Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Hylton Surgery on 23 April 2015. Overall, the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. The practice was rated as good for providing services for five of the key population groups. The practice was rated as requires improvement for the population group ‘People experiencing poor mental health (including people with dementia).’

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

• The practice had engaged a temporary business services manager until such time as a permanent practice manager could be appointed. The GP partners had given this person a clear remit to deliver an improvement agenda and support the practice to continue developing. Staff told us they felt involved in the process of developing the practice and were well supported by the current practice management team. Weaknesses in the practice’s performance had been identified and action had already been taken to address some of these. A development plan was being prepared to support the continuing delivery of good patient care;
• Staff actively sought feedback from patients, and were taking steps to revive their Patient Participation Group (PPG);
• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses;
• Potential risks to patients and staff were being reviewed, and steps had been taken to ensure most were well managed;
• The premises were clean and hygienic, and good infection control arrangements were in place;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. However, the system for recalling patients experiencing mental health problems for their annual healthcare review were not fully effective;
• Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment;
• The practice had good facilities and was well equipped to treat patients and meet their needs.

There were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Carry out a Legionella risk assessment;
• Comply with the NHS Protect guidance regarding the security of prescription forms;
• Evaluate and improve the systems in place for recalling patients experiencing mental health problems for their annual healthcare review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating April 2015 – Good)

The key questions at this inspection 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 South Hylton Surgery on 15 June 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient feedback was consistently positive. All 30 CQC comments cards we received were positive about the practice, this was in line with the results of the National GP Patient Survey. Patients we spoke with were positive about the practice.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• At our previous inspection in April 2015, we told the provider that they should make improvements in some areas. We saw at this inspection improvements had been made. The practice had completed a legionella risk assessment, ensured the security of prescription forms and had improved the systems in place for recalling patients experiencing mental health problems for review.

We saw one area of outstanding practice:

• The service understood the needs of different people and groups of people, and delivered care and support in a way that meets these needs and promoted equality. They encouraged patients with learning disabilities and dementia to have care reviews completed in their home environment. This was to reduce stress and anxiety for patients. For 2017/2018, 52% of patients with a learning disability and 59% of patients with dementia had their review completed at home. For the remaining patient’s, reviews had been completed at the practice. This was due to patient choice or because the patient attended the practice for another reason and the review appointment had been booked to coincide with this. This reduced the number of times the patient needed to attend the practice.

The areas where the provider should make improvements are:

• Review their process when managing significant events so that they always act in accordance with the Duty of Candour.
• Evaluate and improve the systems in place for exception reporting patients at the practice.
• Act so that all persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties. Specifically, complete staff appraisals for those staff who had not been appraised in the last 12 months.

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

Please refer to the detailed report and the evidence tables for further information.