Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Imeary Street Surgery on 17 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, responsive and well-led services. It was also good for providing services for the following population groups: People with long-term conditions; Families, children and young people; Working age people; People experiencing poor mental health (including people with dementia); People whose circumstances may make them vulnerable. We found the practice to be outstanding for providing caring services as well as for services for older people.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients, staff and visitors to the practice were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The majority of patients said they found it easy to make an appointment with a GP and that there was continuity of care, with urgent appointments available the same day.
• The practice offered an extended opening time up to 7pm one night per week which improved access for patients who worked full time.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice:

• The practice had been pro-active in ensuring that their older patient population were able to access online patient services such as booking appointments and requesting repeat prescriptions by arranging IT training sessions in the surgery waiting room. This had not only enabled older patients to register for online services but had led to some patients enrolling to undertake additional IT training with the provider leading to the development of improved social networking opportunities.
• The practice had achieved a high level of attainment in ensuring its patient population over the age of 65 and those in clinical risk groups had received a flu vaccination through opportunistic targeting during routine appointments and by holding specific flu vaccination clinics. This attainment had been recognised by NHS England. The percentage of patients in the ‘influenza clinical risk group’, who had received a seasonal flu vaccination, was 69.5% (national average 52.2%) and the percentage of patients aged 65 or older who had received a seasonal flu vaccination was 84% compared to a national average of 73.2%.
• The practice was proactive in identifying and responding to the needs of carers and had established an effective working relationship with the local carers association and other non-profit support groups. A comprehensive carer’s pack had been developed giving information on support and services available for carers and family members.
• The practice was working with health quality checkers from Healthwatch, and a local charity that advocates for people with a learning disability, to ensure practice literature and leaflets were in an easy to understand format and to assess how the practice responded to patients with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall.

We last inspected the service in June 2015, when it was rated as good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Imeary Street Surgery on 26 April 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. There was an open and honest culture around incident reporting.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Quality data showed the practice performed well in management of long term conditions such as asthma and diabetes. It ensured that care and treatment was delivered according to evidence based guidelines.
• Patients spoke highly of how they were treated with compassion, kindness, dignity and respect. Patient survey results showed that patients consistently reported higher levels of satisfaction compared to the local area and national results. Patient feedback on the day was received in large numbers and was consistently positive.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it, with again consistently higher results in the National GP Patient Survey than local and national averages.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had designed a new dementia review process to make this more holistic, incorporating areas such as falls risk and continence. While yet to carry out a full review of this service, the practice had sought informal feedback which was positive.
• The practice had developed a comprehensive Mental Capacity Act Policy, which the practice had shared and had since been adopted by other practices in the area.

The areas where the provider should make improvements are:

• Carry out yearly fire drills.
• Review identified actions in infection control audits.
• Carry out a risk assessment for the updating of DBS checks.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice