Archived: Great Western Surgery

Updated 2 September 2016

Letter from the Chief Inspector of General Practice

In January 2016 a comprehensive inspection of Great Western Surgery was conducted. The practice was rated as requires improvement for effective care and for patients with long term conditions. Overall the practice was rated as good. During that inspection we found that the provider was not adequately assessing, monitoring and improving the quality and safety of services provided. Although the practice achieved overall high scores on a national care monitoring tool, there were anomalies and some poor performance which was not investigated or accounted for, specifically for those with long term conditions. Clinical audit was not always used to identify where improvements were required or achieved.

We also asked the provider to review how cervical screening rates could be improved.

The report setting out the findings of the inspection was published in February 2016. Following the inspection we asked the practice to provide an action plan detailing how they would improve on the areas of concern.

We conducted a desk top review of the practice as part of a focused inspection of Great Western Surgery on 9 August 2016 to ensure the changes the practice told us they would make had been implemented and to apply an updated rating.

We found the practice had made significant improvements since our last inspection on 19 January 2016. At this inspection we rated the practice as good for providing effective services. The overall rating for the practice remains good. For this reason we have rated the location for the key question to which this related and the population group, people with long term conditions. This report should be read in conjunction with the full inspection report of 19 January 2016.

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

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Monitoring of patient care data had been significantly reviewed and was being monitored.

• Audits had been undertaken to identify where improvements were required or achieved. A programme of continuing audit and improvements was in place.

• T he practice had reviewed their systems and processes to increase their cervical screening rates.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 September 2016

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

• The practice achieved 95% on its Quality Outcomes Framework (QOF) scores in 2015 (a national monitoring tool for the performance of GP practices).

• Audits were undertaken including completed audits to demonstrate improvement.

• The practice followed guidance in the management of chronic diseases.

• Patients at risk of hospital admission were identified and had care plans written where appropriate.

• Longer appointments and home visits were available when needed.

• There was a process to offer a structured review to check patients’ 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, such as a local diabetes consultant, to deliver a multidisciplinary package of care.

The practice had reviewed and updated the systems for recalling patients with chronic long term conditions including phone call follow ups for those that were not engaging with their planned reviews. This was being monitored monthly. The practice had included patients at risk of developing diabetes in this group as well as patients with established chronic conditions.

The practice worked with a “community navigator” to identify patients who may require additional support for their chronic disease management. Including support with social issues, lifestyle interventions and psychological support.

Updated 25 February 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.
• Staff were aware of the circumstances and rights when gaining consent from patients under 16.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• GPs worked with midwives and health visitors in the provision of care.

Updated 25 February 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.
• Care plans were available for patients deemed at high risk of unplanned admissions.
• Access for patients with limited mobility was good including for those with mobility scooters.
• There were named GPs for this group of patients.
• Screening for conditions which patients in this population group may be at risk of was provided, such as dementia.

Updated 25 February 2016

• 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.
• Extended hours appointments were available before normal working hours Monday to Friday.
• Phone consultations were offered to patients and online appointment booking was available.

Updated 25 February 2016

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

• Dementia screening was offered to patients and 54 patients were offered memory screening, of whom four were diagnosed with dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• QOF performance for mental health related indicators was 100% compared to the CCG average of 93% and national average of 93%. Out of 25 patients with mental health problems, 18 had physical health checks in 2014/2015 and 23 out of 25 had care pans.

Updated 25 February 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 vulnerable patients.
• GPs regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• 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.