The Nunhead Surgery

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Nunhead Surgery on 28 January 2016 where the practice was rated Good overall. However, breaches of regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and we rated the practice as requires improvement for providing safe services.

The specific concerns in the previous inspection related to safety were:

• Not all staff had received the appropriate level of safeguarding, basic life support, infection control or fire safety training.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12(1).

We undertook this focussed inspection on 31 October 2016 to check that they had followed the action plan provided and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Nunhead Surgery on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• All staff had completed appropriate fire safety, safeguarding and infection control training. Two members of non-clinical staff had not completed basic life support training within the previous 12 months and the practice’s training schedule indicated that this training would be completed every 18 months for clinical staff and every three years for non-clinical.

The areas where the provider should make improvement are:

• Ensure that all staff complete annual basic life support training in accordance with current legislation and guidance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 26 May 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.

• Performance for diabetes related indicators was similar to the CCG and national average. For instance the percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 65.2% compared with 72.8% within the CCG and 77.5% nationally. 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 76.72% compared with 78.03% nationally. The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August 2014 to 31 March 2015 was 86.09% compared to 94.45% nationally. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 83.95% compared to 80.53% nationally. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87.62% compared with 88.3% nationally. The practice informed us that they had a high proportion of patients on their register with diabetes which made it challenging to achieve some of their targets for patients in this population group.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 26 May 2016

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

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions was 74.1% compared to the national average of 75.35%.

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

• The practice’s uptake for the cervical screening programme was 89.56%, which was above the CCG average of 79.9% and the national average of 81.83%.

• 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 and health visitors.

Updated 26 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.

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

• The practice employed a community nurse to review patients over 65 who had not attended their GP within the last 15 months and those over 80 as part of the locality’s holistic health assessment scheme.

• The practice provides services to a local care home. We were told during discussions with the care home manager that there is one GP who comes to visit the home every Monday which ensured continuity of care. We were told that GP’s respond to emergencies when requested and that they refer to secondary care services when appropriate. We were also told that the GP is involved in end of life pathway management with the local hospice.

Updated 26 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, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

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

Updated 26 May 2016

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

• The practice had a robust call up system for people with mental health issues who did not attend appointments or who attended out of hours.

• The practice offered in house cognitive behavioural therapy, counselling and specialised drug and alcohol counselling. The practice, in conjunction with a local NHS Trust, hosted a Community Mental Health Dementia Specialist Nurse who ran a community based Dementia Clinic. This clinic allowed for patients to be seen closer to their homes and covered the population of two other neighbouring practices.

• 88.33% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• Performance for mental health related indicators was similar to the CCG and national average. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 88% which was the same as the average national performance. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 90% which again was the same nationally. The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months was 92% compared to 94% nationally.

• 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.

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

Updated 26 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 homeless people, travellers and those with a learning disability.

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

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

• 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.