Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at The Acorn Surgery on 16 April 2015.
We found the practice to be good for providing caring, responsive and well led services. We found the practice required improvement for providing safe and effective services. It was also good for providing services for all of the population groups we report on: older people, people with long term conditions, families, children and young people; the working age people including those recently retired and students, people in vulnerable circumstances and people experiencing poor mental health. We also found the practice to be outstanding for providing services for the population group of older people.
Our key inspection findings were as follows:
- There were systems in place for reporting, recording and monitoring significant events to help provide improved care. Risk assessments were completed when identified, such as no current full time practice manager.
- The practice was working with an external consultant to support the assistant practice manager. A number risks assessments were identified but had not all been addressed.
- Staff were clear of their roles in regards to monitoring and reporting of incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.
- Staff shared best practice through internal arrangements and meetings and also by sharing knowledge and expertise with external consultants and other GP practices.
- There was a strong multidisciplinary input in the service delivery to improve patient outcomes.
- Feedback from patients about their care and treatment was positive.
- The practice was responsive to the needs of vulnerable patients and there was a strong focus on caring and on the provision of patient-centred care.
- The practice provided patients with information on health promotion and ill health prevention services available in the practice and the local community.
- The practice had a clear vision and strategic direction which was to improve the health, well-being and lives of those that they care for at the practice. Staff were suitably supported and patient care and safety was a high priority.
We saw several areas of outstanding practice including:
- The practice was engaged with a very active Patient Participation Group (PPG) For example the practice and PPG members had responded to concerns raised in the practice about the waiting time for appointments and were working together to develop a “did not attend” policy, had taken part in surveys, organised their own PPG survey in 2014, and were in the process of fundraising for equipment. The practice and PPG members worked together and had a strong relationship with the emphasis on providing, promoting and supporting services for the practice patients. The practice and PPG members also together initiated a healthy lifestyle promotion and weight management programme, supported and facilitated by the practice with clinical overview by a lead GP and practice nurse before any uptake of the programme was started.
- The practice had implemented initiatives developed within the local Southwark community to support and improve the lives of patients living with dementia and their carers such as offering all carers annual health checks. The practice was also participating in local area meetings focused on various services for example the Southwark community based dementia pilot. The practice was then able to provide additional support and resources for people with dementia, their Carers and Families, promoting independence and choice. Resources available to neighbourhood practice patients included therapies such as massage, walking groups, silver surfing (IT training), benefits advice, E- learning, self-management courses).
- The practice also participates with local initiatives and provided access to additional resources that included Reminiscence Arts (life story book free from), Scrap-Books – digital life story work, pets as therapy either as owners or visiting services and musical theatre and Singing for the Brain.
However, there were also areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Ensure the availability of oxygen for use in the event of medical emergencies. Current resuscitation guidelines emphasise the use of oxygen, and this should be available whenever possible.
- Ensure availability of an Automated External Defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.
In addition the provider should:
- Complete annual reviews of significant events and complaints and share learning across all practice staff.
- Carry out risk assessments to protect staff and patients.
- Develop and implement a chaperone policy to support staff.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice