Park Road Surgery - Brockbank NewApproachComprehensive … · 2020-04-01 ·...

This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Good –––

Are services well-led? Good –––

PParkark RRooadad SurSurggereryy --BrBrockbockbankankQuality Report

37 Park RoadTeddingtonRichmond Upon ThamesTW11 0AUTel: 02089775481 Date of inspection visit: 5 May 2016

Date of publication: 27/07/2016

1 Park Road Surgery - Brockbank Quality Report 27/07/2016

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 4

The six population groups and what we found 7

What people who use the service say 11

Detailed findings from this inspectionOur inspection team 12

Background to Park Road Surgery - Brockbank 12

Why we carried out this inspection 12

How we carried out this inspection 12

Detailed findings 14

Overall summaryLetter from the Chief Inspector of GeneralPractice

We carried out an announced comprehensive inspectionat The Park Road Surgery - Brockbank, also known as ThePark Road Surgery on 5 May 2016. Overall the practice israted as good.

Our key findings across all the areas we inspected were asfollows:

• There was an open and transparent approach to safetyand an effective system in place for reporting andrecording significant events.

• Staff assessed patients’ needs and delivered care inline with current evidence based guidance. Staff hadthe skills, knowledge and experience to delivereffective care and treatment.

• Patients when interviewed said they were treated withcompassion, dignity and respect and they wereinvolved in their care and decisions about theirtreatment.

• Information about services and how to complain wasavailable and easy to understand.

• Risks to patients were assessed and well managed,except for some medical equipment had not beencalibrated within the past twelve months.

• There was no instant messaging system on thecomputers in all the consultation and treatmentrooms, which alerted staff to any emergency.

• Patients said they found it easy to make anappointment with a named GP and that there wascontinuity of care, with urgent appointments availablethe same day.

• There was a clear leadership structure and staff feltsupported by management. The practice proactivelysought feedback from patients and staff, which it actedon.

• The provider was aware of and complied with therequirements of the Duty of Candour.

The area where the provider should make animprovement is to:

• Ensure that equipment used at the practice iscalibrated at regular intervals, in accordance with thepractice policy.

Summary of findings


• Ensure that adequate arrangements are in place torespond to emergencies and major incidents.

• Ensure the practice improves performance identifiedin the GP Patient survey (January 2016), relating toaccess to care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services.

• There was no instant messaging system on the computers inany of the consultation or treatment rooms, which alerted staffto any emergency.

• Risks to patients were assessed and well managed, except forthe pulse oximeter and doppler not being calibrated within thepast twelve months.

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

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

• When there were unintended or unexpected safety incidents,patients received reasonable support, truthful information, averbal and written apology. They were told about any actions toimprove 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 andsafeguarded from abuse.

Good –––

Are services effective?The practice is rated as good for providing effective services.

• Data from the Quality and Outcomes Framework showedpatient outcomes were comparable to the local and nationalaverage:

• Performance for diabetes related indicators was comparable tothe local and national average.

• Performance for mental health related indicators wascomparable to the local and national average.

• Staff assessed needs and delivered care in line with currentevidence 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.

Good –––

Are services caring?The practice is rated as good for providing caring services.

Good –––

Summary of findings


• Data from the National GP Patient Survey showed patientsrated the practice as comparable to others for several aspectsof care.

• Patients when interviewed said they were treated withcompassion, dignity and respect and they were involved indecisions about their care and treatment.

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

• We saw staff treated patients with kindness and respect, andmaintained patient and information confidentiality.

Are services responsive to people’s needs?The practice is rated as good for providing responsive services.

• Practice staff reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group to secure improvements to serviceswhere these were identified.For example, the practiceproactively worked with the local CCG to co-ordinate supportfor elderly patients requiring additional care and support.

• Patients said they found it easy to make an appointment with anamed GP and there was continuity of care, with urgentappointments available the same day.

• The practice had good facilities and was well equipped to treatpatients and meet their needs.

• Information about how to complain was available and easy tounderstand and evidence showed the practice respondedquickly to issues raised. Learning from complaints was sharedwith staff and other stakeholders.

Good –––

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

• The practice had a clear vision and strategy to deliver highquality care and promote good outcomes for patients. Staffwere clear about the vision and their responsibilities in relationto this.

• There was a clear leadership structure and staff felt supportedby management. The practice had a number of policies andprocedures to govern activity and held regular governancemeetings.

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

Good –––

Summary of findings


• The provider was aware of and complied with the requirementsof the Duty of Candour. The partners encouraged a culture ofopenness and honesty. The practice had systems in place forknowing about notifiable safety incidents and ensured thisinformation was shared with staff to ensure appropriate actionwas taken.

• The practice proactively sought feedback from patients, whichit acted on. The patient participation group was active.

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

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

• The practice offered proactive, personalised care to meet theneeds of the older people in its population.

• The practice was responsive to the needs of older people, andoffered home visits and urgent appointments for those withenhanced needs.

• All these patients had a named GP and a structured annualreview to check their health and medicines needs were beingmet. For those patients with the most complex needs, thenamed GP worked with relevant health and care professionalsto deliver a multidisciplinary package of care.

Good –––

People with long term conditionsThe practice is rated as good for the care of people with long-termconditions.

• Nursing staff had lead roles in chronic disease managementand patients at risk of hospital admission were identified as apriority.

• Performance for diabetes related indicators were comparableto the local and national average, for instance:

• 76% of patients with diabetes on the register had their bloodsugar recorded as well controlled (CCG average 77%, nationalaverage of 77%).

• 81% of patients with diabetes on the register had a recordedfoot examination and risk classification (CCG average 91%,national average of 88%).

• 72% of patients with diabetes on the register had theircholesterol measured was well controlled (CCG 79%, nationalaverage 81%).

• Longer appointments and home visits were available whenneeded.

• All these patients had a named GP and a structured annualreview to check their health and medicines needs were beingmet. For those patients with the most complex needs, thenamed GP worked with relevant health and care professionalsto deliver a multidisciplinary package of care.

Good –––

Summary of findings


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

• There were systems in place to identify and follow up childrenliving in disadvantaged circumstances and who were at risk, forexample, children and young people who had a high number ofA&E attendances. Immunisation rates were relatively high for allstandard childhood immunisations.

• 71% of patients diagnosed with asthma had an asthma reviewin the last 12 months this was lower than the CCG average of74% and national average of 75%.

• Patients told us that children and young people were treated inan age-appropriate way and were recognised as individuals,and we saw evidence to confirm this.

• 90% of women aged 25-64 had it recorded on their notes that acervical screening test had been performed in the preceding 5years; this was higher than the CCG average of 83% andnational average of 82%.

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

• We saw positive examples of joint working with midwives andhealth visitors.

Good –––

Working age people (including those recently retired andstudents)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 retiredand students had been identified and the practice had adjustedthe services it offered to ensure these were accessible, flexibleand offered continuity of care.

• The practice was proactive in offering online services as well asa full range of health promotion and screening that reflects theneeds for this age group.

• The practice offered extended opening hours on Mondayevenings and Wednesday and Friday mornings.

Good –––

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

Good –––

Summary of findings


• The practice was piloting the Rapid Access Team (RAT), amobile GP service working alongside the dedicatedmultidisciplinary community team to offer a rapid assessmentof, and rapid treatment for, acutely unwell houseboundpatients.

• The practice held a register of patients living in vulnerablecircumstances including homeless people, travellers and thosewith a learning disability.

• The practice offered longer appointments for patients with alearning disability.

• The practice regularly worked with multi-disciplinary teams inthe case management of vulnerable people.

• The practice informed vulnerable patients about how to accessvarious support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adultsand children. Staff were aware of their responsibilities regardinginformation sharing, documentation of safeguarding concernsand how to contact relevant agencies in normal working hoursand out of hours.

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

• Performance for mental health related indicators wascomparable or lower than the local and national average:

• 86% of patients diagnosed with dementia had a recordedreview in a face to face meeting in the last 12 months (CCGaverage 86%, national average 84%).

• 78% of patients with schizophrenia, bipolar affective disorderand other psychoses had their alcohol consumption recordedin the preceding 12 months, this was much lower than the CCGaverage of 92% and the national average of 90%.

• 94% of patients with schizophrenia, bipolar affective disorderand other psychoses had a comprehensive, agreed care planrecorded in the last 12 months (CCG average 94%, nationalaverage 88%).

• The practice regularly worked with multi-disciplinary teams inthe case management of people experiencing poor mentalhealth, including those with dementia.

• The practice carried out advance care planning for patientswith dementia.

Good –––

Summary of findings


• The practice had told patients experiencing poor mental healthabout how to access various support groups and voluntaryorganisations.

• The practice had a system in place to follow up patients whohad attended accident and emergency where they may havebeen experiencing poor mental health.

• Staff had a good understanding of how to support patients withmental health needs and dementia.

Summary of findings


What people who use the service sayThe national GP patient survey results published onJanuary 2016 (01/01/2014 – 30/06/2015). The resultsshowed the practice was performing in line with nationalaverages. Two hundred and sixty one survey forms weredistributed and 113 were returned. This represented 1%of the practice’s patient list.

• 57% found it easy to get through to the surgery byphone, (CCG average 78%, national 73%).

• 76% were able to get an appointment to see orspeak to someone the last time they tried, (CCGaverage 80%, national average 76%).

• 82% described the overall experience of their GPsurgery as fairly good or very good, (CCG average86%, national average 85%).

As part of our inspection we also asked for CQC commentcards to be completed by patients prior to our inspection.We received 12 comment cards which were all positiveabout the standard of care received. Patients describedtheir experience at the practice as positive, clinical staffwere knowledgeable and caring and non-clinical staffwere patient and supportive.

We spoke with four patients during the inspection. Allfour patients said they were happy with the care theyreceived and thought staff were approachable,committed and caring.

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC Lead Inspector.The team included a GP specialist adviser and a practicemanager specialist adviser.

Background to Park RoadSurgery - Brockbank• The Park Road Surgery - Brockbank, also known as The

Park Road Surgery, is located in the London Borough ofRichmond Upon Thames. The building is situated on amain road. The practice is located on the ground andfirst floor of a converted residential property. There areeight consulting rooms and a room for babyconsultations. There are two toilets; one for patientswith disabled access and another for staff. Access to thesurgery is via the main front entrance of the building onlevel flooring and side entrance with automatic doorsfor wheelchair access, patients with mobility issues wereoffered an appointment on the ground floor.

• The service is registered with the Care QualityCommission to provide regulated activities of;diagnostics and screening services, treatment ofdisease, disorder or injury, surgical procedures,maternity and midwifery services and family planning

• Five GP partners (two female and three male) run thepractice. The partners are supported by; two salariedGP’s and two permanent GP locums, two nurses, onehealthcare assistant (HCA), one practice manager andreception staff.

• The GP’s at the practice collectively provided 52 clinicalsessions a week.

• The practice is open between 08:30am – 6:30pmMonday – Friday. Appointments are available from8:30am – 6:30pm.

• Extended surgery hours are offered from:

• 6:30pm – 8:00pm every Monday.

• 7:00am - 8:00am – Wednesday and Friday

• When the practice is closed patients can call NHS 111 inan emergency or a local out of hour’s service.

• The practice has a patient list size of approximately13,100 patients. The practice is situated in an area whichis classified as the tenth least deprived decile. Themajority of the patients within the practice are eitheryoung or of working age. A small percentage of patientsare aged between 65 and 85.

Why we carried out thisinspectionWe inspected this service as part of our newcomprehensive inspection programme.

We carried out a comprehensive inspection of this serviceunder Section 60 of the Health and Social Care Act 2008 aspart of our regulatory functions. The inspection wasplanned to check whether the provider is meeting the legalrequirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

PParkark RRooadad SurSurggereryy --BrBrockbockbankankDetailed findings


How we carried out thisinspectionBefore visiting, we reviewed a range of information we holdabout the practice and asked other organisations to sharewhat they knew. We carried out an announced visit on 5May 2016. During our visit we:

• Spoke with; GPs (partners and salaried), practice nurse,healthcare assistant, practice manage and receptionstaff.

• Spoke with four patients.

• Spoke with three PPG members.

• Observed how patients were being cared for and talkedwith carers and/or family members

• Reviewed an anonymised sample of the personal careor treatment records of patients.

• Reviewed 12 comment cards where patients andmembers of the public shared their views andexperiences of the service.

To get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

We also looked at how well services were provided forspecific groups of people and what good care lookedlike for them. The population groups are:

• Older people

• People with long-term conditions

• Families, children and young people

• Working age people (including those recently retiredand students)

• People whose circumstances may make themvulnerable

• People experiencing poor mental health (includingpeople with dementia)

Please note that when referring to informationthroughout this report, for example any reference to theQuality and Outcomes Framework data, this relates tothe most recent information available to the CQC at thattime.

Detailed findings


Our findingsSafe track record and learning

There was an effective system in place for reporting andrecording significant events.

• Staff told us they would inform the practice manager ofany incidents and there was a recording form availableon the practice’s computer system.

• The practice carried out a thorough analysis of thesignificant events.

We reviewed safety records, incident reports nationalpatient safety alerts and minutes of meetings where thesewere discussed. Lessons were shared to make sure actionwas taken to improve safety in the practice. For example, apatient collected their repeat prescription and when theycollected their medicine found the medicine dose wasincorrect. The practice apologised to the patient andinvestigated the matter. The significant event wasaddressed in line with the practice policy and wasdiscussed at the next team meeting. The error was also fedback to the other stakeholders.

When there were unintended or unexpected safetyincidents, patients received reasonable support, truthfulinformation, a written apology and were told about anyactions to improve processes to prevent the same thinghappening again.

Overview of safety systems and processes

The practice had clearly defined and embedded systems,processes and practices in place to keep patients safe andsafeguarded from abuse, which included:

• Arrangements were in place to safeguard children andvulnerable adults from abuse. These arrangementsreflected relevant legislation and local requirements.Policies were accessible to all staff. The policies clearlyoutlined who to contact for further guidance if staff hadconcerns about a patient’s welfare. There was a leadmember of staff for safeguarding. The GPs attendedsafeguarding meetings when possible and alwaysprovided reports where necessary for other agencies.Staff demonstrated they understood theirresponsibilities and all had received training onsafeguarding children and vulnerable adults relevant to

their role. GPs and the nurse were trained to childprotection or child safeguarding level 3. All non-clinicalstaff were trained to Safeguarding level 1 with regards tochild protection or child safeguarding.

• A notice in the waiting room advised patients thatchaperones were available if required. All staff whoacted as chaperones were trained for the role and hadreceived a Disclosure and Barring Service check (DBScheck). (DBS checks identify whether a person has acriminal record or is on an official list of people barredfrom working in roles where they may have contact withchildren or adults who may be vulnerable).

• The practice maintained appropriate standards ofcleanliness and hygiene. We observed the premises tobe clean and tidy. The practice nurse was the infectioncontrol clinical lead who liaised with the local infectionprevention teams to keep up to date with best practice.There was an infection control protocol in place andstaff had received up to date training. Annual infectioncontrol audits were undertaken, identifiedimprovements were implemented. For example,following a recent audit non-clinical staff were providedwith training to manage the sharps bins. In particularthey were trained on how to dispose of the sharpswaste.

• The arrangements for managing medicines, includingemergency medicines and vaccines, in the practice keptpatients safe (including obtaining, prescribing,recording, handling, storing and security). The practicecarried out regular medicines audits, with the support ofthe local CCG pharmacy teams, to ensure prescribingwas in line with best practice guidelines for safeprescribing. Prescription pads were securely stored andthere were systems in place to monitor their use. One ofthe nurses had qualified as an independent prescriberand could therefore prescribe medicines for specificclinical conditions. They received mentorship andsupport from medical staff for this extendedrole. Patient Group Directions (PGD) had been adoptedby the practice to allow nurses to administer medicinesin line with legislation (PGDs are written instructions forthe supply or administration of medicines to groups ofpatients who may not be individually identified beforepresentation for treatment). The practice had a systemfor production of Patient Specific Directions (PSD) toenable Health Care Assistants to administer

Are services safe?

Good –––


vaccinations after specific training when a doctor ornurse were on the premises (PSDs are writteninstructions from a qualified and registered prescriberfor a medicine including the dose, route and frequencyor appliance to be supplied or administered to a namedpatient after the prescriber has assessed the patient onan individual basis).

• We reviewed five personnel files and found appropriaterecruitment checks had been undertaken prior toemployment. For example, proof of identification,references, qualifications, registration with theappropriate professional body and the appropriatechecks through the Disclosure and Barring Service.

Monitoring risks to patients

Risks to patients were assessed and well managed, exceptfor the pulse oximeter and Doppler not being calibratedwithin the past twelve months.

• There were procedures in place for monitoring andmanaging risks to patient and staff safety. There was ahealth and safety policy available with a poster in thereception office which identified local health and safetyrepresentatives. The practice had up to date fire riskassessments and carried out regular fire drills. Allelectrical equipment was checked to ensure theequipment was safe to use and clinical equipment waschecked to ensure it was working properly, except forthe pulse oximeter and Doppler not being calibratedwithin the past twelve months. The practice had avariety of other risk assessments in place to monitorsafety of the premises such as control of substanceshazardous to health and infection control and legionella(Legionella is a term for a particular bacterium whichcan contaminate water systems in buildings).

• Arrangements were in place for planning andmonitoring the number of staff and mix of staff neededto meet patients’ needs. There was a rota system inplace for all the different staffing groups to ensure thatenough staff were on duty.

Arrangements to deal with emergencies and majorincidents

The practice had some adequate arrangements in place torespond to emergencies and major incidents.

• There was no instant messaging system on thecomputers in any of the consultation or treatmentrooms, which alerted staff to any emergency, thepractice, however, confirmed they were in the process ofupgrading their computer system to facilitate this.

• All staff received annual basic life support training andthere were emergency medicines available in thetreatment room.

• The practice had a defibrillator available on thepremises and oxygen with adult and children’s masks. Afirst aid kit and accident book were available.

• Emergency medicines were easily accessible to staff in asecure area of the practice and all staff knew of theirlocation. All the medicines we checked were in date andfit for use.

The practice had a comprehensive business continuity planin place for major incidents such as power failure orbuilding damage. The plan included emergency contactnumbers for staff.

Are services safe?

Good –––


Our findingsEffective needs assessment

The practice assessed needs and delivered care in line withrelevant and current evidence based guidance andstandards, including National Institute for Health and CareExcellence (NICE) best practice guidelines.

• The practice had systems in place to keep all clinicalstaff up to date. Staff had access to guidelines from NICEand used this information to deliver care and treatmentthat met peoples’ needs.

• The practice monitored that these guidelines werefollowed through risk assessments, audits and randomsample checks of patient records.

Management, monitoring and improving outcomes forpeople

The practice used the information collected for the Qualityand Outcomes Framework (QOF) and performance againstnational screening programmes to monitor outcomes forpatients. (QOF is a system intended to improve the qualityof general practice and reward good practice). The mostrecent published results were 97% of the total number ofpoints available, with 5% exception reporting. (Exceptionreporting is the removal of patients from QOF calculationswhere, for example, the patients are unable to attend areview meeting or certain medicines cannot be prescribedbecause of side effects). This practice was not an outlier forany QOF (or other national) clinical targets. Data from 2014- 2015 showed;

• Performance for diabetes related indicators wascomparable to the local and national average:

• 76% of patients with diabetes on the register had theirblood sugar recorded as well controlled (CCG average78%, national average of 78%).

• 81% of patients with diabetes on the register had arecorded foot examination and risk classification (CCGaverage 91%, national average of 88%).

• 72% of patients with diabetes on the register had theircholesterol measured was well controlled (CCG average79%, national average 81%).

▪ The percentage of patients with hypertension havingregular blood pressure tests was comparable to thelocal and national average:

• 84% of patients with hypertension had a last bloodpressure reading measuring150/90mmHg or less in thepreceding 12 months (CCG average 83%, nationalaverage 84%).

▪ Performance for mental health related indicators wascomparable to the local and national average:

• 86% of patients diagnosed with dementia had arecorded review in a face to face meeting in the last12 months (CCG average 86%, national average 84%).

• 78% of patients with schizophrenia, bipolaraffective disorder and other psychoses had theiralcohol consumption recorded in the preceding 12months (CCG average 92%, national average 90%).

• 94% of patients with schizophrenia, bipolaraffective disorder and other psychoses had acomprehensive, agreed care plan recorded in the last12 months (CCG average 94%, national average 88%).

Clinical audits demonstrated quality improvement.

There had been six clinical audits undertaken withinthe last two years, two of which were completedaudits where the improvements made wereimplemented and monitored. For example, followingan audit looking at the prescribing of Clopidogrel, anoral antiplatelet used to inhibit blood clots incoronary artery disease, peripheral vascular disease,cerebrovascular disease, and to prevent heart attackand stroke. The practice as part of the audit used themedicine increasingly for various indications andvariable durations. The result of the audit showedthat adherence to the audit criteria was low duringthe first cycle. However, there was notableimprovement during the second cycle, afterimplementation of the recommendations.Clopidogrel should not be prescribed beyond therecommended period or it should be stopped whenthe patient remains at risk of cardiovascular disease.As a result of the re-audit 98% of patients had theduration of prescription correctly recorded in theirrecords and had, regular reviews compared to 13% atthe begging of the audit.

Are services effective?(for example, treatment is effective)

Good –––


• The practice participated in local audits, nationalbenchmarking, accreditation, peer review and research.

Effective staffing

Staff had the skills, knowledge and experience to delivereffective care and treatment.

• The practice had an induction programme for all newlyappointed staff. It covered such topics as safeguarding,infection prevention and control, fire safety, health andsafety and confidentiality. All newly appointednon-clinical staff shadowed more senior members ofstaff for a minimum period of two weeks.

• The practice could demonstrate how they ensuredrole-specific training and updating for relevant staff forexample, for those reviewing patients with long-termconditions. Staff administering vaccines and takingsamples for the cervical screening programme hadreceived specific training, which had included anassessment of competence. Staff who administeredvaccines could demonstrate how they stayed up to datewith changes to the immunisation programmes, forexample by access to on line resources and discussionat practice meetings.

• The learning needs of staff were identified through asystem of appraisals, meetings and reviews of practicedevelopment needs. Staff had access to appropriatetraining to meet their learning needs and to cover thescope of their work. This included ongoing supportduring sessions, one-to-one meetings, appraisals,coaching and mentoring, clinical supervision andfacilitation and support for revalidation for GPs andother clinical staff. All staff had had an appraisal withinthe last 12 months.

• Staff received training that included safeguarding, fireprocedures, basic life support and informationgovernance awareness. Staff had access to and madeuse of e-learning training modules and in-housetraining.

Coordinating patient care and information sharing

The information needed to plan and deliver care andtreatment was available to relevant staff in a timely andaccessible way through the practice’s patient record systemand their intranet system.

• This included care and risk assessments, care plans,medical records and investigation and test results.Information such as NHS patient information leafletswere also available.

• The practice shared relevant information with otherservices in a timely way, for example when referringpatients to other services.

Staff worked together and with other health and social careservices to understand and meet the range and complexityof patients’ needs and to assess and plan ongoing care andtreatment. This included when patients moved betweenservices, including when they were referred, or after theywere discharged from hospital. We saw evidence thatmulti-disciplinary team meetings took place on a monthlybasis and that care plans were routinely reviewed andupdated.

Consent to care and treatment

Staff sought patients’ consent to care and treatment in linewith legislation and guidance.

• Staff understood the relevant consent anddecision-making requirements of legislation andguidance, including the Mental Capacity Act 2005.

• When providing care and treatment for children andyoung people, staff carried out assessments of capacityto consent in line with relevant guidance.

• Where a patient’s mental capacity to consent to care ortreatment was unclear, the GP or practice nurseassessed the patient’s capacity and, recorded theoutcome of the assessment.

• The process for seeking consent was monitored throughrecords audits.

Supporting patients to live healthier lives

The practice identified patients who may be in need ofextra support.

• These included patients in the last 12 months of theirlives, carers, those at risk of developing a long-termcondition and those requiring advice on their diet,smoking and alcohol cessation.Patients were thensignposted to the relevant service.

• A dietician was available by referral and smokingcessation advice was available from a local supportgroup.


Good –––


The practice’s uptake for the cervical screening programmewas 90%, which was higher than the national average of82%. There was a policy to offer telephone reminders forpatients who did not attend for their cervical screeningtest. The practice demonstrated how they encourageduptake of the screening programme by using information indifferent languages and for those with a learning disabilityand they ensured a female sample taker was available.There were failsafe systems in place to ensure results werereceived for all samples sent for the cervical screeningprogramme and the practice followed up women who werereferred as a result of abnormal results. The practice alsoencouraged its patients to attend national screeningprogrammes for bowel and breast cancer screening.

Childhood immunisation rates for the vaccinations givenwere comparable or above the CCG averages. For example,childhood immunisation rates for the vaccinations given tounder two year olds ranged from 86% to 97% (CCG 82.1% to94%) and five year olds from 76% to 99% (CCG 77% to 94%).

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for people aged 40–74. Appropriatefollow-ups for the outcomes of health assessments andchecks were made, where abnormalities or risk factorswere identified.


Good –––


Our findingsKindness, dignity, respect and compassion

We observed members of staff were courteous and veryhelpful to patients and treated them with dignity andrespect.

• Curtains were provided in consulting rooms to maintainpatients’ privacy and dignity during examinations,investigations and treatments.

• We noted that consultation and treatment room doorswere closed during consultations; conversations takingplace in these rooms could not be overheard.

• Reception staff knew when patients wanted to discusssensitive issues or appeared distressed they could offerthem a private room to discuss their needs.

All of the 12 Care Quality Commission comment cards wereceived were positive about the service experienced.Patients said they felt the practice offered an excellentservice and staff were helpful, caring and treated them withdignity and respect.

We spoke with a member of the patient participationgroup. They also told us they were satisfied with the careprovided by the practice and said their dignity and privacywas respected. Comment cards highlighted that staffresponded compassionately when they needed help andprovided support when required.

Results from the national GP patient survey showedpatients felt they were treated with compassion, dignityand respect. The practice was comparable to the local andnational average for its satisfaction scores on consultationswith GPs and nurses. For example:

• 85% said the GP was good at listening to them (CCGaverage of 89%, national average of 88%).

• 78% said the GP gave them enough time (CCG average86%, national average 86%).

• 88% said the last nurse they spoke to was good attreating them with care and concern (CCG average 91%,national average 91%).

Care planning and involvement in decisions aboutcare and treatment

Patients told us they felt involved in decision making aboutthe care and treatment they received. They also told usthey felt listened to and supported by staff and hadsufficient time during consultations to make an informeddecision about the choice of treatment available to them.Patient feedback on the comment cards we received wasalso positive and aligned with these views.

Results from the national GP patient survey showedpatients mostly responded positively to questions abouttheir involvement in planning and making decisions abouttheir care and treatment. The results were in line with localand national averages. For example:

• 86% said the last GP they saw was good at explainingtests and treatments, (CCG average 87%, nationalaverage 86%).

• 78% said the last GP they saw was good at involvingthem in decisions about their care (CCG average 81%,national average 81%).

• 86.3% said the last nurse they saw was good atexplaining tests and treatments (CCG average 88%,national average 89%).

Staff told us that translation services were available forpatients who did not have English as a first language. Wesaw notices in the reception areas informing patients thisservice was available.

Patient and carer support to cope emotionally withcare and treatment

Notices in the patient waiting room told patients how toaccess a number of support groups and organisations.

The practice’s computer system alerted GPs if a patient wasalso a carer. The practice had identified 150 patients, 1%, ofthe practice list as carers. Written information was availablethrough the practices carers’ noticeboard to direct carers tothe various avenues of support available to them.

Staff told us that if families had suffered bereavement, theirusual GP contacted them or sent them a sympathy card.This call was either followed by a patient consultation at aflexible time and location to meet the family’s needs and/orby giving them advice on how to find a support service.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needs

The practice reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group (CCG) to secure improvements toservices where these were identified. For example, thepractice proactively worked with the local CCG toco-ordinate support for elderly patients requiringadditional care and support.

• The practice offered a ‘Commuter’s Clinic’:


• 7:00am -8:00am – Wednesday and Friday

• There were longer appointments available for patientswith a learning disability.

• Home visits were available for older patients andpatients who would benefit from these.

• Same day appointments were available for children andthose with serious medical conditions.

• Patients were able to receive travel vaccinationsavailable on the NHS as well as those only availableprivately.

• There were disabled facilities, a hearing loop andtranslation services available. Patients with mobilityissues were offered appointments on the ground floor ofthe practice.

Access to the service

• The practice is open between 08:30am – 6:30pmMonday – Friday.Appointments are available from8:30am – 6:30pm.

• The GP’s collectively work 52 clinical sessions a week.

• Extended surgery hours are offered from:


• 7:00am -8:00am – Wednesday and Friday

• In addition to pre-bookable appointments that could bebooked up to three weeks in advance, urgentappointments were also available on the same day forpeople that needed them.

• When the practice is, closed patients can call NHS 111 inan emergency or a local out of hour’s service.

Results from the national GP patient survey showed thatpatient’s satisfaction with how they could access care andtreatment was comparable to or lower than the local andnational averages.

• 76% of patients were satisfied with the practice’sopening hours (CCG average 73%, national average78%).

• 57% patients said they could get through easily to thesurgery by phone (CCG average 78%, national average73%).

• 36% patients said they always or almost always see orspeak to the GP they prefer (CCG average 36%, nationalaverage 36%).

People told us on the day of the inspection that they wereable to get appointments when they needed them.

Listening and learning from concerns and complaints

The practice had an effective system in place for handlingcomplaints and concerns.

• Its complaints policy and procedures were in line withrecognised guidance and contractual obligations forGPs in England.

• There was a designated responsible person whohandled all complaints in the practice.

• We saw that information was available to help patientsunderstand the complaints system, posters weredisplayed in the waiting area and leaflets were availablefor patients at the reception desk.

We looked at 18 complaints received in the last 12 monthsand found that they were satisfactorily handled, dealt within a timely way which was open and transparent.Complaints were discussed during regular team meetings,lessons were and action was taken to as a result to improvethe quality of care. For example, a relative complainedabout the difficulty they experienced getting the deathcertificate. The complaint was dealt with in line with thepractice policy and was discussed at the next teammeeting. Training was provided to relevant staff to ensurethey were familiar with the new process.

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


Our findingsVision and strategy

The practice had a clear vision to deliver high quality careand promote good outcomes for patients.

• The practice had a mission statement that wasdisplayed in the waiting areas and staff knew andunderstood the values.

• The practice had a robust strategy and supportingbusiness plans, which reflected the vision and valuesand were regularly monitored.

Governance arrangements

The practice had an overarching governance framework,which supported the delivery of the strategy and goodquality care. This outlined the structures and procedures inplace and ensured that:

• There was a clear staffing structure and that staff wereaware of their own roles and responsibilities.

• Practice specific policies were implemented and wereavailable to all staff.

• A comprehensive understanding of the performance ofthe practice was maintained.

• There were robust arrangements for identifying,recording and managing risks, issues and implementingmitigating actions.

Leadership and culture

The partners in the practice had the experience, capacityand capability to run the practice and ensure high qualitycare. They prioritise safe, high quality and compassionatecare. The partners were visible in the practice and staff toldus they were approachable and always took the time tolisten to all members of staff.

The provider was aware of and complied with therequirements of the Duty of Candour. The partnersencouraged a culture of openness and honesty. Thepractice had systems in place for knowing about notifiablesafety incidents

When there were unexpected or unintended safetyincidents:

• The practice gave affected people reasonable support,truthful information and a verbal and written apology.

• They kept written records of verbal interactions as wellas written correspondence.

There was a clear leadership structure in place and staff feltsupported by management.

• Staff told us the practice held regular team meetings.

• Staff told us there was an open culture within thepractice and they had the opportunity to raise anyissues at team meetings and felt confident in doing soand felt supported if they did.

• Staff said they felt respected, valued and supported,particularly by the partners in the practice. All staff wereinvolved in discussions about how to run and developthe practice, and the partners encouraged all membersof staff to identify opportunities to improve the servicedelivered by the practice.

Seeking and acting on feedback from patients, thepublic and staff

The practice encouraged and valued feedback frompatients, the public and staff. It proactively sought patients’feedback and engaged patients in the delivery of theservice.

• The practice had gathered feedback from patientsthrough the patient participation group (PPG) andthrough surveys and complaints received. There was anactive PPG, which met regularly, carried out patientsurveys and submitted proposals for improvements tothe practice management team. For example, the PPGpersuaded the practice to change their telephonesystem so that patients when they call in were putthrough to the correct team to deal with their query,instead of having one general line for all queries.Thiswas following the results of the most recent GP patientsurvey.

• The practice had gathered feedback from staff generallythrough staff meetings, appraisals and discussion. Stafftold us they would not hesitate to give feedback anddiscuss any concerns or issues with colleagues andmanagement.Staff told us they felt involved andengaged to improve how the practice was run.

Continuous improvement

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


There was a focus on continuous learning andimprovement at all levels within the practice. The practiceteam was forward thinking and part of local pilot schemesto improve outcomes for patients in the area. For example,the practice was piloting the Rapid Access Team (RAT), amobile GP service working alongside the dedicatedmultidisciplinary community team to offer a rapidassessment of, and rapid treatment for, acutely unwell

housebound patients. A system whereby a group of GP’s inthe local area can provide regular home visits forincapacitated patients. The GP would use a laptop duringthe visit, providing them with full access to patient records.The pilot provides patients with mobility issues regular andprompt access to GP services in the locality. Patients werealso able to ask the team questions regarding their careand provide feedback on their experiences.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


Park Road Surgery - Brockbank NewApproachComprehensive … · 2020-04-01 ·...

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