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Inspection Summary


Overall summary & rating

Good

Updated 14 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Captain French Surgery on 21 April 2016. Overall, the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
  • Most risks to patients were assessed and well managed.
  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in January 2016 showed that patients rated the practice highly for the care they received. For example, 100% patients said they had confidence and trust in the last GP they saw or spoke to compared to the CCG average of 97% and the national average of 95%.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they were able to get an appointment with a GP when they needed one.
  • Urgent appointments were available on the day they were requested.
  • Extended hours appointments were available with a GP, nurse or healthcare assistant three mornings and one evening a week.
  • 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 was responsive to the needs of the population and worked with the local clinical commission group and other local practices to ensure services were provided that met the needs to the population.
  • Staff offered care that supported patient centred end of life care; the practice was ranked second in the locality for this provision.

The areas where the provider should make improvement are:

  • Review the arrangement for training at the practice to include regular fire training for staff.
  • Review the arrangements for clinical audit; demonstrate a clear link between audits and quality improvement.
  • Complete a risk assessment of the window blinds used at the practice to reduce potential hazards for children and vulnerable adults.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • 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 and prevent the same thing happening again. When we discussed significant events with staff they said they were made aware of the outcomes of significant events when they had been directly involved.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. For example, there was an effective safety alert system and safeguarding leads were in place. 
  • Most risks to patients were assessed and well managed. However, areas of concern identified included looped blind cords in patient areas and the management of sharps receptacles.

Effective

Good

Updated 14 July 2016

The practice is rated as good for providing effective services.

  • We found that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Data showed patient outcomes were at or above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring their effectiveness; they had achieved 96% of the points available in 2014/15. This was 1.1% below the local average and 1% above the national average. For 11 of the 19 clinical domains within QOF the practice had achieved 100% of the points available.
  • Quality improvement work was taking place. However, there was limited evidence that clinical audit was driving improvement in performance to improve patient outcomes.
  • 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 other health care professionals to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 14 July 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for almost all aspects of care. For example, results from the National GP Patient Survey showed that 100% of respondents had confidence and trust in their GP (CCG average 97%, national average 95%). 99% of respondents said that they GP had confidence or trust in the last nurse they saw or spoke to (CCG average 98%, national average 97%).
  • 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 offered by the practice was available. For example, they provided this information on the practice’s website, patient leaflet and in the waiting areas.
  • The practice had close links to local and national support organisations and referred patients when appropriate. The practice had received two awards from a local carers organisation in recognition of the support they provided for carers, including their gold GP Carer Friendly Award.
  • Health checks for carers had been withdrawn, the practice planned to re-introduce a new system of health checks for carers.

Responsive

Good

Updated 14 July 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice was actively involved in a CCG funded care home project for the elderly with the three GP practices in Kendal.
  • 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.
  • Patients could access appointments and services in a way and at a time that suited them. Data from the National GP Patient Survey, published in January 2016, showed that patients rated the practice highly for accessibility. For example, 96% said the last appointment they got was convenient (CCG average of 94%, national average of 92%) and 94% were able to get an appointment to see or speak to someone the last time they tried (CCG average 88%, national average 85%).
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Specialist clinics and support services were available for patients.
  • Information about how to complain was available, for example on the practice website and in the waiting area.

Well-led

Good

Updated 14 July 2016

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

  • The practice had a clear vision with quality and safety as their top priority. 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.
  • 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.
  • 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 practice proactively sought feedback from staff and patients, which it acted on.
  • There was an active patient participation group (PPG) and the practice had acted on feedback from the group.
Checks on specific services

People with long term conditions

Good

Updated 14 July 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.
  • Patients at risk of hospital admission were identified as a priority for care and support by the practice, comprehensive care plans were in place and regularly reviewed.
  • Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with hypertension. This was 0.4% above the local CCG average and 2.1% above the national average. The practice had achieved 91% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 2.6% below the local CCG average and 1.8% above the national average.
  • Longer appointments and home visits were available when needed.
  • All patients with a long-term condition had a named GP and were offered 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 practice held regular clinics for long terms conditions, for example, for patients with diabetes.

Families, children and young people

Good

Updated 14 July 2016

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

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Appointments were available outside of school hours and the premises were mostly suitable for children and babies. However, we found that the window blinds in some areas accessible to patients were a potential hazard for children and vulnerable adults, as no cleat secured the looped cord.
  • There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 80% to 100% (CCG average 83% to 97%) and for five year olds ranged from 68% to 95% (CCG average 73% to 98%).
  • Urgent appointments for children were available on the same day.
  • Pregnant women were able to access an antenatal clinic provided by the midwifery service who use a room in the practice.
  • Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 98% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 0.1% below the local CCG average and 1% above the national average.
  • The practice provided contraceptive and sexual health services.

Older people

Good

Updated 14 July 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 their population.
  • All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check.
  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
  • The practice worked closely with the local care home, the lead GP visited weekly.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 0.4% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
  • The practice maintained a palliative care register and offered immunisations for pneumonia to older people.

Working age people (including those recently retired and students)

Good

Updated 14 July 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.
  • Patients could order repeat prescriptions and book GP appointments online.
  • Telephone appointments were available.
  • A text message reminder service was available.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • The practice’s uptake for cervical screening was 81%, comparable to the CCG and national average of 82%.
  • Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
  • The practice website provided a good range of health promotion advice and information.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 July 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 for patients experiencing poor mental health.
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 98% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 2.7% above the local CCG average and 5.3% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.3% above the local CCG average and 5.5% above the national average. However, only 74% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is below the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.

People whose circumstances may make them vulnerable

Good

Updated 14 July 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.
  • The practice held a register of patient with learning disability; patients with learning disabilities had been invited to the practice for an annual health check. 65 patients were on this register and 49% had a health check in the last 12 months.
  • Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.
  • The practice offered longer appointments for patients with a learning disability if required.
  • The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Local support services were available at the surgery, the practice had in in-house counselling service that was also available for staff. A local support group that supports people with mental health problems through horticulture met regularly at the practice.

  • All patients at risk of hospital admission were identified by the practice as ‘VIP’s’, this included vulnerable patients. These patients were identified as a priority for care and support by the practice.

  • 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 no fixed abode could register with the practice and the practice had close links to a local organisation that supported people with housing issues.
  • Good arrangements were in place to support patients who were carers.
  • The practice had set up a support group for patients with neurological conditions.