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Greenwich Peninsula Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 9 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenwich Peninsula Practice on 3 February 2016. Overall the practice is rated as good.

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

  • There was a transparent and proactive approach to safety and a system was in place for reporting and recording significant events. However not all incidents and complaints were recorded and learning shared.

  • Patients’ needs were assessed and care delivered in line with current best practice guidance.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • Risks to patients were assessed and well managed.

  • Staff received ongoing training and development to ensure they had the skills, knowledge and experience to deliver effective care and treatment.

  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision to deliver a high quality service which was responsive to patients needs and promoted the best possible outcomes for patients.

  • There was a clear leadership structure and staff felt supported by management.

  • Patient surveys indicated that some patients did not find it easy to make an appointment with a named GP and were dissatisfied with the level of continuity of care provided. Patients also said they did not feel involved in their care or decisions about their treatment. However, the practice was aware of these issues and had as a result recently recruited several new permanent members of clinical staff.

  • The practice proactively sought feedback from staff and patients, which it acted on.

There were also areas of practice where the provider should make improvements:

  • The provider should continue to review the impact on care to patients resulting from the lack of consistency of GP staff and make efforts to stabilise the turnover of clinical staff within the practice.

  • The provider should ensure that the practice website is updated on a regular basis to keep patients informed of the frequent changes in clinical staff within the practice.

  • The provider should formally record, investigate and share learning on all incidents and complaints for quality assurance purposes.

  • The provider should consider ways to proactively identify patients with carer responsibilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 May 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Lessons were shared to make sure action was taken to improve safety in the practice. However, not all incidents and complaints were recorded and learning shared.

  • When there were unintended or unexpected safety incidents patients received support, truthful information, a verbal or 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.

Effective

Good

Updated 9 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework 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.

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

  • There was evidence of regular appraisals and support and encouragement for personal development for all staff.

  • Staff worked with multidisciplinary teams to ensure the requirements of patients with complex needs were identified and met.

  • Clinical Audits demonstrated quality improvement.

Caring

Good

Updated 9 May 2016

The practice is rated as good for providing caring services.

  • Aggregated data from the 2015 National GP Patient Survey showed that patients rated the practice equal to or lower than others for most aspects of care.

  • Comments from patients we spoke to about the care and support received from their GP were mostly positive. Patients said they were treated with compassion, dignity and respect but did not always feel involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

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

Responsive

Good

Updated 9 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with relevant organisations including the Clinical Commissioning Group and local GP Federations to secure improvements to services where these were identified.

  • Urgent appointments were available on the same day. However patients said that they found it difficult to make an appointment with a named GP and there was limited continuity of care.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

  • The practice was located in purpose-built accommodation with good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand.

  • Evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 9 May 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 values of the practice and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by management.

  • The practice had appropriate policies and procedures in place to govern activity and held regular team meetings to update staff.

  • There was an overarching governance framework which supported the delivery of the strategy and promote 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 practice encouraged a culture of openness and honesty.

    The practice had systems in place for reporting incidents and  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. There was an active patient participation group (PPG).

  • There was a strong focus on continuous learning and improvement at all levels. New staff had received induction and all staff received regular appraisals.

Checks on specific services

People with long term conditions

Good

Updated 9 May 2016

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

  • Patients at risk of frequent hospital admission were identified and followed up as a priority.

  • Nationally reported data showed that outcomes for patients with long term conditions such as diabetes and chronic obstructive pulmonary disease (COPD) were above the CCG and national average.

  • All patients with long term conditions were invited for an annual review to ensure 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 practice was participating in the Year of Care programme aimed at improving the diagnosis and management of long term conditions.

Families, children and young people

Good

Updated 9 May 2016

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

  • There were safeguarding systems in place to identify and follow up children who were at risk.

  • Childhood immunisation rates were comparable with the CCG average for all standard childhood immunisations.

  • The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the the last 12 months was comparable to the CCG and national average.

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

  • Cervical screening rates were comparable with CCG and national average.

  • Appointments were available outside of school hours.

  • The premises were suitable for children and babies and baby feeding and changing facilities were available if required.

  • There were joint working arrangements with midwives and health visitors.

Older people

Good

Updated 9 May 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.

  • All patients over 75 years have been allocated a named GP and were invited to attend an annual health check.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those who required them.

Nationally reported data showed that outcomes for patients with conditions commonly found in older people

were above the CCG and national average

Working age people (including those recently retired and students)

Good

Updated 9 May 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 had been considered and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, appointments were available until 8.30 pm one evening per week and between 9.00 and 11.30 am on Saturday. Urgent appointments were available every day.

  • There was a good uptake for NHS Health Checks. The practice had achieved 100% of their annual target of 229 NHS Health Checks completed for 2015/16.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 May 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 diagnosed poor mental health who had a comprehensive agreed care plan in the last 12 months was 96.0%.This was higher than the national average of 88.5%.

  • The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 84.6%. This was comparable to the national average of 84.0%.

  • The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • There was up to date information available in the waiting area informing patients about 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.

People whose circumstances may make them vulnerable

Good

Updated 9 May 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 those with a learning disability.

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

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

  • There was up to date information available in the waiting area informing patients about 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.