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Inspection Summary


Overall summary & rating

Good

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mill Hill Surgery on 12 April 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, with the exception of managing some medical emergencies and control of substances hazardous to health.
  • 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 felt the practice offered an excellent service and staff were helpful, friendly, caring, professional and treated them with dignity and respect
  • 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:

  • Undertake a formal risk assessment for not having a defibrillator for use in a medical emergency.
  • Undertake risk assessments for the control of substances hazardous to health (COSHH) and for looped cord window blinds installed.
  • Ensure that separate receptacles are available for the disposal of sharps used to administer live vaccines.
  • Implement a system to monitor and track the distribution of prescription pads kept at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed, with the exception of managing some medical emergencies and control of substances hazardous to health.

Effective

Good

Updated 15 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) 2014/2015 showed performance for diabetes and mental health related indicators were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had a programme of CCG linked and independent clinical audits that demonstrated quality improvement.

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

  • There was evidence of appraisals and personal development plans for most staff.

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

Caring

Good

Updated 15 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed the practice was at or above average for its satisfaction scores on consultations with GPs and nurses.

  • Patients said they felt the practice offered an excellent service and staff were helpful, friendly, caring, professional and treated them with dignity and respect.

  • 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.

Responsive

Good

Updated 15 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified. For example, they attended monthly CCG meetings and peer reviewed referral and admission rates to identify areas for improvement.

  • 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.

  • 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.

Well-led

Good

Updated 15 August 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • 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 meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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 proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • The practice team was forward thinking and part of local pilot schemes to improve outcomes for patients in the area.

Checks on specific services

People with long term conditions

Good

Updated 15 August 2016

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

  • The practice ran nurse and GP led chronic disease clinics and patients were invited for annual health checks including medication review.

  • QOF data for 2014/2015 showed the practice was performing at local and national averages for indicators related to chronic disease, for example in diabetes and hypertension.

  • Longer appointments and home visits were available when needed.

  • There were named clinical leads for a variety of chronic conditions, including diabetes, heart disease and asthma. Staff in these roles had received additional training to support in their chosen area.

  • The practice engaged in local enhanced services to identify patients with long-term conditions at risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk.

  • A dietician was employed by the practice and provided lifestyle advice to those with long-term conditions and also those at risk of developing a chronic condition.

  • The practice held regular multi-disciplinary team meetings with district nurses and the community palliative care team to discuss the management of patients with complex medical needs.

Families, children and young people

Good

Updated 15 August 2016

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

  • There was a named GP lead for safeguarding vulnerable children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.
  • The practice had a higher than average number of patients below 14 years of age in their practice population and planned their services accordingly to meet their needs. They ran a daily children’s clinic from 11am to 12.00pm and any acutely unwell children were added to the list and seen on the day.
  • The practice offered shared ante-natal care with the community midwives and performed routine post-natal mother and baby checks.
  • Uptake rates for childhood immunisations were above local CCG averages.
  • The practice had support from the Children’s and Adolescents Mental Health Services (CAMS) when managing young patients experiencing mental health issues and they referred to the local Service for Adolescents and Families (SAFE) if required.
  • The practice offered well woman and family planning services, including fitting of long term contraceptive devices. Cervical screening uptake rates were in line with national averages.
  • The practice had a weekly visiting health advocate from a local female genital mutilation (FGM) charity to encourage and support women through translation, to engage with the cervical screening programme and to assist in the onward referral to FGM clinics where the need was identified.

Older people

Good

Updated 15 August 2016

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

  • The practice had a named lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
  • They created chronic visit sessions for all GP partners that allowed housebound patients to receive health reviews at home by a GP who knew them well to address chronic disease issues and update care plans.
  • The practice engaged in local enhanced services to identify older patients at risk of hospital admission and invited them for review to create integrated care plans aimed at reducing this risk.
  • They provided primary medical services to a local residential care home with one of the GP partners taking a leading role in providing medical care to the residents to maintain continuity.
  • The practice held regular multi-disciplinary team meetings with district nurses and the community palliative care team to discuss the management of older patients with complex medical needs.
  • Longer appointments were available for care plan reviews and for older patients with complex medical conditions.

Working age people (including those recently retired and students)

Good

Updated 15 August 2016

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

  • The practice offered extended hour surgeries on the first Wednesday of every month and on alternate Saturday mornings for patients who were unable to attend the practice in normal working hours. Telephone consultation appointments were also available daily.

  • There was the facility to book appointments and request repeat prescriptions online.

  • The practice nurses offered travel advice and travel vaccination as required.

  • The practice offered NHS health checks for patients aged 40 –74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 August 2016

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

  • One hundred per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.

  • Alerts were placed on a patients electronic records if they were at risk of dementia. They used the GP Cognition Assessment Test (GPCOG) to screen patients at risk of dementia with referral on to local memory services if required. The integrated care plan template used by the practice also included a section on screening for dementia to prompt discussion when reviewing these patients.

  • QOF data from 2014/2015 showed the practice was performing in line with local and national averages for performance indicators relating to mental health.

  • The practice participated in the local Shifting Settings of Care scheme that facilitated the transition of patients with stable mental health conditions discharged from secondary care back to primary care services. They had a primary mental health worker who attended the practice to review these patients and provide support to the clinicians managing their conditions.

  • The clinical team attended educational sessions offered by the community mental health team to keep up to date with local policies and new guidance.

People whose circumstances may make them vulnerable

Good

Updated 15 August 2016

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

  • There was a named lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.

  • The practice had participated in a scheme with a local homeless charity to provide healthcare for patients with no fixed abode. They allowed these patients to use the practice address for registration to facilitate hospital communications and appointments.

  • They registered patients from a local women’s refuge to provided medical care if required.

  • They maintained a register of patients with learning disabilities and they were offered annual health checks with extended appointments.