EPS) which meant prescriptions could be sent directly to the patient’s chosen pharmacy at the time of the consultation.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 August 2016

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 and patients with dementia and carried out annual reviews.

  • The practice offered weekly and fortnightly monitored prescriptions for patients experiencing poor mental health until their condition stabilised.

  • Patients experiencing poor mental health were told how to access various support groups and voluntary organisations.
  • Double appointments were available to allow sufficient time to deal with patients with complex issues.

  • Home visits were available to carry out reviews when necessary.

People whose circumstances may make them vulnerable

Good

Updated 26 August 2016

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

  • The practice displayed information in the waiting area about how to access local support groups and voluntary organisations.

  • The practice had access to a HUB where patients could be offered a face-to-face or telephone service for help with bereavement, depression or anxiety. Help with loneliness, alcohol and substance misuse problems was also available along with mental health issues or physical and learning disabilities.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. They held a register of vulnerable patients but the registers did not reflect all of the current vulnerable patients registered with the practice so that they were clearly identified to staff on the practice computer system.

  • 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.

  • The practice held a carers’ register and information was available to direct carers to avenues of support available to them.

  • The majority of patients’ first language was English, however a translation service was available if needed and there was an open registration policy in place.