Pickhurst Surgery

Updated 12 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 24 February 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of regulation 17(1) and 17(2) (b) and (c) (Good Governance) and Regulation 18(2) (a) (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this desk-based focussed inspection on 2 November 2016 to check that the practice 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 Pickhurst 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:

• Risks to patients were assessed and well-managed, including those related to safeguarding, chaperoning, fire safety and storage of patient records.

There were areas of the practice the provider should make improvements:

• Review the arrangements for the all the actions from legionella risk assessment are undertaken in a timely manner.
• Review the arrangements for the monitoring of diabetes for patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 May 2016

The practice is rated as requires improvement 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.
• The national Quality and Outcomes Framework (QOF) data for 2014/15 showed that 69% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 47% which was below the national average of 88%.
• The national Quality and Outcomes Framework (QOF) data showed that 70% of patients with asthma in the register had an annual review, compared to the Clinical Commissioning Group (CCG) average of 74% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions 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.
• The practice ran a hearing test clinic for those over the age of 50 through an external organisation and referred patients for hearing assessments. Patients who were not registered with this surgery were also able to access this service.

Updated 5 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 urgent care and A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 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 85%, which was comparable to the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had regular meetings with their health visitor to discuss any children under five or families that were giving cause for concern.
• The practice ran a midwife led antenatal clinic, a GP led postnatal and health surveillance clinic and a nurse led child immunisation clinic one day every week; however patients can book outside of these hours as required.

Updated 5 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 offered housebound patient reviews at least annually to all patients on the housebound register. These patients do not have to be unwell to request a home visit from a doctor of their choice.
• All the patients over the age of 75 had a named doctor and these patients were encouraged to see the doctor of their choice in order to facilitate continuity of their care.
• The practice performed advanced care planning and end of life care plans and supported patients who have expressed a wish to die in their own home.
• The practice provided a phlebotomy service at the practice to facilitate access for older patients who may have difficulty in getting to the hospital.
• The GPs visited a care home on a weekly basis, supporting the needs of the residents.

Updated 5 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.
• The practice’s nursing staff offered Well man and Well women screening and conducted NHS health checks with near-point cholesterol testing.

Updated 5 May 2016

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

• The number of patients with dementia who had received annual reviews for 2014/15 was 81% which was below the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.
• 83% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was in line with the CCG average of 84% and below the national average of 88%.
• 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.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice promoted ‘talking therapies’ for the management of anxiety, depression and stress related problems. The practice had access to a counsellor who provided sessions at the surgery where necessary.

Updated 5 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. These patients were flagged in their clinical system.
• The practice offered annual reviews and longer appointments for patients with a learning disability. The GPs visited a local college with learning disability residents on an ad-hoc basis, supporting the needs of the residents.
• 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.