You are here

Archived: Dr Rushda Ghani Good Also known as South Saxon House Surgery

This service is now registered at a different address - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at  Dr Rushda Ghani's practice on 2 February 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 not having risk assessed the practice for Legionella and not having had an electrical internal wiring check within the previous five years.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, with the exception that we found not all staff had received up to date training in the safeguarding of children and vulnerable adults. However, all staff that we spoke to showed a good level of understanding of the safeguarding of children and vulnerable adults.
  • 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.
  • Most patients said they found it easy to make an appointment with a named GP and that 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.
  • The practice educated patients about minor injuries and illnesses to try to decrease patient use of the accident and emergency department.
  • 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 must make improvement are:

To ensure that all staff have received training in the safeguarding of children and vulnerable adults to the appropriate level.

Ensure that a risk assessment and all recommended actions are completed, monitored and recorded to minimise the risk of legionella. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).

Ensure that the electricity supply and internal wiring for the practice are tested.

Ensure that recruitment checks, including full employment history and references, are completed and retained even if the person is previously known to the practice.

The areas where the provider should make improvement are:

Assess why data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care including involvement of patients in decisions about their care and treatment. Consider relevant action based on the findings.

Assess why data from the national GP patient survey showed that the percentage of patients that said they would recommend their GP surgery to someone who has just moved to the local area was lower than the national average. Consider relevant action based on the findings.

Review whether new systems in place for identifying carers within the practice population are effective with a view to increasing the percentage of carers on the carers' register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 21 April 2016

The practice is rated as requires improvement 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 that not all administration and reception staff had been trained in the safeguarding of vulnerable adults. We could not find evidence that one of the nursing staff had been trained in child safeguarding and the safeguarding of vulnerable adults at the time of the inspection.

  • However staff demonstrated on the day a good understanding of the processes of safeguarding children and vulnerable adults.

  • Risks to patients were assessed and well managed with the exception that no risk assessment for Legionella had been carried out and the internal wiring had not been tested within the last five years. The practice explained that they had been in dispute with the landlord over organising these risk assessments and tests and were due to move premises shortly. They told us that the new premises already had these checks in place. They carried out monthly inspections of the current premises.

  • One member of the nursing staff was well known to the practice manager, and had been through a recruitment process with her at another practice. However there was no record of a CV, application form, interview notes or references available at this practice. There were records of DBS checks, photographic identification and registration certificates available.

  • All other records for the recruitment of new staff were complete.

  • The practice had robust systems and processes in place for managing emergencies.

Effective

Good

Updated 21 April 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 for the locality and compared to the national average.

  • 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.

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

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 21 April 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care.

  • However patients who commented on comment cards and in person praised the caring aspects of the practice.

  • 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 21 April 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 (CCG) to secure improvements to services where these were identified. For example the practice had the fourth highest dementia diagnosis rate in the local CCG area.

  • Patients said they found it easy to make an appointment 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.

  • The practice educated patients about minor injuries and illnesses to try to decrease patient use of the accident and emergency department.
  • 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.

Well-led

Good

Updated 21 April 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 this.

  • 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 knowing about 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 21 April 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.

  • Provision of one stop clinics and screening clinics for patients with long term conditions. At these clinics all tests and consultations with the nurse and if necessary GP were carried at the same appointment.

  • The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 98.1% (national average 88.3%)
  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 86.4% (national average 78.00%)
  • Home visits were available when required.

  • All appointments for patients on the Learning Disability, End of Life Care, Dementia and Unplanned Admission Avoidance registers were for 20 minutes

  • 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.

  • The GP arranged joint home visits with other professionals such as the occupational therapist, specialist cancer care nurse or physiotherapist when required.

Families, children and young people

Good

Updated 21 April 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 average or above average for all standard childhood immunisations.

  • The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months was 76.8% (national average 75.3%)

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 80.6% (national average 81.8%)

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses. All staff had access to the health visitor’s contact number.

Older people

Good

Updated 21 April 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 patients, and offered home visits and urgent appointments for those with enhanced needs.

  • All local care homes on the practice list were visited weekly with additional visits as required.

  • An afternoon session was set aside each week by the GP to pro-actively visit vulnerable and isolated patients at home.

Working age people (including those recently retired and students)

Good

Updated 21 April 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.

  • There was a link on the website home page to a practice survey and patients were encouraged to leave comments and suggestions as to how the service and care could be improved

  • Evening appointments were available to all patients.

  • Appointments could be booked or cancelled and repeat prescriptions ordered online.

  • 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.

  • Telephone appointments were available with each clinician during each surgery.

  • Patients were offered new patient health checks and health checks for 40 to 74 year olds.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 April 2016

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

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95.5% (national average 88.5%)
  • 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.

  • A Mental Health Worker was available for a session in the practice every week.

People whose circumstances may make them vulnerable

Good

Updated 21 April 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 in vulnerable circumstances including homeless patients and those with a learning disability. All patients that staff members perceived to be vulnerable were flagged up on the computer system.

  • The practice offered longer appointments for patients with a learning disability as standard.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • The GP set aside one afternoon a week to visit some of the practice’s vulnerable patients at home.

  • 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. However not all staff had received adult safeguarding training to the appropriate level.