Archived: Victoria Cross Surgery

Updated 30 September 2016

Letter from the Chief Inspector of General Practice

In February 2016 a comprehensive inspection of Victoria Cross Surgery was conducted. The practice was rated as requires improvement for safe, effective and well led, and good for caring and responsive. Overall the practice was rated as requires improvement. During that inspection we found concerns related to: the investigation and actions following significant events; the recording of discussions and actions during practice meetings; the training for safeguarding children and adults; the child protection register; the security of blank prescriptions; recruitment checks; the system of clinical audit; the mandatory training and appraisals; the governance arrangements for infection control; fire safety arrangements; and legionella risk assessment.

We advised the practice they should: improve the cervical screening uptake and smoking cessation advice uptake; develop and implement a clear action plan to improve the outcomes for learning disabilities patients and patients experiencing poor mental health; and ensure that complaints information is updated.

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

We visited the practice and carried out an announced focused inspection of Victoria Cross Surgery on 25 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 improvement since our last inspection on 10 February 2016. At the inspection undertaken in February 2016 we rated the practice as requires improvement for providing safe, effective and well led services. For this reason we have only rated the location for the key questions to which this related. The practice is now rated as good for providing safe, effective and well led services. This report should be read in conjunction with the full inspection report of 10 February 2016.

At this inspection we found:

• Risks to patients were assessed and managed.
• Systems were in place to monitor the outcomes for patients.
• Recruitment and training records were up to date and monitored.
• Significant events were investigated and any actions undertaken and learning shared.

The areas where the practice should make improvements are:

• Ensure an on-going system including audits to monitor and improve outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 September 2016

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

There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All patients with long term conditions had a named GP and a structured annual review to check that 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

Updated 30 September 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. The practice had updated and were monitoring the child protection register.

• Immunisation rates for the standard childhood immunisations were above the locality average.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.

• The practice’s uptake for the cervical screening programme was 74%, which was below the national average of 82%, however the uptake was already considerably higher for this year.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw good examples of joint working with midwives, health visitors and school nurses.

• The practice was providing youth counselling and sexual health clinics.

Updated 30 September 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 patients in its population.

• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The percentage of patients aged 65 or over who received a seasonal flu vaccination was higher (74%) than the national average (73%).

• The premises were accessible to those with limited mobility. However, the front door was not automated and the practice did not provide a low level desk at reception.

• There was a register to manage end of life care and unplanned admissions.

• There were good working relationships with external services such as district nurses and community navigator.

Updated 30 September 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.

• 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 offered at the practice premises. In addition, the practice offered extended hours appointments as part of the clinical commissioning group overflow service arrangements at two different clinics in the Swindon area which opened from 7am to 8pm (Monday to Friday).

Updated 30 September 2016

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

85% of patients with dementia had been reviewed in the last 12 months, which was above the national average of 84%.

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

The practice signposted patients experiencing poor mental health how to access various support groups and voluntary organisations.

The practice offered in house counselling support as well as support through local support groups.

Opportunistic health checks and care were offered where possible.

Updated 30 September 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 circumstances including those with a learning disability.

• There were no arrangements to allow patients with no fixed address to register or be seen at the practice. However, the practice ensured patients with no fixed abode wishing to register with the practice, were signposted to another local practice who provided a specialist service for these patients.

• The practice offered annual health checks for patients with learning disabilities.

• Longer appointments were offered to patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice signposted vulnerable patients to 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 services.