The Integrated Care Partnership

Updated 19 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Integrated Care Partnership on 7 July 2015. The practice had been rated as good for effective, caring, responsive and well led, however, required improvement in safe. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensure that cleaning equipment is stored appropriately and hygienically and monitor the levels of cleanliness throughout the practice. Ensure that after infection control audits, areas of non-compliance are followed up and action plans created to ensure compliance. Ensure that a risk assessment for legionella is completed.

We undertook this announced focused inspection on 1 August 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and are rated as Good under the safe domain.

This report only covers our findings in relation to those requirements.

• There were robust and effective systems in place for controlling the risk of infection. The practice was clean and hygienic. Cleaning equipment was stored appropriately and infection control audits had taken place. Action plans had been created for areas of concern found after audits which had been dated and actioned. An assessment for Legionella had been completed.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 August 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medicine needs were being met. The GPs followed national guidance for reviewing all aspects of a patient’s long term health. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice nurses were trained and experienced to support patients with managing their conditions and preventing deterioration in their health. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness. The practice had an in-house dietitian, and ran dietetic education sessions for both diabetic patients and those found to be at risk of developing diabetes.

Updated 20 August 2015

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. Immunisation rates were slightly higher than average for all standard childhood immunisations. Specific services for this group of patients included family planning clinics, antenatal clinics and childhood immunisations. The practice offered contraceptive implants. The premises were suitable for children and babies. Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff. The practice ensured that children needing emergency appointments were seen in a timely manner. Several partner GPs ran a daily surgery at Epsom College for students aged 13 to 18 years of age.

Updated 20 August 2015

The practice is rated as good for the care of older patients. Patients were made aware of their named GP but could request to see a GP with a specialist interest. For example, diabetes, cardiology or ophthalmology. Nationally reported data showed that outcomes for patients were positive for conditions commonly found in older patients. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues. Clinics included diabetic reviews, warfarin (INR) clinics and blood tests. Blood pressure monitoring was also available. The practice offered personalised care to meet the needs of the older patients in its population. Elderly patients with complex care needs and those at risk of hospital admission had personalised care plans. It was responsive to the needs of older people, and could offer home visits. The practice supported various care homes and residential homes. In 2014 the practice completed a dementia screening project where 418 of their older patients were invited to be screened. The practice held monthly Gold Standard Framework meetings for those patients with end of life care needs. The practice had a safeguarding lead for vulnerable adults. The practice had good relationships with a range of support groups for older patients.

Updated 20 August 2015

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 open from 7:30am until 8pm Monday to Thursday and 7:30am-7pm Fridays. Saturday appointments could also be requested. Patients were able to request a GP to telephone them instead of attending the practice. 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. The practice offered NHS health-checks and nurses were trained to offer smoking cessation advice. Patients could request routine travel immunisations.

Updated 20 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with severe mental health needs had care plans and received annual physical health checks. New cases had rapid access to community mental health teams. There was a weekly session held at the practice by the Samaritans who could offer support. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A dementia identification scheme had been previously run at the practice. The project involved screening and identified individual patients who were then invited to the practice for screening blood tests and where necessary referred to the memory clinic. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 20 August 2015

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 for example those with complex health needs. The practice ensured that patients classed as vulnerable had annual health checks. It offered longer appointments for patients when required. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had told 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. Translation services were available for patients who did not use English as a first language. The practice could accommodate those patients with limited mobility or who used wheelchairs. Carers and those patients who had carers were flagged on the practice computer system and were signposted to the local carers support team. The practice had recognised the need for a ‘hard to reach’ population group to be able to access appointments on the same day. This prevented this group failing to turn up for appointments and enabled the practice to offer opportunistic help and advice. For patients with no fixed abode, the practice could register them at a proxy address at the town hall so that care could still be provided.