Archived: The Acorn Surgery

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Acorn Surgery on 16 April 2015. Breaches of legal requirements were found. Specifically, we had found that the practice had no chaperone policy in place, and that significant events were not reviewed on an annual basis. The practice also had no access to oxygen or an Automatic External Defibrillator (AED) to support patients requiring emergency treatment. 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(2)(a)(b)(f) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 19 October 2015 to check that they had followed their plan 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 Acorn 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:

• The practice had Oxygen and an Automatic External Defibrillator (AED) in place to ensure the welfare and safety of service users in a medical emergency.
• The practice had implemented a chaperone policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of patients with long term conditions (LTCs).

The care of patients with conditions such as cardiovascular diseases, diabetes mellitus, asthma, hypertension and chronic obstructive pulmonary disease (COPD) was based on national guidance and clinical staff had the knowledge and skills to respond to their needs. The care and medicines of patients in this group were reviewed regularly and staff worked with other health and care professionals to ensure a multi-disciplinary approach for patients with complex needs. This included providing chronic disease clinics and completing regular reviews including specialised ones such as diabetes and respiratory virtual clinics.

For example, the practice completed regular monitoring and risk assessments of patients within this group taking asthma and COPD medicines. Patients identified with asthma had regular reviews and their plans of care were updated accordingly in discussion and agreement with them. These patients were provided with education and information during consultations to avoid unplanned hospital admissions. Patients were also sign posted to other specialist services. Patients with long term conditions (LTCs) were monitored following hospital stays.

Patients with long term medication needs were registered and monitored to ensure blood tests and prescriptions were being managed routinely and in line with guidance, patients’ needs and their agreed care plans.

The GPs were engaged with stakeholders working jointly to provide end of life care for patients where required.

Updated 25 June 2015

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

There were suitable safeguarding policies and procedures in place, and staff we spoke with were aware of how to report any concerns they had. Staff had received training on child protection which included level three for GPs and nurses. There was evidence of joint working with other professionals including midwives, and health visitors to provide good antenatal and postnatal care. The practice offered ante-natal checks with a midwife and post-natal and baby clinics with a health visitor twice a week.

Patients in this population group that required an urgent appointment were seen in addition to booked appointments. The practice policy was to prioritise all patients who were under the age of 16 who attended the practice. Child immunisations were provided in line with national guidelines with any non-attendance being followed up by the GPs or nurse. Immunisations were offered and only given with consent of parents which was recorded on the patient’s record.

The practice was spacious, well lit and ventilated, clean and accessible with automated doors and good access for all people. All rooms and areas within the practice were clean and spacious and secured. Facilities included toilets, disabled toilets and baby changing facilities were available..

Updated 25 June 2015

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

The practice was responsive to the needs of older people including those with dementia. People could access a variety of therapies through

 Older people were cared for with dignity and respect and there was evidence of working with other health and social care providers to provide safe care. Support was available in terms of home visits and rapid access appointments for terminally ill and housebound patients.

The lead GP completed planned weekly and monthly meetings with other health care providers such as health visitors, palliative care nurses and district nurses to discuss registered patients requiring care and treatment and any other patients that were of concern. All patients 65 years of age and over were specifically being cared for by a named GP and could access urgent daily appointments as required. Older people were given the option of home visits, double appointments and telephone contact to a GP of their choice.

The practice also provided Integrated Care Pathway (ICP) where there was a register of elderly patients at risk and care managed through Health Holistic Assessment (HHA). 93% of these patients had received care management at home or surgery in the last year. The ICP was a local initiative that the practice had worked with other partners from the Southwark Clinical Commissioning Group (CCG) to achieve.

Patients in this group were provided with early identification and access to influenza vaccine appointments including follow ups for patients that did not attend the practice. The practice offered an electronic prescribing service which could be requested once registered with the practice.

Bereavement and counselling support services were available through the practice GPs, with referral to NHS services as required.

The practice was also participating in local area initiatives focused on various services for example the Southwark community based dementia pilot. This project provided additional support and resources patients, their carers and families could access to promote independence and choice. Resources available included therapies such as massage, eco-therapy which is a walking group, silver surfing (IT training), benefits advice, e- learning, self-management courses (dealing with feelings and emotions).

The practice also participates with local initiatives and provided access to additional resources that included Reminiscence Arts (life story book), Scrap-Books – digital life story work, pets as therapy either as owners or visiting services and musical theatre and Singing for the Brain.

Updated 25 June 2015

The practice is rated as good for the population group 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 there were appointment options available to patients such as pre bookable appointments, online access for medicines and appointment booking and extended hours for nurse led clinics and appointments. The practice offered health checks, travel vaccinations, phlebotomy, counselling, alcohol and substance misuse and health promotion advice including smoking cessation. The practice also offered telephone consultations during opening times Monday to Friday. The practice nurse was responsible for contraceptive advice and health checks for all patients.

Updated 25 June 2015

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

The practice was signed up to the dementia local enhanced service (LES) to provide care and support for people with dementia. The services were planned and co-ordinated to ensure that people’s needs were suitably assessed and met. Staff had a clear understanding of the Mental Capacity Act (MCA) and how and who to report any concerns to within the practice. Reviews of care records of patients with dementia and mental health issues showed they were receiving regular reviews of their health, there was a multi-disciplinary approach to their care, and they had support from the community mental health teams, on site counselling services. The provider also ensured that patients within this group received regular medicines and care plan reviews. The practice had a dedicated GP to manage personality disorder cases and frequent A&E attendance. The practice also provided GP led weekly appointments and meetings for these patients. Practice GP led clinics for patients with drug and alcohol problems could also be accessed twice weekly.

Updated 25 June 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. People attending the practice were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. The practice had policies in place relating to the safeguarding of vulnerable adults and children and whistleblowing. Staff we spoke with were aware of their responsibilities in identifying and reporting concerns.

The practice provided a chaperone and advocacy service on request and could provide trained staff to support patients requiring this service. Clinical staff within the practice had a good understanding of the Mental Capacity Act (MCA), and how it applies, and were able to tell us the actions they would take if they had concerns for patients, relatives or their carers. They worked with other health and social care professionals to ensure multi-disciplinary input in the case management of vulnerable people and their carers. The practice was signed up to the learning disability direct enhanced service (DES) to provide an annual health check for people with a learning disability to help improve their health outcomes, and had completed them for those patients on the practice register.

The practice clinical staff held regular clinical meetings with district nurses to discuss care and treatment for people within this patient group. Meetings with other agencies related to patient well-being such as counsellors, domestic violence, drug and alcohol rehabilitation teams regularly attended to analyse patient needs and arrange appropriate care planning and treatment.

The GPs were able to provide examples which included significant event reviews and actions to maintain care and treatment for vulnerable patients. The practice worked in corroboration with local health care partners and practices. This patient group was able to access care or treatment within the practice and any patient concerns or requests were referred to one of the GP partners for approval. The practice held a register of carers who had actively received additional support by being offered seasonal flu vaccinations in addition to eligible practice patients.