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Tattenham Health Centre Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 25 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tattenham Health Centre on21 September 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.
  • 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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 usually found it easy to make an appointment 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 practice participated in the hospital admission avoidance scheme and maintained a register of patients who were at high risk of a hospital admission.
  • The practice encouraged and valued feedback from patients, the public and staff.
  • The practice was part of a group of GP practices offering evening appointments until 9pm as well as weekend appointments, from two locations in Epsom and Leatherhead.
  • Extended hours appointments were offered at the practice on Tuesdays and Wednesdays until 7pm.
  • Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses.
  • Clinical staff were trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard (DOLS). The practice had developed their own mental capacity review template.

Areas where the provider should make improvements are:

  • Continue with the planned programme of appraisals.
  • Ensure the new system for the tracking and storage of prescriptions used in printers is maintained.
  • Ensure staff are aware of the procedures to follow in the event of a fire at the practice.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 October 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, with the exception of prescription stationary security and ensuring staff practised what steps to take in the event of a fire.
  • Risks to patients were assessed and well managed.
  • The practice was clean and tidy and there were arrangements in place to ensure appropriate hygiene standards were maintained.
  • Information about safety was valued and was used to promote learning and improvement. All staff were encouraged to be open and transparent and fully committed to reporting incidents. Incident reporting was thorough and analysis of incidents gave a picture of safety.
  • The practice had a comprehensive business continuity plan in place for major incidents such as power failure or building damage. The plans included emergency contact numbers for staff.

Effective

Good

Updated 25 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. For example, 90% of patients described the overall experience of this GP practice as good compared to the clinical commissioning group (CCG) and the national average of 85%.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff had received regular annual appraisals and we saw dates planned for October 2016 for those staff remaining to be appraised. Appraisals files contained personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. For example, patients at high risk of hospital admission.

Caring

Good

Updated 25 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • 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 and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 25 October 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients said they usually found it easy to make an appointment with urgent appointments available the same day.
  • The practice was part of a group of GP practices offering evening appointments until 9pm and weekend appointments, from two locations in Epsom and Leatherhead.
  • Extended hours appointments were offered at the practice on Tuesdays and Wednesdays until 7pm
  • 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 and other stakeholders.
  • The practice website had information in relation to different long terms condition including information for asthma, diabetes and minor illness.

Well-led

Good

Updated 25 October 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.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 25 October 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.
  • All these patients had a named GP and 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.
  • A specialist diabetic nurses visited the practice every month for those patients who needed additional support.

  • The practice offered diabetic foot screening. CQC data indicated that the practice achieved 90% for annual foot checks in patients with diabetes compared to the national average of 88%.

  • 95% of patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness, which was the same as the national average of 90%
  • Patients were supported to self manage their long-term condition by using agreed plans of care and were encouraged to attend self-help groups

Families, children and young people

Good

Updated 25 October 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 people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice ensured that children needing emergency appointments would be seen on the same day.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • 78% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 81% and a national average of 82%.
  • 72% of patients with asthma had an asthma review in the last 12 months that included an assessment of asthma control. This compared to a CCG average of 74% and a national average of 75%.
  • GPs and nurses carried out family planning and contraceptive services which included coil and contraceptive implant fitting.
  • Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
  • Appointments were available at the practice with the GP until 6.30pm and on two afternoons a week until 7pm.

Older people

Good

Updated 25 October 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were appropriately shared with local organisations to facilitate communication and the continuity of care.
  • The practice worked with the community assessment diagnostic unit (CADU) to help older patients avoid hospital admissions.
  • The practice was working to the Gold Standards Framework for those patients with end of life care needs. (The Gold Standards Framework is a framework to enable an expected standard of care for all people nearing the end of their lives. The aim of the Gold Standards Framework is to develop a locally-based system to improve and optimise the organisation and quality of care for patients and their carers in the last year of life).
  • The practice supported patients who lived in nursing and residential homes by undertaking home visits when needed and providing advice over the telephone.
  • The practice offered flu, pneumonia and shingles vaccination programmes.

Working age people (including those recently retired and students)

Good

Updated 25 October 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 was part of a group of GP practices offering evening appointments until 9pm as well as weekend appointments, from two locations in Epsom and Leatherhead.
  • Extended hours appointments were offered at the practice on Tuesdays and Wednesdays until 7pm.
  • Telephone consultations were available during working hours.
  • Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
  • Travel health and vaccination appointments were available.
  • The practice offered Saturday flu clinic appointments to fit in around working patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 October 2016

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

  • Patients were monitored as part of the Quality and Outcomes Framework (QOF) to check that they had an up-to-date care plans. 85% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared well to a CCG average of 89% and a national average of 88%.
  • 92% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This was higher than 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.
  • The practice 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.
  • The practice 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.
  • Clinical staff were trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard (DOLS). The practice had developed their own mental capacity review template.

People whose circumstances may make them vulnerable

Good

Updated 25 October 2016

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 invulnerable circumstances including homeless people, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed 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.
  • Patients with a learning disability or other significant disability were known to the practice. This meant staff could quickly identify when dealing with a patient, if they required additional assistance.
  • 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.