Springfield Surgery

Updated 12 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springfield Surgery on 24 May 2017. Overall the practice is rated as good.

• The practice had a strong vision, which put working with patients to ensure high quality care and treatment as its top priority.
• The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• 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.
• The GP provider ensured all staff were supported to develop their skills and abilities and delegated specific roles and responsibilities. As a result, all business and clinical matters were delivered effectively at the practice.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. The practice had an inclusive approach and each member of the staff team had responsibility implementing systematic checks to ensure patients received safe and timely care.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice was committed to evidence based practice to improve the quality of care and treatment. Clinical auditing was based on up to date guidance and research to reflect innovation and the changing clinical needs of patients.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care. The practice offered emergency open access surgeries each morning alongside bookable appointments.
• The practice had a very active patient participation group (PPG) who were supported and encouraged by the practice to participate in the development and improvement of the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw areas of outstanding practice including:

• The practice supported and facilitated the PPG to meet at regular intervals to discuss the practice developments. The PPG had facilitated for almost one year weekly Walking for Health walks, which were open to all patients. The PPG also held regular Healthy Hazel Grove open day events for all people in the community. Previous event themes including raising awareness of diabetes, healthy lifestyles and the focus for the event planned for June 2017 was social isolation.
• There were thorough governance arrangements in place with dedicated staff roles and framework where a weekly review of GP referrals and the needs of patients discharged from hospital was undertaken. This ensured patients received person centred, safe and effective care and promoted continuous learning and development within both clinical and administration teams.
• The GP provider had created health care information videos which were played in the practice waiting room. For example one of these targeted the older population groups to raise awareness and encourage uptake of the cancer bowel screening test.
• The practice was a participating member of the Stockport Foodbank and issued food vouchers to patients who were in need of this support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 July 2017

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

• The practice nurse had a lead role in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice achieved similar patient outcomes for the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2015/16 when compared to local and national averages.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 12 July 2017

The practice is rated as good for the care of families, children and young people.

• Systems were 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 accident and emergency (A&E) attendances.
• Data for childhood immunisation rates for the vaccinations given in 2015/16 indicated that the practice was achieving immunisation rates similar to the CCG averages.
• Quality and Outcome Framework (QOF) 2015/16 data showed that 83% of patients with asthma on the register had an asthma review in the preceding 12 months compared to the local and England average of 75%.
• The practice’s uptake for the cervical screening programme was 82%, reflecting the local and national averages of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 12 July 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• Planned weekly visits were undertaken to a local care home by a designated GP to monitor their patients’ health and wellbeing. This provided continuity of care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example the practice had a staff member designated as a cancer champion. The focus of the cancer champion was to encourage older patients to undertake the bowel screening test.

Updated 12 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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 offered flexible surgery times including morning, afternoon and evening surgeries. Later evening appointments were available until 7.30pm on Tuesdays and the practice opened one Saturday morning each month.
• 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.

Updated 12 July 2017

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

• Patients at risk of dementia were identified and offered an assessment.
• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting within the last 12 months. This was higher than the CCG average of 85% and the England average of 84%.
• The practice carried out advance care planning for patients living with dementia. Care plans were reviewed every six months with the support of a community psychiatric nurse (CPN).
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which reflected the local average and was similar to the England average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 12 July 2017

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 and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.